In a collaborative effort spanning across continents, experts and researchers worldwide have united in a compelling plea for a new paradigm to enhance the global capability to swiftly research, develop, and manufacture critical tools such as diagnostics, vaccines, and treatments for combating epidemics.
Their collective voice resonates as the Intergovernmental Negotiating Body convenes to address a pandemic accord and resonates with the recent accord among G20 Health Ministers, underlining the significance of regional research networks, especially for nations with limited resources.
This clarion call is powerfully articulated in a new paper in The Lancet Global Health published today, researchers say that a focus on stopping epidemics before they become pandemics – with a new emphasis on sharing of technologies and know-how – is the key to pandemic preparedness and response.
“Time and again, developing countries are left waiting for tools like vaccines developed by others, while wealthier countries produce and access them first,” said the Right Honourable Helen Clark , former Co-Chair of The Independent Panel for Pandemic Preparedness and Response.
“The deadly lessons from COVID-19 demand transformative change, starting with action to ensure that all regions have the technology and capacities required to develop products that stop outbreaks before they spread worldwide. That’s not only equitable, it’s strategic.”
In the paper titled ‘From private incentives to public health: rethinking research and development for pandemic preparedness,’ the authors, including including distinguished researchers from the Global South, lament the disproportionate focus on building new vaccine manufacturing facilities in developing regions. Instead, they advocate for nurturing regional research and development leadership in health, a move that would bolster resilience on a local scale.
The researchers expound that the pivot towards averting epidemics before they spiral into pandemics, underscored by the sharing of knowledge and technological prowess, is the cornerstone of effective pandemic readiness.
“In the 21st century, given available technologies and in the wake of a pandemic that has led to some 24 million excess deaths, there should be no question that we need a new model – one that fully empowers all regions to be self-reliant,” said Dr. Amadou Sall, the Director of the Institut Pasteur de Dakar, Senegal, one of the few African vaccine research and production sites.
“Many of these technologies have been available for decades now, and others have been developed with public funds. It’s time to make them available in Africa and on other continents,” said Dr. Sall.
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The esteemed Right Honourable Helen Clark, former Co-Chair of The Independent Panel for Pandemic Preparedness and Response, emphasizes, “The deadly lessons from COVID-19 demand transformative change… That’s not only equitable, it’s strategic.” Clark insists on dismantling the status quo where developing nations are perennially disadvantaged in accessing crucial tools due to the dominance of wealthier counterparts.
During their latest meeting on 18 and 19 August, the G20 Health Ministers recognized the need for “sustainable global and regional research and development networks to facilitate better access to VTDs (vaccines, treatments and diagnostics) globally, especially in developing countries.”
The authors suggest concrete strategies to transform this vision into reality. A pivotal concept is the establishment of research hubs helmed by local scientists, enabled to customize established technologies devoid of intellectual property constraints, producing tailored solutions for emerging pathogens—a concept they term ‘last-mile innovation.’
Dr. Els Torreele, the lead author of the paper, emphasizes, “In outbreak control, speed and versatility are of the essence… last-mile innovation will let researchers develop and produce products people can use, where they live.” This approach not only accelerates response times but also aligns with local health systems.
“If, for example, the mRNA technology platform is a shared source of knowledge and technology and made accessible through networks of collaboration, researchers can innovate and develop vaccines that address local or regional health needs and are suited to optimal delivery into local and regional health care systems,” said Professor Petro Terblanche, the CEO of Afrigen Biologics, the Centre of the WHO/MPP mRNA technology development and transfer programme in South Africa.
Claudia Vaca-González notes that the ‘last-mile innovation’ approach requires simplifying the regulatory requirements in order to facilitate both the clinical regional research networks´ work and to accelerate marketing authorization and availability of medical products. “All of the efforts to remove the intellectual property barriers and transfer technology might be lost without an access-sensitive regulatory environment.”
In addition to medical products for diseases that are outside the interest of the global pharmaceutical industry, examples of the types of innovations needed include products that do not require ultra-cold chains; those with simpler routes of administration – oral drugs or intranasal vaccines for example – as opposed to injectables; and those that require as few doses as possible with a broad window of effectiveness.
A treatment that only works if administered within a few days of disease onset is of little use in areas where rapid diagnostics are not readily available.
The authors also make a strong case for a common goods approach to R&D, in which the ownership and control over technologies that are critical for public health are governed collectively and in the public interest.
“The public sector is already investing billions in research, which is then often sold or handed out to the private sector who decide whether or not to develop products based on profit potential,” said Dr. Joanne Liu, a Canadian paediatrician, former International President of MSF and member of The Independent Panel. “We’re saying, tools to protect lives and stop outbreaks from crossing borders must be common goods – and must and can be funded with that mindset.”
The paper argues that The Pandemic Fund, for example, and many of the development banks, could finance research and development for the common good rather than just vaccine manufacture and distribution through a market approach.
The authors advocate for a paradigm shift in ownership and control of critical technologies, invoking examples like the CERN research facility in Europe, urging collective governance for public health’s sake.
Dr. Soumya Swaminathan, Chairperson of MSSRF and former Chief Scientist of the World Health Organization, summarizes the authors’ stance eloquently, “Our proposal… would give researchers from developing countries greater ability to quickly and collectively contribute to solutions to infectious outbreaks in their regions.”
The authors’ call comes as the Intergovernmental Negotiating Body working on a pandemic accord is set to meet in Geneva next week to continue negotiations. Issues of equitable access to pandemic countermeasures are being negotiated in specific articles on research and development and on technology sharing and co-development, and are considered some one of the most difficult areas to solve. The G20 is also set to finalise its leadership declaration during the 9-10 September Summit.
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Notes:
Their work has been captured in two Lancet Comments in 2023: Stopping epidemics when and where they occur, and It is time for ambitious, transformational change to the epidemic countermeasures ecosystem, and in other recent publications including: The future of epidemic and pandemic vaccines to serve global public health needs, and Breakthrough treatments for Ebola virus disease, but no access – what went wrong, and how can we do better?
This paper in The Lancet Global Health represents a continued refining of ideas intended to ensure an end-to-end ecosystem for pandemic countermeasures. Such an ecosystem was proposed by The Independent Panel for Pandemic Preparedness and Response in its landmark report “COVID-19: Make it the Last Pandemic.”