The best way to pandemic-proof the world is through ‘last-mile innovation’ based on strong regional and subregional research and development (R&D) hubs that can tackle disease outbreaks before they become pandemics.

These hubs should be led by local scientists and have the capacity to adapt established technologies without intellectual property restrictions to produce vaccines, treatments and diagnostics to address threatening pathogens.

This is the argument put forward by a group of health experts in a paper published this week in The Lancet amid three separate global negotiations aimed at improving the world’s response to future pandemics.

They assert that there has been too much focus on building new vaccine manufacturing facilities in developing regions and argue that the Pandemic Fund and development banks could finance “R&D for the common good rather than just vaccine manufacture and distribution through a market approach”. 

“As we have seen again during COVID-19, a system that largely relies on market dynamics to drive the research, manufacture and marketing, results in highly inequitable access and preventable deaths, particularly in developing countries,” said co-author Dr Soumya Swaminathan, former Chief Scientist, World Health Organization (WHO).

“Our proposal, which centres on equity from the start, would give researchers from developing countries greater ability to quickly and collectively contribute to solutions to infectious outbreaks in their regions. When each region has that ability, all of the world is better protected from pandemic threats, which are only going to increase due to climate change.”  

Speed is essential

“Time and again, developing countries are left waiting for tools like vaccines developed by others, while wealthier countries produce and access them first,” said Helen Clark, one of the authors and 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.”

Dr Els Torreele, the lead author, explained that “in outbreak control, speed and versatility are of the essence, so having the ability to rapidly adapt the most suitable existing technology to local needs is critical”.

“The opportunity for ‘last-mile innovation’ will let researchers develop and produce products people can use, where they live, for the outbreaks in their regions,” added Torreele.

Dr Amadou Sall, Director of the Institut Pasteur de Dakar in Senegal, added that “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”.

“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 Sall, who is also a co-author.  

Sharing mRNA technology

Professor Petro Terblanche, who heads the WHO’s mRNA technology development and transfer programme in South Africa, explains that if, for example, mRNA technology is made accessible, “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”.

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.  

They cite the CERN research facility in Europe, which is jointly funded by 23 countries, as an example of a sub-regional R&D hub. 

“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 Medecins sans Frontieres (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.” 

Timely intervention

The authors’ call comes as the Intergovernmental Negotiating Body (INB) 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 Health Ministers also recognised 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” at its meeting last week.

Meanwhile, the United Nations High-Level Meeting on pandemics is set for 20 September in New York, and will adopt a political declaration mapping out how to address future pandemics.

Image Credits: Rodger Bosch for MPP/WHO, Kerry Cullinan.