The G20 Needs to Address the Lack of Coordination in the Global Vaccine Supply Chain for Pandemic Preparedness

Despite the vivid challenges of the early phase of the COVID-19 pandemic, the world remains unprepared to manufacture and distribute vaccines for the next large health emergency or pandemic. Although the global response to COVID-19 has seen major advances in vaccine technology and distribution, it has also highlighted persistent weaknesses in the overall global vaccine supply chain. Vaccine manufacturing is extremely complex—about 9,000 different materials from 300 suppliers in 30 different countries may be required to produce a vaccine. If any of these components are missing, vaccine production can grind to a halt. This happened during the COVID-19 pandemic when many of the critical components required to manufacture COVID-19 vaccines were initially and periodically in short supply. Addressing these bottlenecks required urgent measures that could be difficult to repeat without provoking international controversy. Some emergency national actions taken to produce COVID-19 vaccines were heavily criticized because of their negative impact on equitable availability of vaccines. The use of the Defense Production Act by the United States was cited for limiting component supply, and export restrictions by the European Union and India slowed vaccine delivery to other regions.

Managing the vaccine supply chain during a pandemic—from upstream manufacturing to last-mile delivery—will require high-level global coordination and the sharing of information across different public and private agencies in the supply chain continuum. While many discussions are underway about a possible pandemic accord/treaty that would include provisions regarding access to medical countermeasures, the discussions become highly charged when addressing intellectual property and specimen/pathogen data sharing. These are undoubtedly important areas for discussion, but there are less ambiguous areas involving simpler coordination and information exchange to identify and alleviate potential supply chain bottlenecks under different scenarios related to the type of vaccine (platform), the nature of demand, and vaccine manufacturing capacity. Sharing such information and conducting mock tabletop simulation exercises can help governments and manufacturers to get ahead of supply chain risks that may arise during a public health emergency or large-scale disease outbreak. In a world of shared risks, readying the global vaccine supply chain to deal with demand surges requires an ongoing, unified effort between the governments of countries where the bulk of the input materials and vaccine manufacturing is carried out, and the manufacturers (vaccine manufacturer, equipment suppliers, and raw material suppliers).

Coordination for some of the material inputs for the COVID-19 vaccine supply chain was carried out more than halfway into the COVID pandemic by setting up an ad-hoc COVAX manufacturing and supply chain task force that delivered innovations such as the COVAX Marketplace for open sharing of raw materials inputs for vaccines manufacturing. Other coordination structures, such as the US-EU joint task force, also helped to improve COVID-19 vaccine manufacturing practices. However, there is no standing permanent body to prepare and manage the global vaccine supply chain for future pandemics. Without this coordinating body, pandemic vaccine responses will be ad hoc, ineffective, and inequitable.

It's time for a G20 task force on vaccine manufacturing and supply chains

As the leading forum for the major vaccine producing nations to discuss these policies, the G20 could take a lead and establish a task force focused on vaccine manufacturing and supply chains. A permanent G20 task force could orchestrate the vaccine supply chain during pandemics and help it prepare better during interpandemic periods by creating next-generation solutions. Such a task force should bring together G20 member countries, CEPI, GAVI, the World Health Organization (WHO), and manufacturer associations such as the International Federation of Pharmaceutical Manufacturers and Associations, the Biotechnology Innovation Organization, and the Developing Countries Vaccine Manufacturers Network. The task force should build on the activities of CEPI, GAVI, the World Economic Forum, and the health security agencies of G20 member countries to reduce duplicative efforts. However, its governance structure should be a formal G20 structure. As vaccine manufacturing is expanding in Africa and Latin America, thereby creating even greater pressure on supply chains, the Africa CDC and the Pan American Health Organization (PAHO) should also be members of this task force.

The task force should be setup to comprehensively cover supply chain risks for all infectious diseases with pandemic potential by stress testing different portions of the vaccine supply chain under different scenarios; understanding where potential bottlenecks will arise; and devising predetermined plans (including prepositioning of material stockpiles) and partnerships to alleviate such bottlenecks. The task force’s mission should not be just to prevent supply chain disruption but also to ensure sufficient and diversified supply sources during a pandemic, in order to ensure equitable distribution. During interpandemic periods, the task force should meet twice a year for rapid assessment of strategic and operational-level plans for raw material sourcing, manufacturing, and cross-border distribution under different scenarios requiring different types of vaccine/vaccine platforms. G20 countries should allocate meaningful funding for establishing and running this task force work so it carries out this vital role during interpandemic periods. The members of the task force would be drawn from agencies and organizations with a mandate to work on global health security and routine vaccination to achieve health equity. As a result, beyond a G20 coordination/secretarial task it will not necessarily require much additional staffing. The activities of the secretariat would require collating technical inputs, some of which are already a part of the work carried out by CEPI, G20 country health security agencies, WHO, GAVI, PAHO, AU/Africa CDC, and the World Economic Forum. The secretariat/coordination would also create an annual report on the state of supply chain preparedness and highlight the unmitigated risks.  

The sometimes-chaotic COVID-19 vaccine supply chain resulted in significant and lasting global inequities, as the populations of many low- and middle-income countries struggled to access vaccines in the early days of the pandemic. These failures could easily recur during the next pandemic even with global south manufacturing expansion if the world doesn’t focus on the underlying coordination challenges in the vaccine supply chain. By establishing a standing task force, the G20 will take an important step towards effectively responding to the next pandemic. The alternative is to ignore the unacceptable prospect of another disorganized and inequitable pandemic response.