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    By Cristina Niculescu and Nadya Velikova

    One might say that vaccines have become the victims of their own success.

    The COVID-19 vaccines were developed in record time, but it has been hard to gain widespread support for their use. We have become accustomed to vaccinations over many decades. But we also have grown much more concerned with vaccine safety. Many people today tend to forget or take for granted the benefits of vaccination programmes. Fake news and easy access to all kinds of information through social media are causing people not to trust their doctors and science as much as they did 50 years ago.

    Despite the number of successful vaccines created for COVID-19, and almost two years after the start of the pandemic, people are still leading a compromised quality of life because of lockdowns, complicated travel restrictions, limited access to healthcare, etc.

    Vaccines and mass vaccination programmes have contributed to the eradication of certain diseases in wealthy countries. Today, many infectious diseases from the past are rare and almost forgotten.  Childhood immunizations have helped eradicate smallpox and nearly eradicated diphtheria, Haemophilus influenza type B meningitis, measles, mumps, poliomyelitis, rubella, and tetanus. In the developing world, the lack of vaccines still causes children to die, while in developed countries, we have the vaccines but there is growing hesitancy to take them. This resistance is putting at risk the gains achieved after decades of hard work by the medical community, researchers and governments.

    Everything in the toolbox

    When it became clear that the coronavirus would be a big crisis, the European Investment Bank decided to leverage all its financing tools and all the technology that science could offer to help companies and society. We did not focus on one company or one technique. We reached out to traditional vaccine developers and the new ones, such as BioNTech in Germany, which created one of the leading mRNA vaccines. MRNA is a novel technology that can pave the way for vaccines to treat many other illnesses, including cancer.

    From the first encounter with BioNTech, we had a special feeling. It was clear right away that this company had a lot to offer. The founders, Ugur Sahin and Özlem Türeci, were successful scientists, with a track record of publishing in high-impact scientific journals. They had built a business based on this innovative technology, yet they were very modest and confident about the solutions they could offer.

    At the start of the pandemic, we pushed hard to persuade everyone at the bank to agree to invest in the type of mRNA vaccines that BioNTech was developing, despite the fact that this technology previously had been studied mostly for cancer treatment.  We had a good feeling that this was going to be a success not only in fighting COVID-19, but that it also would pave the way to treat other diseases such as cancer, malaria and tuberculosis. It is clear today that this small German company, started  by two immigrants passionate about science, will have a tremendous global impact, contributing to major societal challenges worldwide.

    On the issue of migration, BioNTech is also an inspiring example of how we should not be afraid of diversity and instead welcome everyone who is willing to contribute their talent, passion and hard work to making Europe, and the world, a safer place.

    Be bold and risky

    Not every project the Bank supported during this crisis was successful, but we did not have the privilege to hope that one solution would work for everyone or the comfort to invest a lot of time choosing and supporting only the best ones. Instead, we took bold and sometimes risky decisions. We now have many vaccines that are doing a good job around the world.

    We are still looking for new success stories. In October 2021, the Bank approved a €45 million loan to help the Spanish pharmaceutical company Hipra manufacture its Covid-19 vaccine. This vaccine, which is still in the trial phase, is based on the traditional “recombinant protein” technology used by several other pharmaceutical companies. Hipra’s vaccine has been modified to be more effective against the COVID-19 variants. It can also be stored in a standard refrigerator, so it could be helpful in developing countries and remote areas, where it can be hard to supply the special freezers needed for the BioNTech vaccine.

    As we get closer to the end of the pandemic’s second year, we have several challenges – ensuring that these vaccines keep working against the variants, encouraging people to trust vaccines, and distributing the medicine to all parts of the world. Vaccination rates are low in many countries, and we do not know what new versions of the virus will emerge. As long as people get infected, and COVID-19 keeps spreading, there is a risk of new variants. If countries persuade large parts of their populations to accept vaccination, we could hope for fewer variants.

    We must keep educating people about the benefits of vaccination and about vaccine safety. We must become more open to risky research, increase investment in life sciences and be prepared for health emergencies like the one caused by COVID-19.

    Stockpiling for the long haul

    The development of COVID-19 vaccines was the first step, but it did not mean that the global pandemic would end. Countries had a big challenge to purchase enough vaccines and distribute them. The production, distribution and access to vaccines have been happening in different ways in different parts of the world. Many low- and middle-income countries have been relying on vaccines from the COVAX initiative. A very low percentage of people in Africa are vaccinated, compared with about 60 percent in the United States and 80 percent in Spain. 

    The different vaccination rates is a result of many factors, including the local production of COVID-19 vaccines in developed countries, country preferences, extended supply chains, export bans, shortage of raw materials required for manufacturing. The pandemic has offered many lessons on vaccine production and distribution for the pharmaceutical industry, governments, non-governmental organizations and private companies.

    Now or never

    We are in the now-or-never moment to improve the way vaccines are produced and distributed. Solutions that the Bank could explore to improve vaccine availability include stockpiling essential medicines, supporting the production of vaccines in other locations, sharing more knowledge and technologies, developing flexible manufacturing units, and investing in more advanced production methods. The goal is to have a vast, global vaccine supply ready to ensure a rapid and efficient response to crises.

    We are starting to shift gears at the Bank by spending more time on the distribution of vaccines and on companies that can produce stockpiles of vaccines created by other firms. We need to find ways to produce vaccines in more locations, which lets us help more remote locations, especially in poorer countries.

    We have seen a lot of success in vaccines lately, but there are still a lot of gaps and deficiencies. The crisis has shown us how much we depend on a global supply chain. A vaccine is created in one location and produced in another country, but the plastic or glass supplies are made in third location in another part of the world. We often have not been able to get crucial supplies in large quantities because a lot of the trade stopped during the crisis as governments instituted bans on a wide range of products. The United States halted exports of important supplies  to certain parts of the world, and India banned exports to locations such as Africa at one point. People seem less willing to collaborate well when lives are on the line. 


    A global outlook for vaccine development

    Europe needs to spend more time assessing what is essential to produce and distribute vaccines, and then make tough changes to protect the continent and ensure that Europe can serve its society. We also have a responsibility to offer more assistance to less fortunate parts of the world that lack the funding, expertise or infrastructure to buy and distribute vaccines. We will always depend on the global supply chain to some extent, so we must take a global approach with vaccine development and distribution.

    Regarding vaccine stockpiles, we should support producers in Europe and encourage other producers to open manufacturing sites here and around the world. We are working more closely with the European Commission, the World Health Organisation, the Coalition for Epidemic Preparedness Innovations (CEPI), and other health groups to boost vaccine production.

    Stocking up on vaccines

    • In June 2021, we signed a €30 million global vaccine distribution deal with the Belgian biotechnology company Univercells. The company plans to expand the production of large volumes of COVID vaccines at a new Belgian site and help build other plants worldwide to stockpile vaccines.
    • We invested in a COVID-19 vaccine plant in Senegal in 2021 to boost regional healthcare services in Africa and make low-income parts of the world less reliant on imported medicine. This new facility at the Pasteur Institute in Dakar, Senegal, plans to supply as many as 25 million doses of COVID-19 vaccines a month by the end of 2022. Africa currently imports 99% of its vaccines.
    • BioNTech and the European Union are working together on evaluating mRNA vaccine manufacturing sites in Africa. Possible locations include Rwanda and Senegal. MRNA technology could be instrumental in fighting illnesses in many developing countries. The technology can be adjusted without too much trouble to improve vaccines or make new ones.

    Behind the curve in life sciences

    The European Union was behind the curve in life sciences research when the pandemic began, but we are catching up as we learn to accept more risk. The EIB is working harder today to help more early-stage companies with projects that are out of the ordinary but still worthwhile. We were one of the first banks to invest in BioNTech’s mRNA vaccines, signing a €100 million agreement with the company in 2020. Around the same time, we approved a €75 million deal to help another German company, CureVac, work on its own range of mRNA vaccines. CureVac’s vaccine efficacy was below the results from BioNTech and Moderna, partly because the company’s trials happened when the more infectious COVID variants were widely spread. CureVac is developing a second-generation vaccine that could get approval as a booster shot for COVID-19.

    We signed  €30 million deal with another biotechnology company, Bavarian Nordic of Denmark. The company is in the middle of successful trials for a next-generation COVID vaccine that could be used as a booster shot. Valneva in France is another company we supported that is working on a possible COVID booster shot.

    It would be great if we worked harder to fill the gap created when investments at universities and other research institutions shifted to COVID in 2020. This caused a significant drop in research linked to other important research areas, such as cancer and many other diseases. A large amount of healthcare research has been pushed aside during the pandemic. One important problem that needs more research is antimicrobial resistance, or AMR, which occurs when bacteria or viruses no longer respond to our medicines. AMR threatens the treatment of an extensive range of diseases. As the pandemic draws to an end, let us remember that many life sciences problems need more attention. Even if these problems are not in the news every day like COVID-19, they have not disappeared. In fact, due to the limited access to hospitals during the pandemic, diseases that have been largely under control, at least in developed countries, such as measles, have become a concern again.

    The EIB has a long history of supporting the broader life sciences sector. We invest over €800 million per year in this field. Over the past 10 years, we have lent more than €1 billion yearly to healthcare infrastructure. Our Bank portfolio for COVID-19 includes more than 20 top European companies with promising projects in vaccines, treatments and testing, representing a total investment of around €770 million.

    Cristina Niculescu and Nadya Velikova are life sciences specialists at the European Investment Bank