If you live in Dubai, New York, or London, the pace of Covid-19 vaccinations makes it seem like the end to the coronavirus pandemic is in sight. But if you call Lagos or Nairobi home, the contrast is stark: fewer than 100,000 shots have been administered on the African continent, while the UAE, the US and the UK are vaccinating vastly more than that everyday.
The pandemic will not end until everyone is vaccinated – and quickly. At the current pace, full vaccination will not occur until the end of 2022, but we must find a way to make enough vaccines, about 15 billion doses, before serious vaccine-resistant variants overtake us. That's daunting, but it is possible to meet the challenge.
At this point it seems likely that we will need to develop and distribute new Covid-19 vaccines annually. About 1.5 billion people get flu shots each year, but Covid-19 vaccinations would require a significantly larger effort. Scaling up vaccination capacity will have other benefits: it will give us the infrastructure to also tackle future pandemics, because although the virus has killed nearly 3 million, a fast-mutating flu pandemic could kill tens of millions.
This reality was reflected in this week’s push by a consortium consisting of the World Health Organisation, the EU, and more than two dozen world leaders for an International Pandemic Treaty championing equitable access to data sharing, diagnostics, and the production of vaccines.
Currently, very few of the approved vaccines are meeting their production targets, with some facilities struggling more than others. Even if every manufacturer delivered on their projections, most calculations predict that it will take two years to vaccinate the planet.
Some countries may share their vaccines with others, but to produce vaccines continually and efficiently, we need production sites distributed around the world. GreenLight’s novel RNA manufacturing process – quick to start, built for scale, and using small bioreactors – may be part of the solution. We are partnering with governments, multilateral institutions and companies on all continents to accelerate pandemic response.
For our plan or any plan to succeed, however, we need broad agreement on an approach that supports the public good. We propose a global public-private partnership to build a network of seven globally distributed RNA vaccine factories capable of quickly producing sufficient doses for the entire world.
Key challenges of the status quo are the nascent supply chain and high cost of production. A scaled partnership will dramatically increase vaccine supply, counter new variants, cut costs, and help end the pandemic. The RNA factories the partnership builds would be created by building or converting pharma-grade manufacturing plants – most antibiotics factories capable of microbial fermentation would work – in strategic locations so that most of the world’s population would live within a few days’ travel of at least one such plant.
Right now, most of the world’s RNA manufacturing takes place in the US or the EU. Although capacity is being built out, we need a dramatic expansion of RNA manufacturing space.
Unlike other vaccines, RNA is not grown in cells. We can move from identifying a new variant to testing a vaccine in a few weeks and deploying it soon afterwards.
We need to develop a vaccine that can be delivered at regular refrigeration temperature. Although RNA vaccines have had to be stored at minus 20 degrees, CureVac’s vaccine, currently in stage 3 trials, keeps in a refrigerator for up to three months.
Costs must also come down. At $10 to $40 per dose, RNA vaccines are significantly more expensive than the cheapest alternative vaccines, currently the Oxford/AstraZeneca at around $3 to $5 per dose. This, too, is solvable: scaling up production and improving technology, including easing the refrigeration issue, should naturally bring prices down. Our projections are that the RNA industry should be competitive with other types of vaccines within the year.
We need to keep improving our vaccines. In countries with weak health infrastructures, a single-shot vaccine will make compliance more effective. One review of multi-dose vaccine programmes in the US found that as few as 40 per cent of patients completed the regimen, a problem that is worse in places that struggle most to control Covid, as we have tragically seen in Brazil. Injected vaccines are also a barrier; ultimately, a nasal vaccine might be the ideal solution.
Vaccines for Covid-19 cannot yet be manufactured in Africa. Local manufacturing – that is to say, a factory on the continent itself – would help meet the demand and increase the pace of vaccinations. The Covax initiative plans to send 600 million doses to Africa, enough for only about 20 per cent of its population; so far only 20 million have been delivered. Africa is, essentially, at the back of the line.
The last year has been a showcase for the power of science and of human ingenuity. To go from identifying a pandemic virus to getting a vaccine for that virus into millions of arms within a year is extraordinary, when the normal process takes a decade or more. But to fight this deadly virus and all its variants requires the agility and ingenuity to equip every country with the tools it needs to stay victorious.
Andrey Zarur is chief executive and co-founder of GreenLight Biosciences, a biotech company