In January 2023 IAVI released a white paper after a meeting between global health experts. As a result of a convergence of several diseases in 2022, mpox, ebolavirus, and COVID-19, IAVI and the Rockefeller Foundation established the meeting: “delivering vaccines for emerging infectious diseases: harnessing the power of innovative partnerships”. The objective was to “spark strategic discussions” on how to “galvanise partnerships to address vaccine development and access for EIDs”.
The paper states that emerging infectious diseases (EIDs) have caused “deadly local and regional outbreaks” with occasional “pandemic waves”. The authors acknowledge the “fact” that “new patterns of climate and human migration, travel, and interaction with the natural world” contribute to “unpredictable outbreaks” of both known and unknown infectious diseases.
“We will need to address these new threats effectively or suffer the consequences for our inaction or incompetence.”
The paper recognises the fast development and distribution of COVID-19 but identifies that it is “not the norm during EID outbreaks”. By contrast, the usual approach is for “research and developers to engage in a flurry of activities until the outbreak abates, followed by a loss of urgency and lack of progress on projects that had been taken up with great energy”.
Identifying opportunities in gaps
The meeting gathered experts from all areas and the paper “distils” their discussions into “gaps” and “opportunities” that were identified in each category. We have summarised these below.
R&D partnerships: accelerating the development of vaccines for EIDs
- Lack of trust among stakeholders
- Lack of resource and sample sharing in geographic areas of EID prevalence
- Little access to early financing, which impedes accelerated advancement of vaccine candidates and research on diseases that have yet to “emerge”
- Failure to sustain partnerships during “peacetime”
- Continue collective discussions targeted towards solutions
- Focus on building trust
- Sustain the partnerships forged during the COVID-19 pandemic
Access partnerships: ensuring prompt and equitable access from day zero through “the last mile”
- Resource-limited countries are over reliant on extremely subsidised EID responses, so local needs are not met
- Existing business models prioritise development of vaccines with significant market in high income settings
- When vaccines have dual-market relevance, they are distributed or deployed inequitably
- Define a sustainable business model for EID vaccine development
- Strengthen national and regional leadership
- Ensure clear and binding commitments for future accessibility of products
- Create an enabling ecosystem
Funding partnerships: creating a sustainable financing ecosystem to advance EID development and deployment
- Funding often comes from Overseas Development Aid (ODA) programmes, but EID preparedness and response needs do not align with ODA agendas and are not currently being supplemented by domestic resources in LMICs
- Failure of agencies working on EID vaccine development to coordinate on shared priorities, leading to lack of efficiencies and synergies
- Change the conversation around R&D and develop compelling shared messaging so that all stakeholders are aware of opportunities and needs
- Identify new partners and new partnership models, especially within the industry, and devise innovative ways to engage them
- Better align current founders and partners to fill gaps in the EID vaccine product development continuum
- Clearly differentiate the unique requirement of EID vaccine development and deployment from other global health needs
What are the next steps?
It’s all very well gathering and identifying opportunities but putting these ambitions into play is the true test. The “reflections” from this meeting highlight the importance of “galvanised” funding. Although an “ideal model doesn’t exist yet”, the paper suggests that “multisector partnerships that harness and encourage scientific innovation, build in access considerations early and across the product development continuum, and which are backed by sustainable and flexible funding” are the best candidates.
This kind of model must be “collectively nurtured” to share the “significant risks” that product developers currently face.
“Without centralised coordination and leadership – underpinned by strong community engagement and support – our efforts will invariably fall short, and the boom/bust cycle of EID vaccine development is bound to persist”.
Although the paper encourages further discussion, the meeting attendees agree that this cycle would have “grave consequences for low- and middle-income countries”.
“True preparedness will be achieved only when communities most affected by EIDs are included as equal stakeholders throughout the product development process, including locally led science, development, and delivery.”
How do you envisage “true preparedness” and what steps do you think must be implemented before it is achieved? To read the full paper click here. We look forward to hearing more from representatives of IAVI at the World Vaccine Congress in Washington this April, so do join us to continue the discussion.