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To Democratize Vaccine Access, Democratize Production

U.S. and European COVID-19 shots aren’t enough. It is time to tap into Africa, Asia, and Latin America’s enormous production capacity.

Workers pack syringes at the Hindustan Syringes and Medical Devices factory in Faridabad, India, on Sept. 2, 2020.
Workers pack syringes at the Hindustan Syringes and Medical Devices factory in Faridabad, India, on Sept. 2, 2020. Sajjad Hussain/AFP/Getty Images

As wealthy countries inoculate millions of their citizens against COVID-19 and other countries wait to even begin the rollout, G-7 leaders are increasingly struggling to address geopolitically charged vaccine inequities.

French President Emmanuel Macron recently noted his fear that countries would turn to China and Russia for vaccines and “the power of the West will … not be a reality.” He later walked back his statement somewhat, clarifying that vaccines are a matter of public health—not power. They are, of course, both. But Macron and other leaders will never get either issue right as long as they remain focused on what portion of a relatively small supply of vaccines to share. Rather, the real game-changer lies in a very feasible effort to expand the pool of available vaccines.

At the moment, vaccine production approved in the United States and Europe is needlessly limited to a handful of companies struggling to get enough vaccines out the door to meet demand. Yet in Africa, Asia, and Latin America, there is enormous human and production capacity that could be mobilized to make more vaccines and address the needs of people in low- and middle-income countries. Governments and companies, especially in middle-income countries, have been asking to do so. As Western firms have demurred, Russia has taken them up on their offers, sharing Sputnik V know-how for production in Brazil, India, Turkey, and South Korea. If U.S. and European Union leaders want to address both the public health and diplomatic imperatives facing them—while also vaccinating their own populations—they should consider doing the same.

Vaccine development is largely funded by public money. The United States and Europe have poured massive resources into research and development as well as advance purchase agreements that remove risks for companies to develop vaccines. The United States, for example, put $2.48 billion into the new National Institutes of Health (NIH)/Moderna vaccine alongside a huge investment of effort in government scientists who pioneered them. Likewise, the German government provided $445 million to develop the Pfizer-BioNTech vaccine.

This spending brought remarkable breakthroughs for stopping COVID-19 and for future global health security. The kinds of shots Moderna, Pfizer-BioNTech, and others have developed are messenger RNA (mRNA) vaccines, which are simpler to make, easier to scale, and faster to adapt in the face of variants than traditional vaccines. The technology might soon bring breakthroughs against HIV, malaria, or influenza and enable rapid COVID-19 vaccine development against new emerging diseases. Logistical challenges that have dogged the deployment of COVID-19 vaccines, like cold chain storage, can be tackled. Moderna, for example, announced just before approval that its vaccine can now be kept refrigerated, not frozen, for 30 days.

The United States and Europe have far more to gain by sharing these technologies than by hoarding them, from preventing a never-ending cycle of new variants to rebuilding global trade and gaining soft-power influence. They should immediately work to allow production of cutting-edge COVID-19 vaccines in Africa, Asia, and Latin America. Some observers have claimed that such an effort would not be possible, take too long, or cost too much. They are wrong, as the world’s experience developing HIV medicines shows. After millions died without access to medications, today’s cutting-edge HIV drugs frequently come to market with near-simultaneous production by multiple companies in low- and middle-income countries. This is a direct result of government investment in production capacity, sharing of technology, and use of voluntary and compulsory measures to overcome patent barriers.

With cooperative technology transfers, new production capacity, including for mRNA vaccines, could be up in months. A year ago, no company in the world had produced mRNA vaccines at scale; now hundreds of millions of doses are being made. Vaccine manufacturers have retrofitted dozens of factories—most in less than six months. For example, Swiss company Lonza created a plan to produce the Moderna vaccine within two months of receiving the know-how.

There’s no reason such speedy progress can’t be achieved by low- and middle-income countries too. For example, Biovac and Aspen in South Africa, Institute Pasteur in Senegal, and Vacsera in Egypt could rapidly retool factories to make mRNA vaccines. In India, looking beyond Serum Institute, which has been one of the few companies licensed to make the Western-developed vaccines, is key—there are potential partners like Cipla that have made key HIV/AIDS drugs. There are scores of other opportunities around the world.

Governments will need to use their legal and political authority to push companies to share patents and know-how. Washington was the first to put an HIV patent into the Medicines Patent Pool and encouraged companies that received NIH funding to follow. This led to sharing of patents for drugs now relied on by millions around the world. Today, the NIH holds intellectual property rights for several COVID-19 vaccine technologies and has funded much of the research on mRNA vaccines in particular. Under U.S. law, this gives Washington the right to order government use of these technologies and the leverage to push companies reliant on its support to share knowledge. Given a nudge, it seems highly likely that companies will agree to voluntary licenses.

Sharing patents is necessary but not sufficient. To expand production within six months, companies need to be incentivized to share know-how and technology. This is common practice among companies already. There is even a whole subindustry dedicated to conducting tech transfers by helping pharmaceutical companies teach contractors how to source materials, set up production lines, and ensure quality without burdening limited human resources in originator companies.

For key COVID-19 vaccines, the United States and EU could pay leading vaccine developers a one-time fee for technology transfers, and licenses could include royalties on sales made by companies in low- and middle-income countries. If history is any guide, these companies will not only ramp up supply but also make vaccines less expensively. Having been largely financed by public funds, vaccine makers have already recouped their investments and should be focused on supply, quality, and affordability rather than profit.

There is plenty of funding to make this work. For example, the United States Agency for International Development and the U.S. International Development Finance Corporation could fund projects that build factories and train staff. The World Bank has made $12 billion available to finance COVID-19 vaccines and $4 billion through the International Finance Corporation for manufacturing. Countries have largely not taken the funding because a coordinated effort to transfer know-how and technology has been missing. The United States and EU could quickly find the missing pieces so factories can be retooled and vaccine production started in the coming months.

This investment of political attention and funding would be in United States’ and Europe’s economic best interests. Rich countries stand to lose $4.5 trillion if lower-income countries are allowed to go unvaccinated. And this is certainly not the last pandemic. Opening vaccine technology and assisting countries around the world to manufacture them can help bring this pandemic to an end while addressing destabilizing geopolitical inequality that is driving COVID-19 deaths.

Matthew M. Kavanagh, PhD is assistant professor of global health at Georgetown University and director of the Global Health Policy and Politics Initiative at the O’Neill Institute for National and Global Health Law.

Mara Pillinger is an associate at the O’Neill Institute for National and Global Health Law at Georgetown University, working on global health policy and governance initiative.

Renu Singh is a research assistant professor in the Division of Public Policy at Hong Kong University of Science and Technology and a scholar at the O’Neill Institute for National and Global Health Law at Georgetown University.

Katherine Ginsbach is a law fellow at the O’Neill Institute for National and Global Health Law at Georgetown University.