ViewPoints Interview: Duke’s Andrea Taylor Shares Insight on Launch And Scale Speedometer

In a recent interview with PharmaShots, Andrea Taylor, Researcher at Launch And Scale Speedometer shared her insights and highlights on data how rich countries’ shopping spree for COVID-19 vaccines means fewer vaccinations for billions in low-income countries

Shots:

• The Launch and Scale Speedometer project aims to systematically analyze the factors that support or hinder the introduction and scaling of interventions, including but not limited to drugs, diagnostics, and devices, to address critical global health challenges
• The Covax Facility is currently the only mechanism to bring low-income countries into the market and ensure equitable access to successful vaccine
• The study reveals that while it will likely take 3-4years to manufacture enough vaccines to cover the world’s population, close to 7B doses of COVID-19 vaccine candidates are already being negotiated through deals involving mainly high-income countries, vaccine developers and global vaccine manufacturers

Tuba: How high-income countries are creating a threat to low-income countries’ ability to access future vaccines for COVID-19?

Andrea: The issue is that, because of global manufacturing constraints, every direct deal made by high-income countries takes doses off the future market. This means that very little may be left by the time vaccines actually come to market and that low-income countries, which aren’t able to make advance purchases, may lose out. It may be two or three years before we are able to manufacture enough doses to cover even high priority populations in low-income countries, while high-income countries may get first access to the doses that are produced in the first year or two.

Tuba:  Can we have detail on the analysis done by Duke Global Health Innovation Center?

Andrea: We have provided detailed analysis on our website: https://launchandscalefaster.org/COVID-19. I am happy to answer any specific questions you might have about our analysis.

Tuba:  Could you please share in detail about Launch And Scale Speedometer?

Andrea: The Launch and Scale Speedometer project aims to systematically analyze the factors that support or hinder the introduction and scaling of interventions, including but not limited to drugs, diagnostics, and devices, to address critical global health challenges. The primary goals of this project are to:

• obtain high-quality data on launch and scale-up trends of health interventions globally;
• generate and share valuable insights to improve launch and scale pathways; and,
• increase collaboration and accountability across the health sector for achieving efficiency and effectiveness for launch and scale so that interventions reach the people who need them more quickly and efficiently.

As part of this project, we have launched a focused workstream on the development and distribution of vaccines, therapeutics, diagnostics and other interventions related to combating the COVID-19 pandemic.

Tuba:  How Launch and Scale Speedometer help the equitable allocation of COVID-19 vaccines globally?

Andrea: We are mapping the advance purchases made globally to provide transparency and insight into the flow of purchase agreements. Our findings indicate a pattern of purchasing by high-income countries that may undermine the commitment to equity made by these same countries. Equitable allocation appears to be at risk, given the number of doses already reserved before any vaccine candidates are even on the market. Our findings serve as a warning and we hope that our analysis will inform investments in mechanisms that promote equity, such as the Covax Facility, as well as increasing manufacturing capacity, particularly in low- and middle-income countries. We will update our advance purchase data every two weeks and continue research into additional areas such as manufacturing capacity, partnerships, and distribution strategies.

Tuba:  8.8B Doses are already reserved, even before any candidate in the market. Comment over the statement.

Andrea: As I noted above, this is an issue in light of the global manufacturing constraints. Despite generous investments in equity through support of the Covax Facility, many high-income countries have also made direct deals to purchase large numbers of vaccine, in some cases enough to cover their populations several times over. This undermines their investment in equity by removing doses from the market before we can ensure that all countries have access to enough to cover the high-priority populations. However, we can mitigate the impact of this somewhat by increasing manufacturing capacity.

Tuba: Can we have an insight on the confirmation status of vaccine doses procured by the Country’s income level?

Andrea: What our findings show is that high-income countries have been very successful in purchasing a portfolio of vaccine candidates, increasing the chance that at least one of these investments will come to market. A few middle-income countries have also been successful in making advance purchases, particularly those with manufacturing capacity, such as India and Brazil. We have also seen middle-income countries leveraging participation in clinical trials to secure advance deals for vaccine candidates. However, low-income countries have been left out of this market entirely.

Tuba: What are the critical challenges facing by low-income countries like Ethiopia and Peru in the distribution of vaccines?

Andrea: Peru is actually a middle-income country and has been able to secure advance market purchases, in part by leveraging participation in clinical trials. But both middle- and low-income countries will face significant challenges in distribution. These include poor cold-chain infrastructure (particularly an issue for vaccine candidates requiring freezer or supercold storage temperatures), large populations living in remote areas far from healthcare providers, and immunization programs designed to target newborns and children, rather than the elderly. In addition, some countries are facing significant issues with misinformation about COVID-19 that may impact take-up of vaccines.

Tuba: What you think can help low income & middle-income countries to secure vaccine doses?

Andrea: The Covax Facility is currently the only mechanism we have to bring low-income countries into the market and ensure equitable access to successful vaccines. There are at least two additional strategies, though, that can help to strengthen the positions of low- and middle-income countries. The first is to unlock additional manufacturing capacity in low- and middle-income countries, particularly in sub-Saharan Africa. This is no guarantee but makes it more likely that manufactured doses will stay on the continent. The second strategy is for low- and middle-income countries to pool financing and procurement as a regional block. For example, the African Union and the Africa CDC are developing a “whole-Africa” approach that aims to raise $5 billion to purchase vaccines that can be distributed across African countries. While these countries individually have been unable to compete on the advance purchase market, they will have a stronger position and purchasing power as a block.

Tuba: Approximately 200 Covid-19 candidates are in development, who you think are leaders in developing vaccines of COVID-19? When can we expect the first vaccine for COVID-19?

Andrea:   It looks likely that the first vaccines will begin to ship out by March of 2021. The vaccine candidates developed by Pfizer/BioNTech and Oxford/Astra Zeneca appear to be closest to receiving regulatory approval. However, the first vaccines to cross the regulatory finish line will not necessarily be the best candidates, particularly for low- and middle-income countries. Several of the leading candidates in terms of timeline are two-dose vaccines that require freezer or ultracold storage, which will be difficult or impossible for many countries to implement, particularly in rural and remote regions. These may be followed closely by one-dose vaccine candidates that only need standard refrigeration or, better yet, a “warm” vaccine, both of which are currently being tested. These vaccine candidates would be much better investments from the perspective of low- and middle-income countries, in terms of being easier to implement and reducing wastage.

About Andrea Taylor:

Andrea Taylor, Researcher at Launch And Scale Speedometer and led the analysis for the Launch and Scale initiative.

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