Once touted as a game changer for health manufacturing in South Africa and on the continent, Aspen Pharmacare is now at risk of closing its COVID-19 vaccine production line due to a lack of orders. In a time when the importance of distributed manufacturing of medical countermeasures (MCM) resonates widely, how did the only at-scale manufacturer in sub-Saharan Africa get to this point?
In a new paper, we reflect on the current landscape of MCM manufacturing, share lessons learned amid COVID-19, and offer recommendations to the global community to fund MCM purchases on day-zero of the next pandemic to assure equitable global access and sustain demand for MCM in the meantime. At the Second Global COVID-19 Summit tomorrow, we hope to see financing for rapid and equitable access to MCM on the agenda.
Lack of timely and sufficient financing is a major explanation for delayed vaccine orders. Staff and input shortages, export restrictions, over-ordering or “hoarding,” import dependency, oversight of product preferences, and lack of information also limited MCM supply.
In response to these challenges and the massive initial demand for MCM to combat COVID, regional entities like the African Union, PROSUR in Latin America, and ASEAN countries have pledged to accelerate regional manufacturing capabilities. Dozens of new manufacturing and technology transfer initiatives emerged over the last two years, including new plants, investments from development finance institutions and multilateral development banks, bilateral support, regional partnerships, technology transfer initiatives, training hubs, and task forces. But for the most part, these efforts represent an incohesive set of actions taken without assessing the totality of global or regional investments.
Despite the supply in place or on the way, vaccination rates have dropped since the start of 2022 and are currently at their lowest levels since mid-2021. Global sales forecasts continue to be downgraded. This phenomenon is predictable; high initial demand and prices elicited a huge, albeit lagged, production response that led to market saturation. But more troubling is that manufacturers will now decrease production, and this may again be overlooked until too late. If a new vaccine-evading, more dangerous COVID-19 variant were to emerge, there might be increased demand and restricted access all over again. We can break this cycle with stable and flexible manufacturing capacity and at-the-ready surge financing for sufficient volume when needed.
Our paper discusses specific ideas of how to get there. Recommendations to global leaders include:
developing a vision and roadmap for the 200 days mission to slow or stop pathogen spread by deploying MCM quickly (i.e., within 200 days from identification of a pandemic threat),
ensuring better visibility of manufacturing capacity and needs,
creating an Advance Commitment Facility that releases day-zero financing to jumpstart R&D and global and regional MCM manufacturing,
devising strategies to sustain MCM demand during inter-pandemic periods, with benefits for the fight against current infectious diseases,
expanding regulatory capacity and harmonization,
establishing a “mission control” approach for speedy implementation and inclusive governance,
adopting regional technology platforms to serve a range of infectious disease product needs.
COVID-19 has laid bare the need for policymakers to shift to future preparedness and routine procurement as the overall strategy, which manufacturing capacity and technology transfer approaches can then build on. As population demand and commercial markets inevitably shift, a portfolio of companies, geographies, and mechanisms of actions—and product, process, and platform flexibility, risk sharing, and balanced responsibilities and partnerships between buyers and producers—must be assured.
We’ve learned our lessons. Can global leaders apply them?
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.