Scientists have developed vaccines against a new disease in less than 12 months. And yet, 18 months after the first of these COVID-19 vaccines was introduced, only 15% of people in low-income countries have been fully vaccinated. Such injustice costs lives and exposes a long-standing problem: some regions of the world have been forced to rely on others for life-saving science and technology. For example, it is unacceptable that 99% of vaccines are imported into Africa, a continent of 54 independent countries and 1.2 billion people.
The World Health Organization (WHO) is looking for a way to more efficiently get vaccines to more people. Last year, the WHO launched a radical initiative called the mRNA Vaccine Technology Transfer Center. The goal of the initiative is to create a system that develops and manufactures mRNA vaccines and treatments (for COVID-19 and other diseases) from the technology used in the highly successful COVID-19 vaccines from Pfizer and Moderna.
Crucially, the ambition is to achieve this through collaboration between universities and companies based in low- and middle-income countries. In a significant step, on July 8, the US National Institutes of Health, where much of the basic research on mRNA vaccines has been conducted, joined this mission to build capacity in lower-income countries world trade rules and an intellectual property (IP) system that often benefits established corporations, universities and governments in high-income countries.
One hurdle will be persuading governments and organizations to buy locally produced vaccines: such products may initially cost more than products made by established companies that produce on a larger scale and can afford to lower prices. However, for this initiative to be viable over time, local manufacturers of mRNA vaccines and therapeutics must be confident that there will be demand for their products. In order for this to happen, contracts will be required in advance from buyers.
The key buyer is Gavi, the Vaccine Alliance, a public-private global health partnership that provides vaccines to dozens of lower-income countries, funded mostly by high-income countries and the Seattle, Washington-based nonprofit Bill & Melinda Gates Foundation. Gavi said he was committed to supporting vaccine production in Africa; however, it has not specified how much extra money it will spend on regionally produced vaccines, and has not yet promised to buy vaccines from companies working with the mRNA Technology Transfer Center.
In May, leaders of a number of African Union (AU) member states called on Gavi to commit to buying at least 30% of all COVID-19 vaccines made in Africa once new manufacturers come online. Such a commitment will be necessary to achieve the AU’s ambition to have 60% of Africa’s vaccines produced on the continent by 2040.
Setting the scales
Barriers created by IP rights represent another hurdle in the center’s path. Earlier this year, the company at the center’s core, Afrigen Biologics and Vaccines in Cape Town, South Africa, successfully reproduced small amounts of Moderna’s vaccine mRNA. But Moderna has not agreed to license its IP or share data that could help Afrigen ensure its vaccine candidate meets similar safety and efficacy metrics.
Sadly, last month the World Trade Organization (WTO) ended some 20 months of negotiations on an exemption proposed by South Africa and India on intellectual property for COVID-19 vaccines, drugs and diagnostic tests, which would have allowed faster sharing of knowledge. The campaign, which Nature supported, faced strong opposition from the European Union and the pharmaceutical industry.
Instead, WTO members agreed on a deal to change existing rules for sharing intellectual property in an emergency; however, their implementation will be cumbersome and do not constitute a waiver of rights. Many researchers who have dedicated their careers to the study of mRNA want to see it save more lives than widen inequality, and question whether the current IP regime is actually stifling the kind of innovation that might succeed in the mRNA hub.
The center is a refreshing, ambitious alternative to the current vaccine research and development (R&D) model. It is based on cooperation and knowledge sharing and aims to create and support domestic R&D and innovation in low- and middle-income countries. But it is clearly a threat to a system in which companies can claim intellectual property rights over life-saving products that are often created based on findings from publicly funded research.
As economists Mariana Mazzucato and Jayati Ghosh, along with innovation policy researcher Els Torreel, have argued, there is something wrong with a system where people’s taxes pay for science, yet relatively few companies and governments are allowed to do so in the midst of a pandemic. control who has access to life-saving products derived from research. The WHO and its partners are right to try to adjust the benchmarks. In addition to the imperative of justice, epidemics would end sooner if each region of the world could rely on its own defenses to contain the spread of emerging pathogens and virus variants. As Larry Brilliant, the epidemiologist who helped eradicate smallpox, said.
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