The World Health Organization (WHO) and its COVAX partners are hosting a summit next week with governments and pharmaceutical companies to address the bottlenecks in COVID-19 vaccine production and delivery.

This follows a spectacular start in the past week for COVAX, the global vaccine delivery platform, which delivered more than 20 million doses of COVID-19 vaccines to 20 countries, according to WHO Director General Dr Tedros Adhanom Ghebreyesus.

“We currently face several barriers to increasing the speed and volume of production of vaccines, from export bans to shortage of raw materials, including glass, plastic, and stoppers,” Tedros told the body’s bi-weekly media briefing on Friday. 

“Next week, WHO and our COVAX partners will meet with partners from governments and the industry to identify bottlenecks in production and discuss how to solve them.”

The WHO runs COVAX together with GAVI, the global vaccine alliance and the Coalition for Epidemic Preparedness Innovations (CEPI).

COVAX Distribution Remains Small – Relative to Needs

Describing the COVAX launch as a landmark, Tedros added that “the volume of those being distributed through COVAX is still relatively small”, as they covered “between 2-3% of the population of countries receiving vaccines, even as other countries make rapid progress towards vaccinating their entire population within the next few months”.

To help all countries to end the pandemic, the WHO was looking at four approaches, said Tedros.

The first and most short-term was to link vaccine producers with companies that have excess capacity to “fill and finish”, such as the deal reached this week between Johnson & Johnson and Merck, where Merck will provide “fill and finish” services – filling vials with vaccines and packaging them – for the J&J vaccine.

“We need more partnerships like this,” stressed Tedros. “And we need them in all regions. WHO can support this process by identifying gaps and providing a matchmaking service between vaccine producers and companies with capacity.”

The second approach, said Tedros, was “bilateral technology transfer through voluntary licensing from a company that owns the patents on a vaccine to another company who can produce them”. 

“A good example of this approach is AstraZeneca, which has transferred the technology for its vaccine to SK Bio in the Republic of Korea, and the Serum Institute of India, which is producing AstraZeneca vaccines for COVAX,” said Tedros, although he decried the “the lack of transparency” in this approach.

´Coordinated’Technology Transfer

The third approach is a “coordinated technology transfer” that would see universities and manufacturers licensing their vaccines to other companies through a global mechanism, coordinated by WHO.

With this approach, there would be more transparency, global coherence and it would also “facilitate the training of staff at the recipient companies and coordinate investments in infrastructure”, said Tedros.

The final solution, said Tedros, was for countries “to start producing their own vaccines by waiving intellectual property rights as provided for in the TRIPS agreement”.

“Those provisions are there for use in emergencies. The WHO believes that this is a time to trigger that provision and waive patent rights. We thank South Africa and India for their proposal to the World Trade Organisation to waive patents on medical products, or COVID-19, until the end of this unprecedented pandemic.”

Next week’s summit will involve the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), which represents most major pharma companies. However, Marie-Paul Kieny, chair of the Medicines Patent Pools Foundation and a guest at the briefing, said that many other generic manufacturers needed to be brought into the discussion.

Kieny said her foundation was in the process of “leveraging our close relationships with generic manufacturers across the globe to help identify suitable partners to ‘fit and finish’ vaccine needs, and as potential recipients of technology transfer”.

COVAX Roll-out Continues Next Week

This week’s first COVAX deliveries were to Ghana, and Cote d’Ivoire. Shortly afterwards, deliveries were made to Angola, Cambodia, Colombia, the Democratic Republic of the Congo, Gambia, India, Kenya, Lesotho, Malawi, Mali, Moldova, Nigeria, the Philippines. the Republic of Korea, Rwanda, Senegal, Sudan, and Uganda.

By the end of next week, COVAX will deliver 14.4million more doses to 31 additional countries, which will mean it have reached 51 countries out of the 190 COVAX members, said WHO adviser and COVAX representative Dr Bruce Aylward.

Aylward described the process of getting the vaccines to countries as complex.

At a global level, the WHO had to examine the vaccines and grant them emergency use listing, while at country level, “some of the biggest challenges that we’ve seen is the regulatory authorisation for these products as well as the indemnification and liability provisions for the use of these products”, said Aylward.

“The national vaccine plans have to be in place. And then once all that’s in place, we’ve got to be able to link it up with the shipments, the logistics, the purchase orders etc.”

Despite the complexities, Aylward said only 24 countries had not jumped through all the hoops – but were expected to have done so within the next two weeks.

Image Credits: Flickr: Francis Kokoroko/UNICEF.