I’m in my sixth year at the Gates Foundation. One of the feelings of these years is that while Bill Gates’ name is well known, most people don’t know what the Gates Foundation does, why it does it, and how it does. The reason is simple, it is that in the 20 years since the Foundation was founded, what it has done has been very “cold” and “marginal”: the prevention and control of infectious diseases (AIDS, tuberculosis, malaria, neglected tropical diseases) in low- and middle-income countries, the development and innovation of vaccines, medicines and diagnostic tools, poverty reduction and development.
A “golden line” that runs through health and poverty reduction is vaccines. The Foundation was established in 2000 with the first donation of $750 million to create a new international organization such as gavi. In 2017, the Gates Foundation co-sponsored the Alliance for Innovation in Epidemic Prevention (CEPI) to support vaccine development in response to pandemics.
Vaccine development has suddenly become the global focus because of the new corona outbreak. On the one hand, it seems that we should be happy, and the work we support has suddenly received a great deal of attention; In particular, recent “elimination” of the new crown in some areas, new cases and re-control measures show that society is rarely peaceful until mass immunization is achieved through vaccines. From a global perspective, because the new coronavirus has a strong transmission capacity, only when all corners of the world to achieve immunization, human society is truly safe.
So today I want to talk to you about the new crown vaccine, when can come out, and, out, to control the outbreak, how far.
When will the new crown vaccine come out?
It can take 18 months, but it’s actually very fast.
The chain of developing a vaccine is long, often taking eight to 17 years from preclinical research to its final launch. Even the shortest-ever mumps vaccine, previously developed, took nearly five years to get a virus sample to get a market.
Compared with the traditional vaccine, the development of this new crown vaccine can be described as “the speed of the god”. After just a few months of research, the world has now four vaccines into the second phase of clinical, 3 simultaneous clinical phase 1 and 2 in-progress trials. Of the nine vaccines, five were developed by Chinese manufacturers.
Comparison of new crown vaccines with traditional vaccine development times Source: New England Journal of Medicine
The new crown vaccine is expected to be available within 18 months because every aspect of research and development is on the “fast track”.
In the preclinical sequencing process, China published COVID-19 gene sequencing within two weeks of notifying WHO of the outbreak, 10 times faster than atypical pneumonia (SARS) and four times faster than Middle East Respiratory Syndrome (MERS).
On January 13, just three days after the results of the new coronasequencing were released, the National Institute of Allergy and Infectious Diseases (NIAID) made a sample of the virus gene based on messenger rna (mRNA) technology and forwarded it to Moderna, which immediately made the first new coronary candidate vaccine.
In clinical trials, moderna and Consino’s new crown vaccine took only 66 days to get a sample of the virus gene to enter the clinic, about two-thirds shorter than the previous 190 days of the world record holder’s Zika vaccine.
More than 120 candidate vaccines are currently being developed and the actual number is certainly even higher, some of which are being clinically evaluated, WHO said at a routine briefing on new coronary pneumonia two days earlier.
Behind “Speed of God” is technological advances and the result of global cooperation. The new mRNA vaccine technology requires only genetic sequencing of viruses to produce candidate vaccines. This greatly improves the efficiency of early vaccine development. However, because of the difficulty of technology development, high cost, no manufacturers are willing to invest in the previous.
CEPI has funded the development of mRNA vaccine technology over the past few years, which has allowed the technology to be used in the early stages of this outbreak. In the wake of the new corona outbreak, CEPI first funded four vaccine development projects, including Moderna’s vaccine. As of 11 May, it had expanded to nine projects with a size of $448 million.
CePI-funded projects must commit to the global inclusion of research results, not individual countries, which ensures that vaccines are fair lying in the future from the source of research.
Similarly, in support of research on outbreaks, WHO established the Research and Development Blueprint Mechanism (R?amp;D Blueprint) in 2016 to support not only the development of clinical trial standards in the outbreak, but also the selected development priorities and pathogens, the design of research and development pathways, and the presentation of product target characteristics. With the research and development blueprint, scientists can better conduct compliance research on priority issues under the guidance of industry experts and who’s full coordination.
Will the vaccine come out to control the outbreak?
In fact, it is far from enough to successfully develop a safe and effective vaccine, which is only the first step in the long march of the “road to the epidemic”.
With vaccines, if global universal immunization is to be achieved more quickly and efficiently, the extremely complex issues behind vaccine delivery need to be coordinated and addressed, from capacity to price to access and vaccination programs in individual countries. So how to mass produce new crown vaccines and universally is a question that must now be considered.
Global vaccination is the only way to achieve human immunity to the new crown. Ideally, people in all countries should have the opportunity to be vaccinated. It is not hard to imagine, however, that no matter which country is the first to produce a vaccine, it will be under pressure to prioritize its own needs. But if leading vaccine-developing countries are based on national priorities, the results could be disastrous for global public health.
Because the equitable distribution of vaccines is not only a humanitarian practice, but also a global public health need.
No matter how prepared it is, the vaccine cannot be immediately available around the world at the beginning of its inception. Who should prioritize vaccinations in the short term if the global outbreak is to be controlled as quickly as possible? This is not a problem that market bidding can solve and requires the co-ordination and coordination of public health experts from around the world.
The question of who should be given priority is uncertain, but several categories of people deserve special attention. The first is the vulnerable population, headed by medical personnel, who are the closest to the virus, and the second is those prone to super-transmission events, such as employees of collective accommodation, teachers, students, prisoners and practitioners with access to large numbers of people; The priority vaccination sequence, which is divided along this principle, will transcend national boundaries, reduce the death and cost of new crowns as much as possible on a global scale, and accelerate the return of society to normalcy.
Globally, low-income countries are most affected by the new coronary outbreak and are “falling behind” in a dangerous way. The poorer the national health conditions are worse. The lack of clean water and basic medical facilities is a survival challenge for the poor, and the difficulty of their work being transferred online makes it difficult for them to be transferred online, so that once isolated they face unemployment without pay, these three factors alone greatly increase their risk of dying from the virus.
In addition to the immediate health effects of infection, the poor face worsening malnutrition, food shortages, long-term unemployment and homelessness in the outbreak. According to the United Nations World Food Programme, 1 billion people are currently hungry in low- and middle-income countries, while the number of people severely hungry worldwide may double by the end of the year. The United Nations Development Programme has even predicted that the outbreak could destroy half of Africa’s work.
Thus, ignoring low-income countries in the distribution of vaccines and allowing the outbreak to persist is likely to lead to a global humanitarian crisis with irreversible consequences.
African countries face severe food shortages Source: BBC
The 2009 h1N1 flu was a case worth reflecting on. It took the researchers only six months to produce the new flu vaccine, but almost all of the supply was monopolized by developed countries. Vaccine manufacturers eventually donated a small percentage of the vaccine to WHO, but the magnitude was too small, and H1N1 caused 18,000 deaths worldwide. The new corona outbreak is in many ways more frightening than H1N1 – more spreading and deadly, with greater economic and social impacts. If the 2009 H1N1 vaccine is repeated, the world will suffer even more.
In the long run, mass immunization to reach the new crown requires universal vaccination, which means billions of doses of vaccine capacity. Building new vaccine plants often costs hundreds of millions of dollars and takes months, and if new crown vaccines are to be mass-produced within 12 to 18 months, investment in construction and renovation of vaccine plants will need to start now.
But it’s not easy.
Because it is not clear which technology will succeed, and different vaccine technologies require different plant requirements. Inactivated vaccines are common on the market, but there are not many companies around the world that develop inactivated vaccines due to challenges such as the biosafety level 3 standard plant required to produce them. In contrast, the production of mRNA vaccine solely on the preparation of nucleic acid molecules, characterized by rapid and large-scale production, but due to the new technology, there is no corresponding production facilities, technical personnel and quality control processes, and the need for ultra-low temperature cold chain transport, difficult to meet global demand. Other vaccines, such as subunit vaccines, require adjuno-assisted immunization to improve the effectiveness of the vaccine, and there are clear bottlenecks in vaccine production in the face of limited adjuno production.
In the face of uncertain technology prospects and limited capacity for each technology route, perhaps the surest way is to lay out capacity for multiple technical routes ahead of time. Otherwise, countries will face the embarrassment of successfully developing vaccines but spending months waiting to produce them.
Who pays for low-income countries?
Ensuring that vaccines are fair and affordable requires significant funding and sufficient capacity, which requires an effective mechanism to achieve.
Here we are about the Gavi organization we mentioned earlier. At the initiative of the World Bank, WHO, the United Nations Children’s Fund (UNICEF), the Gates Foundation and governments, Gavi was established in 2000 to procure vaccines at low prices for children in poor countries.
On the one hand, by integrating the needs of many poor countries, the scale effect is formed to guarantee their bargaining power with predictable and relatively large demand, and on the other hand, the long-term commitment of the donor countries to provide guarantees to the production enterprises, thereby reducing the investment risk and production costs of enterprises, and encouraging enterprises to continue production and research and development. Gavi has supported 496 vaccine projects in 73 of the poorest countries over the past 20 years, and has vaccinated more than 760 million children, reducing the number of child deaths by more than 13 million.
Innovative and effective financing tools are particularly important at a time when the international community needs to come up with “18-like martial arts” to combat the surging outbreak.
In 2007, Gavi placed orders for pharmaceutical companies through advance market commitments with $1.5 billion in funding from the Gates Foundation and five governments, and continued to procure pneumonia vaccines for 73 low-income countries. Because of its good credit and long-term large orders, Gavi has a strong bargaining power to purchase vaccines, often reducing vaccine prices by dozens of times, making mass vaccinations economically viable in poor countries. As can be seen below, Gavi, a $1,100 vaccine in the U.S., can talk about a $27 purchase price.
Gavi’s integration of the needs of poor countries significantly lowers the purchase price Source: Gavi
In addition, Gavi has been financing “vaccine bonds” in capital markets since 2006. Gavi’s vaccine debt is borrowed in capital markets with a commitment from governments to pay, using the international vaccine financial instrument International Finance For Immunim. Competitive interest rates and the use of solutions to the world’s problems make vaccine debt a popular financial product in capital markets.
These proven effective mechanisms can also be used to guarantee fair coverage of the new corona vaccine. Gavi predicts that the new crown vaccine will need $2 billion to fund the vaccine to 20 million health workers, build a strategic supply pool to respond to outbreaks and provide immunization to high-priority groups. That’s not much compared to the billions of dollars in economic losses that the outbreak causes every day.
Gavi has proposed a commitment to buy large quantities of vaccines at fair prices through a “pre-market commitment” mechanism to incentivize manufacturers to invest in mass production, while funding for scaling up production capacity through innovative financing, including “vaccine bonds”, ensuring the availability of critical raw materials and equipment, and helping to achieve the transfer of vaccines to help achieve equitable access to vaccines.
Multilateral organizations and governments have also been active since the outbreak. On 24 April, WHO and global partners launched the “Global Partnership to Accelerate the Development, Production, and Equitable Access to New Crown Pneumonia Prevention and Control New Tools” initiative (The Access to COVID-19 Tools Accelerator).
On 4 May, in response to WHO’s initiative, the European Union and the countries concerned jointly launched the International Pledging Conference to Address the Outbreak of New Coronary Pneumonia, at which countries pledged 7.4 billion euros and reaffirmed their internationalist position to assure low- and middle-income countries that all research findings will serve the world, not individual countries.
On May 19th the Chinese government also made five commitments at the World Health Assembly, including $2 billion in international aid over the next two years, and pledged that the new crown vaccine, developed by China, would serve as a global public product to ensure that developing countries also have access to and affordable vaccines.
“Vaccine nationalism” will lead to a full-scale loss
With the development of vaccines, a “vaccine nationalism” argument is also emerging. Some countries have begun to try to obtain priority supply rights for vaccines from pharmaceutical companies. While governments are accountable to their own citizens, the end result would be global transmission if the global situation was not taken into account and vaccines were concentrated in the hands of a few countries. After all, as long as there are cases anywhere in the world, the international community will continue to tighten nerves, and travel, production and trade will not return to normal.
“Vaccine nationalism” is not desirable, which also demonstrates the importance of strengthening international multilateral mechanisms. Multilateral organizations and mechanisms, including WHO, The G20, CEPI, Gavi and the “New Tools for Global Cooperation to Accelerate the Development, Production, and Fair Access to New Crown Pneumonia Prevention and Control” initiative, provide a platform for Governments to discuss, integrate and address global issues. These organizations have accumulated valuable experience from the international community over the years in dealing with various public health crises and are an important means of safeguarding the common interests of mankind.
At a time when the outlook for vaccines is uncertain, the availability of vaccines in all countries will be challenged. This is precisely the time when the global community is most willing to cooperate and develop the principle of equitable distribution, and is a good opportunity for Governments, businesses, research institutions, the private sector and international organizations to use existing systems to solve global problems.
Looking back more than 70 years after the founding of the United Nations, the international community has become an interwoven network. While the virus seems to have temporarily ripped apart the international community, the common destiny of mankind is interdependence, not isolation. From this point of view, the significance of the new crown vaccine is not only to save lives, but also to restore the global political and economic order to fill the social rift caused by the outbreak.
The Gates Foundation has been in existence for 20 years this year. The institutions and mechanisms behind the entire vaccine chain mentioned in the article can be proud to say that much of it is related to the work of the foundation, and many of them can be said to be because of the foundation’s work. There are actually a lot of mechanisms, not just technological and product breakthroughs and innovations.
I think that’s why the foundation is focusing on these “cold” areas. Because first, these areas are really about the well-being of most people on our planet, and the new crown reminds us of this in a tragic way;
I think this time, we should all do better.