The COVID-19 pandemic has shown science at its best as we witnessed the rapid development of vaccines, but it also spotlighted the challenges of inequity and the deployment of these vaccines to low- and middle-income countries (LMICs). As we enter the third year of the pandemic on 11 March 2023, how can we be more efficient at ensuring that populations in LMICs have equitable access to vaccines?
by Lawrence Yap
Singapore, like other countries, has learned valuable lessons in the wake of COVID-19. We uncovered gaps and opportunities in our pandemic preparedness and response framework, many of which echo the concerns outlined by the World Health Organization in its latest Global Vaccine Market Report,1 published in early November.
The report calls for a new paradigm in vaccine development and access based on the learnings from the pandemic. More specifically, it calls for greater focus on research and development to address the WHO list of priority pathogens, which includes coronaviruses, influenza viruses, Ebola, and Zika as top contenders that could pose the next pandemic threat.
This is also in line with the five-year, $3.5 billion “100 Days Mission”2 effort led by the Coalition for Epidemic Preparedness Innovations (CEPI), which aims to develop a new vaccine against Disease X within 100 days from the time a pandemic is identified. As part of this plan, different institutes focusing on pandemic preparedness come together to advance global preparedness.
Inequitable Access to Vaccines Remains a Challenge
While the science behind vaccine production has proven to be robust, experts3 have cautioned that more needs to be done to prepare for the next pandemic from a resource perspective. The tragedy of COVID-19 was the unequal distribution of vaccines and the inequity had prolonged the pandemic and possibly led to the propagation of variants.
Coronaviruses and influenza viruses remain the main suspects for posing the next pandemic threat but other threats such as Ebola and Zika are just a few mutations away.3 In preparation for the next pandemic, LMICs in regions such as Africa, South America, South Asia, and the Middle East must have access to and be equipped with the know-how to manufacture medical technologies including future vaccines and treatments.
As such, a multi-pronged approach is imperative for the world to better respond to future threats. More effort is needed to ensure global vaccine equity, particularly in the LMICs.
Focusing On Innovative Technologies to Develop More Accessible Vaccines
In the last three years, we learnt that facilitating equitable access to vaccines is a monumental task. In the case of COVID-19, the first generation of vaccines has worked well for high-income countries with the wherewithal to meet cold chain requirements, high acquisition costs, and the need for multiple doses to effect protection against the virus. However, low- and middle-income countries have lagged in their mass vaccination programmes despite support from COVAX – the largest vaccine supply and distribution operation in world history. Many of these countries depend on supplies from manufacturers in developed economies as they lack the know-how and resources to develop vaccines themselves.
For this reason, Hilleman Laboratories is collaborating with global partners and stakeholders to develop thermostable vaccines that can be more easily stored and distributed. Our focus on the early clinical development of vaccines and biologics for diseases that exert a heavy global burden aims to meet the needs of communities most affected by them.
In the last few years, we have developed a low-cost oral vaccine for cholera and more recently, we are collaborating with a pharmaceutical company to develop a thermostable second-generation Zaire ebolavirus vaccine candidate for populations in the Sub-Saharan Africa region, where the Ebola virus is prevalent. As part of the collaboration, we aim to develop a production process to optimise the production yield, streamline the manufacturing process and create a stable formulation that can be stored at between 2 to 8°C, which can be maintained by consumer-grade refrigerators. We expect that storing, transporting, and distributing the vaccines without the need for advanced cooling systems together with the improvement in production yield will lower the product CoGs profile considerably and broaden access in low- and middle-income countries (LMICs) where the burden of Ebola virus disease (EVD) is greatest. EVD is challenging to contain as outbreaks are difficult to predict and prevent. The African continent has seen occasional outbreaks in past years, and this highlights the need for continued innovation and vaccines that protect against specific ebolavirus strains.
As we move on from the COVID-19 pandemic, we are looking to build on this work and develop more thermostable vaccines for other types of diseases that are prevalent across the LMICs and help communities most affected by these diseases emerge stronger from the pandemic.
Technology Transfers to Develop Local Capabilities and Bridge Inequity Gaps
Sharing technology and supporting innovation via technology transfer is one of the best ways4 to stop a pandemic. One key lesson from the COVID-19 pandemic is the need to expand local and regional production of vaccines to populations around the world.
In Singapore, many major vaccine manufacturers set up manufacturing facilities since the start of the COVID-19 pandemic. Hilleman Laboratories is one of the many companies that have set up a vaccines and biologics production plant here. This decision aligns with the nation’s efforts to strengthen capabilities across the biopharmaceutical manufacturing value chain and allows vaccine manufacturers to pivot to manufacturing vaccines for domestic use when a crisis hits.
Beyond Singapore’s shores, we work with the Developing Countries Vaccine Manufacturers Network (DCVMN), a voluntary alliance of over 40 vaccine manufacturers from 15 developing countries, to upskill vaccine manufacturers from low- and middle-income countries so that they are equipped with the know-how of vaccine development and manufacturing. This will enable them to scale up vaccine production in their home countries and be in a better place to fight against future outbreaks.
Last year, we launched our first-ever Hilleman-DCVMN Technology Transfer Training Programme for vaccine manufacturers to learn, share, and impart knowledge on vaccine production, with a focus on the technology transfer process. In addition to the programme, we also work with global stakeholders and partners to develop and produce new and improved vaccines to positively impact global public health.
With the threat of Disease X looming around the corner, it is more important than ever that we collaborate, learn, and engage with partners and vaccine manufacturers from around the world and broaden access to affordable vaccines to populations in need.
Upskilling Local Talent to Enhance Preparedness Against Future Outbreaks
Building a vaccine production facility and rolling out technology transfer programs are valuable initiatives for our common health security, but ensuring their sustainability is challenging. Talent is a critical resource for innovation, especially in biotech, where very specific expertise is required. The biotech industry across the Asia-Pacific is facing a shortage of talent5 and it has been challenging to attract the right talent with the right capabilities. Biopharma companies need to invest in training and upskilling the existing workforce while providing on-the-job training to potential talents who are keen to grow their career in the industry. In Singapore, we recruit local talents at our research and development facility where new products are conceptualised and brought to the clinic. We recognise that it is important to equip them with the know-how of the technologies to further enrich the local R&D system.
Hilleman Laboratories is also one of the five partner companies for the Helix Immersion Programme (HIP) inaugural run. The programme, launched by SGInnovate — a deep tech ecosystem and investor backed by the Singapore government, aims to nurture more highly skilled talent to address the biotech sector’s persistent manpower challenges in Singapore.6 The collaboration is an opportunity for us to invest in innovation and develop industry-ready talent by providing them exposure to industry operations and on-the-job training. As part of the programme, Hilleman Laboratories will provide on-the-job training for participants in the niche areas of CMC vaccine development and also contract manufacturing and manufacturing facility operations to enable participants to gain industry experience across different areas of research and development value chain. This effort is set to address the shortfall in biotech talent in Singapore, many of whom will play an important role in addressing global challenges including Disease X.
A Multi-Pronged Strategy to Support Innovation Is Key to Preparing for the Next Pandemic
Preparations to stave off the next pandemic are ramping up as we enter into the third year of the COVID-19 pandemic, but more needs to be done to avoid the tragedy of commons that we experienced in the LMIC regions. This will involve the rollout of a multi-pronged strategy across multiple stakeholders in the public and private sectors. Some experts have suggested that the pandemic treaty should commit to an automatic waiver of intellectual property rules for products needed to combat the health threat, while others suggested a mandate to share technology and know-how for vaccine manufacturing.3 These suggestions are no doubt promising for populations in the LMICs but in the meantime, we can do our part to level the playing field through innovation, technology transfer, and upskilling programmes. [APBN]
About the Author
Lawrence Yap is the Head of Global Technical Operation, CMC overseeing both CMC development and clinical manufacturing operations for vaccines and biological therapeutics. Prior to Hilleman Laboratories, he was the Site Head and CMC Director at Takeda Vaccines Singapore. In this role, he provided technical leadership and strategic vision to the process development team to develop, optimise and scale up vaccine production processes for technology transfer to CMO partners. Prior to joining Takeda Vaccines, he was a Senior Manufacturing Manager at Amgen Singapore and led the pioneer team in setting up a next generation manufacturing facility that leverages a reconfigurable manufacturing model and single-use technologies.