From Panic to Neglect: Applying Lessons Learned from COVID-19

There’s a small window of opportunity for the G7 and G20 to apply the lessons learned from this pandemic. Germany’s G7 presidency encourages world leaders to “progress towards an equitable world” and the Indonesian G20 Presidency is thematically titled “recover together, recover stronger.”  The messages are clear: equitable growth is driven by collective action. The same aspirations should frame how we apply the lessons from COVID-19 to be better prepared for future pandemics at a time when attention shifts to other issues such as the war in Ukraine and the looming food crisis. With COVID-19 looking less threatening for some, the risk of a move from panic to neglect should not be underestimated.

The first lesson from COVID-19 that needs to be factored into future policy making is that we should not compromise what worked well for this pandemic. Science and innovation delivered.  New tests, treatments and new vaccines were developed in record time, with the approval of a vaccine 326 days after the virus sequence information was shared. Previously, the fastest a vaccine had ever been developed was four years for Ebola. But this did not happen in isolation. Innovations such as mRNA and viral vector vaccines were developed thanks to decades of research conducted within a robust innovation ecosystem. The response to COVID-19 was a remarkable feat of the best in public-private partnerships. Biotechs and large pharmaceutical companies developed and scaled up not one but several COVID-19 vaccines, in some cases helped by initiatives such as Operation Warp Speed.  Regulatory agencies played a critical role by being willing and able to innovate implementing new regulatory agilities, which made it possible for phase one clinical trials to start just 66 days after the SARS-COV2 sequence was known. The regulatory process thereafter was extremely swift, and was the reason that Margaret Keenan in the UK became the first person in the world to receive a COVID-19 vaccine less than a year after the world knew about SARS-COV-2.

The latest global innovation tracker found that, throughout the pandemic, governments and enterprises across the world increased their investments in innovation – confirming that our way out of economic and health crises lies firmly with innovation.

What followed was the biggest vaccination campaign known to date, with 11 billion vaccine doses produced by the end of 2021.  Already by May 2021, a matter of months after the first vaccines rolled off the new manufacturing lines, production had reached around 1 billion per month, which should have provided reassurances to the global health community that if vaccines doses were shared, there would be enough to vaccinate all the world’s elderly and vulnerable populations within a few months.

Breaking with normal process, the historic manufacturing scale-up took place in parallel to R&D efforts. This meant that there were vaccines ready to be rolled out as soon as they were approved. In the vaccines field, this novel and pandemic-appropriate approach was significantly aided by risk-sharing between companies and governments signing advanced purchase agreements. In addition, more than 370 voluntary partnerships across the world, including with vaccine manufacturers from developing countries, were being set up. These collaborations were built on a foundation of show-how, know-how, skilled workforce, adequate supplies, and quality and regulatory approvals.

At no stage was, as some would like to suggest, IP a barrier to accessing science and innovation.  Therefore, undermining innovation with a waiver on patents for COVID-19 vaccines, as adopted by the World Trade Organization (WTO), flies in the face of what actually happened, and also sends the wrong signal for future pandemic preparedness.

While innovation and vaccine scale-up worked, the system as a whole failed to ensure COVID-19 vaccines reached all who needed them as swiftly as possible. Despite a strong early start of equitable roll out of vaccines, which saw the first vaccines reach Accra in Ghana on the same week the first shipments reached Tokyo, very quickly vaccine deliveries to Africa stopped and did not start again until months later.  We witnessed the global healthcare community falling short of its promise to leave no one behind.

In May 2021, industry was extremely concerned and called to the G7 for urgent action to increase vaccine equity, including sharing doses between countries, removing trade barriers, and supporting country readiness.  But these warnings went broadly unheeded.

We must remedy what went wrong to understand how to plan better for future pandemics.  A mistake repeated more than once is a decision. Of the 10 lessons the biopharmaceutical industry identified, we would point to two that are politically most sensitive.

• Vaccine nationalism imperils everyone

While the first obligation of any government is to ensure the safety of its people, narrow understandings of that duty led to the rise of vaccine nationalism. Several rich countries moved from hedging—not knowing which vaccines would work—to hoarding, in securing as many as 10 doses of the early COVID-19 vaccines for each citizen. This intensified and likely prolonged the COVID-19 pandemic. Refining the concept of “national health security” in a global context will be essential before the next pandemic.

In a similar vein, trade nationalism severely impacted vaccine equity. The U.S. Defense Production Act slowed down global manufacturing scale-up by hampering the vaccine supply chain, and India’s export ban of COVAX vaccine supplies severely affected equitable distribution of vaccines to most countries in Africa for much of 2021. For instance, people in Africa and other regions were let down badly by not receiving the COVAX orders secured from the Serum Institute, even though the shortfall was made up in a matter of months by other vaccine manufacturers. In a globalized world, open borders are crucial to keeping supply chains running.

• Delivery infrastructure must be strengthened

Precious time was wasted not only in waiting for vaccines to be delivered in part due to trade barriers, but also because resources were not secured and deployed to ensure infrastructure and skilled workforce to get vaccines from the tarmac into arms. The reality on the ground in far too many low-income countries is weak health systems with limited infrastructure, technology, and funding. The majority of health systems in LMICs had little to no experience vaccinating adults before the pandemic, and their health facilities and workforce were quickly overwhelmed by the surge in COVID-19 patients needing treatment. A 2020 review of adult immunization programs among WHO member states found that just 62% reported having any immunization programs – the most common of which was influenza vaccination, reported by 59% of countries.

Resilient infrastructures, resources, and expertise are needed to ensure that innovations like vaccines and treatments reach those who need them most. Resilient national health systems and global health security are two sides of the same coin, and it’s an investment that must be made now.

As global leaders look at better pandemic preparedness, it’s essential to turn lessons into strategic commitments – to create an architecture for effective pandemic preparedness and response that we didn’t have two years ago. This architecture must be built on the understanding that science and scientific endeavor, combined with collaboration and solidarity, will be at the heart of how well, fast, and fairly the world can respond. In the next pandemic, we must do better to ground our collective response in clear policies and less politics.