The Asia-Pacific region has the expertise and resources to take a leadership role in not only developing a COVID-19 vaccine but distributing it to those who need it most.
The global vaccine research and development effort in response to the COVID-19 pandemic is unprecedented in terms of scale and speed. Given the imperative for speed while also trialing new treatment options, there is an indication that a vaccine could be available under emergency use or similar protocols by early 2021. This is a fundamental change from the traditional lengthy vaccine development pathway, which takes on average over 10 years, even when compared with the accelerated 5-year timescale for development of the first Ebola vaccines.
To achieve the goal of early 2021, we will need parallel and adaptive development phases, innovative regulatory processes and scaled-up manufacturing capacity, and above all very good post-market surveillance to monitor adverse side effects.
The Asia-Pacific region is playing a critical role in this historic endeavor. Of the confirmed active vaccine candidates, 36 (46%) are in North America, 14 (18%) in the People’s Republic of China, 14 (18%) in other parts of Asia and Australia, with 14 (18%) in Europe. This is according to an analysis by the Coalition of Epidemic Preparedness Innovations.
The analysis also states that most efforts come from smaller private sector manufacturers, with 36% coming from Asia. The importance of Asia-Pacific in the international vaccine market is also reflected in the trade data. Six Asia-Pacific countries are among the top 20 vaccines exporters worldwide. In order of their export volume, they are: India, the Republic of Korea, Australia, Singapore, Indonesia, and the People’s Republic of China. Other countries are smaller producers, but still export more than $100 million worth of vaccines yearly, namely, Malaysia, Philippines, Viet Nam, Fiji, and Thailand.
Being at the forefront of developing new vaccines against COVID-19, Asia can build on its substantial experience in producing vaccines that comply with international standards. The key question is now how to best utilize these existing resources to quickly develop and scale up the production of a COVID-19 vaccine.
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The need for expedited and novel approaches requires close coordination between manufacturers, research institutes, governments and regulatory agencies to ensure quality and safety. Most importantly, we need to find a regional coordination mechanism that ensures the production and distribution of safe vaccines for the entire region within a short amount of time.
The first step would be to map out existing capacities. The governments of vaccine producing countries should request their vaccine manufacturers to give them detailed overviews of existing production capacity, investment needs to upgrade facilities, technology transfer needed and the surge potential. Existing production of crucial vaccines should not be unnecessarily interrupted. Starting production from scratch in a country with no previous experience is usually a lengthy process that will take no less than five years. Therefore, it would be crucial to expand the existing capacities.
Second, countries need to draw up vaccination schedules and logistics. Vaccines will not become available at once, but in batches. Countries need to decide who will be vaccinated first to understand the amounts needed so that they can make advanced market commitments, which are important to inform manufacturers production. The criteria can be based on the profession and risk locations and risk profiles. Furthermore, vaccines typically require a consistent cold chain. Existing solutions to distribute traditional vaccines need to be expanded to solve this problem.
The third step would be to coordinate efforts within the region. Governments in the region should meet to exchange information and design a plan for a regional solution. Non-producing countries should be ready to make commitments to provide financial and possibly human resources for the expansion of vaccine production and procurement. In return, the vaccine producing countries would allot contingencies of newly produced vaccines to those countries. Those negotiations could be thorny, as some vaccine producing countries might have a strong incentive to first distribute the vaccines domestically or to richer countries.
A regional arrangement should include: agreement on vaccination protocols, most importantly who will be vaccinated first among mobile and migrant population groups and health workers; an estimation of vaccines doses needed in the next 10 years; agreement on funding mechanisms of the vaccine production (including R&D), procurement and delivery; development of policies for vaccine approval by regulatory agencies; close collaboration of regulatory agencies to ensure post-market surveillance of adverse side effects especially in countries with weak health surveillance capacity; and agreements on grievance mechanisms for adversely affected people.
Upscaling the vaccine production rapidly and reaching as many people as possible within a short amount of time requires a regional response that is based on the principle of regional solidarity. Vaccines should become available to critical staff, like health care front-liners, throughout the region. Having people immunized in only selected countries, while other countries suffer severe consequences, is not a scenario Asia and the Pacific would want to envisage.
At the same time, rapid approval of new vaccines needs to be safeguarded by sound regulatory systems and surveillance of severe events to ensure we don’t do more harm than good. The same is true for the fast approval of new medicine combinations for COVID-19. We need strong regional coordination and cooperation among vaccine developers, regulators, policymakers, funders, public health bodies and governments to ensure safe and effective vaccines can be manufactured in sufficient quantities and made regionally accessible including to the poorest member countries. Regional coordination and cooperation can be a lengthy process, but in the current crisis delays mean many lives lost.
It is time for the Asia-Pacific region to come together to take a leadership role in not only producing a COVID-19 vaccine but distributing it to those who need it most.