How Asia-Pacific can boost vaccine access in the next pandemic

The COVID-19 pandemic exposed weaknesses and gaps in vaccine manufacturing and regulatory systems in the Asia-Pacific region. This meant that even when financing became available to procure vaccines, it wasn’t sufficient to ensure their equitable allocation. But several initiatives are now in place to help the region better prepare for the next pandemic. The Asian Development Bank, for example, is offering technical assistance to some of its low- and middle-income member countries to strengthen their regulatory systems for vaccines, therapeutics, and diagnostics. The bank is also assisting some of them in building their vaccine manufacturing capabilities and has created a network involving government agencies, academics, researchers, development organizations, and the private sector with the goal of working together to address the key challenges the region faced during the COVID-19 pandemic. Some funders in the region are also looking at working together to support the region’s research and development needs. But the fix requires more than just building manufacturing facilities and strengthening regulations. At the recently concluded ADB-hosted INSPIRE forum focused on health, experts shared insights on what the region needs to put in place to prevent inequities in access to medical products, particularly vaccines, when the next health crisis hits. Manufacturing and beyond While COVID-19 revealed the need for a geographically diversified manufacturing sector for medical products, such as vaccines, several experts said that not all countries should be building their own manufacturing facilities. Dr. Dinesh Arora, principal health specialist at ADB, said the bank is currently supporting Bangladesh to build its own vaccine manufacturing facility — which would be useful as the country prepares to transition out of Gavi support in the coming years — and strengthen its regulatory capacities to ensure the vaccines are safe for both local use and international export. However, he cautioned that not every country should manufacture vaccines. “We got a similar request from Nepal, saying, ‘Can we manufacture vaccines?’ But with a small population base, you can’t be putting your feasibility studies only on the prospects that you will be exporting them later,” he said. On top of that, there are other big competitors in the market, such as China and India, which are major vaccine producers. But the region can have a “tiered network of manufacturers,” that is, some focused on clinical development and others on the final steps of the manufacturing process called fill and finish, said Hani Kim, executive director of the RIGHT Foundation, a South Korea-based funding agency dedicated to supporting global health research and development. “I think there’s a great value in acknowledging where different manufacturers are situated in because we would need their contributions if we want to achieve speed,” she said. The region would also need a government-led plan identifying the demand and delivery of the medical products. This would require strong vital statistics registries. “If our governments don’t have the capability to collect high-quality data to count births and deaths, it doesn’t matter how many manufacturing sites we have in the region. You’re not going to get to the people that need them, especially the members of the marginalized communities,” Kim said. Countries should also utilize digital technologies to optimize health product delivery, ensure equity in the distribution of medical products, and reduce wastage. This can include the use of blockchains and dashboards that use artificial intelligence, solar-powered cold-storage containers, and drones, said Sarabjit Chadha, Asia regional director for FIND. And if countries want to truly leave no one behind and prevent a future viral spillover from animals to humans, attention should also be paid to animal vaccinations. That’s not the case at the moment, according to Syed Ahmed, CEO of Techinvention, a biotech company based in India. “If I were to give or assign a rating of six out of 10 for the human vaccine ecosystem, it would be a few notches below zero if it comes to the animal vaccines. And that’s where all of us have to put in our minds together to see how do we bridge this gap,” he said. Procurement and transparency Experts also talked about the benefits of pooled or collaborative procurement in a health emergency to secure cost savings. But procurement can be tricky. If it’s a new pathogen, there are likely no immediately approved products. But in order for countries to secure supplies when they become available, they need to make advance purchase contracts, or else they risk falling to the back of the queue — which many low- and middle-income countries, including in the Asia-Pacific region, experienced during the COVID-19 pandemic. In mid-2020, when there were over 100 COVID-19 vaccine candidates under development, experts faced this dilemma. Prashant Yadav, a renowned health supply chains expert who served as an external adviser to the World Bank’s COVID-19 program, said he knew countries needed to make advance purchase contracts with many of the vaccine developers, but it was tough not knowing which ones would succeed. With so many candidates, it’s impossible to make advance purchase contracts with all of them. What they did in response was create a COVID-19 vaccine portfolio, based on modeling and expert interviews, identifying a diversified list of vaccine candidates that have high chances of success — something that he says would be helpful in future health crises. “This is a problem that will repeat. We won’t know which vaccine candidate, which diagnostic, which therapeutic is going to work. We’ll have to build a portfolio,” he said. But whether procurement is done best nationally, regionally, or globally, he doesn’t have a definitive response. “I have spent almost a decade of my career trying to solve that problem analytically. I think the answer to it is [that] procurement should be multichannel, which means there should be an option for a country to say, ‘I cannot purchase this medical countermeasure myself. Therefore, I would go to a regional institution or a global institution. But if I can procure it myself, then I should have the choice of procurement,’” he said. Knowledge of the market and the portfolios of manufacturers will be important, however, for countries and institutions involved in procurement. Transparency is also crucial when it comes to supplies as well as pricing. During COVID-19, there was a lot of secrecy in these areas. Philipp Kalpaxis, principal procurement specialist at the ADB, said when the U.S. and European Union signed vaccine deals, they also signed nondisclosure agreements, which became the market practice during the COVID-19 pandemic. This means important information, such as pricing, cannot be shared, giving manufacturers an upper hand in negotiations. Later, it would be revealed that some countries paid more than others for the same vaccine doses, as in the case of South Africa. “It was a market that was really in favor of the private sector, and that is something that we have to address going forward,” Kalpaxis said. “Nobody should sign an NDA or contract of this type.” Crucially, access to financing is an important element in making all this happen. And this is an area where countries in the Asia-Pacific are looking to multilateral development banks such as the ADB. The bank is already providing some support to countries to build their vaccine manufacturing capacities and regulatory systems. But when it comes to surge financing — funds that are readily available in the event of a public health threat — it appears to remain a big question mark.