By Busani Bafana
SEOUL, South Korea | 13 April 2024) (IDN) — People are no longer dying from preventable diseases, thanks to vaccines. Despite this medical breakthrough, vaccine inequality has locked countries in the global south in a disease burden that would be eased through mass vaccination.
COVID-19 led to approximately 7 million deaths, and it is believed that vaccination saved 20 million lives globally.
In the pre-antibiotic era, infections were deadly and a major cause of sickness and death. The International Vaccine Institute (IVI) notes that pandemics have caused mass deaths throughout history with notable epidemics including the Black Death in 1352, the Great Pox, the Spanish flu, the White Death, and the plague of Justinian.
Vaccine inequality
The COVID-19 pandemic highlighted the vaccine ‘apartheid’ which reversed health and development gains as African countries battled to access life-saving vaccines from developed countries. Developing countries were at the back of the queue in accessing vaccines, leading to low vaccinations in those countries.
“Inequality has a cost on human lives. It is something we should be ready to deal with when thinking about the next pandemic,” Jerome Kim, Director General of the International Vaccine Institute and an international expert on the development and evaluation of vaccines, told IDN in an online interview. “Vaccines do not save lives. Vaccination does.”
Before joining IVI, Jerome served as the Principal Deputy of the US Military HIV Research Programme, the Chief of the Laboratory of Molecular Virology and Pathogenesis at the Walter Reed Army Institute of Research, and the US Army programme manager for HIV vaccines.
Dr Kim spoke to Busani Bafana (BB) about the role of vaccines in securing global health and the IVI’s quest for vaccine equity. Excerpts:
BB: Why are vaccines important and how so?
JK: Maybe the easiest way to think about vaccines is that several public health experts, not only vaccinologists, are very clear in saying that vaccines, aside from clean water, are the most significant public health intervention that has been introduced in terms of impact and the number of lives saved. That pretty much encapsulates the belief that vaccines are a simple and cost-effective way to lower the burden of diseases that in the past have killed children and are now much less of a problem due to successful vaccination.
BB: How has the IVI promoted the development of vaccines?
JK: The IVI was founded in 1997 to discover, develop, and deliver safe, effective, and affordable vaccines for global health. IVI’s reason for existing is that the Korean government and the United Nations Development Programme had a common interest; they knew that vaccines were critical for the health of the populations. Vaccine R&D capabilities were very limited in distribution and did not exist for many diseases that particularly threaten low- and middle-income countries. In contrast, companies were spending their own money on vaccines for pneumococcal pneumonia and human papillomavirus, for which markets existed in high-income countries. The bulk of this investment came from the company itself in anticipation of profitable vaccine sales, so we call these “incentivized vaccines”—the presence of known, paying markets “incentivizes” the company to develop vaccines. These vaccines were developed initially for use in high-income countries and gradually they made their way into other countries in the world.
Vaccines for HIV, TB, malaria, or any of the other diseases we call “neglected diseases,” however, don’t have investments from those big companies. These are vaccines that are “unincentivized.” Who is going to bear the responsibility for coming up with the same kind of lifesaving, cost-effective vaccines to take care of typhoid or shigella?
IVI develops vaccine technology in the lab and transfers that technology to companies that will make the vaccine. We then help to find the funding that will allow the company to do the testing of the vaccine, take the vaccine for regulatory approval, and then to WHO for approval and recommendation on its use. We also work with countries to generate the kind of evidence that would allow the Ministry of Health to say this is very cost-effective.
For every dollar spent on vaccination, over 50 US dollars are saved in healthcare and other total health costs. The ministries of health need cost-effectiveness information to persuade the ministries of finance that there is a benefit to vaccination. IVI exists to facilitate the development of vaccines for neglected infectious diseases to make sure that people living in low- and middle-income countries do not suffer undue burden from neglected infectious diseases that are potentially preventable by vaccination.
BB: How is IVI reducing vaccine inequality in the world?
JK: In February 2020 IVI decided not to pursue making its own COVID-19 vaccines. What we told organizations, companies, universities, and foundations was that IVI would help them to move any COVID-19 vaccine forward—from testing in animals to the proof that the vaccine works in humans. We did that because there are a lot of small companies with great ideas that can’t necessarily do all the steps to develop the vaccines. We helped two dozen companies and organizations to test vaccines and to get sites ready to participate in COVID-19 vaccine trials.
The companies that we worked with pledged over one billion doses of COVID-19 vaccines to COVAX. Although we did not make our vaccines, we contributed to the generation of evidence that other companies’ vaccines were safe and efficacious, and those companies had committed to the global mechanism for distribution. Our contribution was to help get those vaccines over the finish line.
BB: IVI’s flagship project has been the vaccinology courses held annually for the past 22 years. What motivated these courses and their impact on your work?
JK: IVI was born during an age when most of the vaccines in the world were manufactured in high-income countries, and we had a situation even back in the 1990s where simple vaccines that children in America had access to in the 1980s or even earlier were not widely used in the low- and middle-income countries. IVI was born out of the idea that it would be a good thing for the world to have a broader base for manufacturing vaccines. Since 2000 and the establishment of Gavi, the Vaccine Alliance and IVI, the world has seen the rate of vaccination in low and middle-income countries rise. Today roughly 80 percent of the world’s children are receiving the basic vaccines that are recommended by the WHO. That is a huge step forward and why is it possible? Because India has become a major manufacturer. India, a country that had not been a major manufacturer of vaccines, is now the source of 60 percent of the world’s vaccines for global health. Concentrating vaccine manufacturing in one country could be a problem should something happen—you could be in a situation where India’s needs come first—which happened during COVID. ´IVI’s perspective is that vaccine technology is not some magic art that has to be restricted to high-income countries or countries that can manufacture billions of doses.
IVI’s experience with 12 technology transfers of six different vaccines to companies around the world tells us you can transfer vaccines to a company that has not made vaccines before. Today, one of those companies makes 90 per cent of the supply of cholera vaccine. This is possible, but you need to have good partners and you need to accomplish technology transfer and training. You also need funding partners and global health advocates to be able to move vaccines for cholera, typhoid, or COVID from conception in the laboratory, testing in the field, purchase and implementation by ministries of health. That is what IVI does, we help every step of the way.
BB: Talk to me about the work of the IVI to build and strengthen the Africa Vaccines Research and Development and the manufacturing ecosystem.
JK: This gets to a really important point that came up close to the end of the pandemic as people began to point out that less than 1 percent of vaccines used in Africa are manufactured in Africa. The Partnership for African Vaccines Manufacturing (PAVM), which is part of the Africa CDC, has set the target that African countries should manufacture 60 percent of the vaccines used in Africa by 2040. That will be a huge step. How do you go from less than one percent to 60% and people around the world have pledged and these are pledges we know of—$5 billion—for vaccine manufacturing in Africa? A lot of that has not fully been spent.
If the goal is to manufacture 60% of the vaccines used in Africa on the continent, we must also do vaccine research and development there because vaccine manufacturing is not just about a plant. There must be an R&D ecosystem that supports the plant before the vaccines even get there to be made as well as vaccine procurement, distribution and vaccination programmes – these are all needed for sustainable vaccine manufacturing. Our thought is that if you only talk about African vaccine manufacturing, what may happen when the next pandemic comes around is that you may not have companies that have been manufacturing vaccines successfully. As much as we think having manufacturing is important, we need to also talk about an ecosystem that exists for R&D, for testing the vaccines in humans, for approving the vaccine and beyond the manufacturing to be able to purchase those vaccines, distribute them and use them in public health programmes around the continent. We need to be thinking broadly about the entire ecosystem of R&D.
BB: What are the challenges of establishing a manufacturing ecosystem and how is it possible in developing countries?
JK: Unfortunately, when we look at R&D investments by African countries (aside from South Africa), there isn’t much being put into grants. When you look in Europe and the USA, China, and other parts of Asia, you see large investments per capita in R&D. In the US, the National Institute for Health, for instance, or the European Union Horizon Programme, you will see billions of dollars are going into developing new technologies, training the next generation of technicians or scientists who work in the bio-manufacturing industry, that is creating new products that address needs that are arising in health. This is not the case in many African countries, and we need a system to fund research, training, and teaching for African scientists. [IDN-InDepthNews]
Photo: Dr Jerome Kim, Director General of the International Vaccine Institute (IVI). Credit: IVI
IDN is the flagship agency of the Non-profit International Press Syndicate.
