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.
Vaccination hurdles
Modern countries do not worry much about illnesses such as tuberculosis or measles, as these diseases have been largely under control for decades and people do not hear about them often. Developed countries do know about other viral diseases, such as Ebola, but these are happening far away, and most people cannot imagine how they could be hurt by this. Here is why many people have started to become reluctant today to vaccinate – exaggerated concerns about risk and a large group of people who are overlooking the benefits of vaccination and giving too much weight to possible safety issues.
Besides hesitancy in the population, vaccination programmes face hurdles from the lack of profitability. Vaccines are not big money makers for big corporations, compared to other types of popular medicines. Corporations usually sell vaccines at low volumes and for low profit. Vaccines generally are needed only once in a lifetime, or sometimes once a year. This is different from medicines for chronic illnesses such as heart disease, which can require daily uses of pills for long periods.
Despite the threat that transmissible diseases pose to public health, the development of new vaccines has been delayed in the last few years by a shortage of investment for the developers and manufacturers involved in research and production. High development costs, low returns on investments, all the business challenges involved in the development and production of vaccines, have forced some biopharmaceutical companies to leave the vaccine development field.
All these problems have hurt vaccine development for many years. We should be grateful to the European Commission that support, and especially funding, came so quickly for COVID-19 vaccine development. Some of the vaccines being administered now were developed in record time.
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.
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.
Preparing for future dangers
One way to make sure we are prepared for future problems is to create a better system to monitor health emergencies. The European Commission recently announced a new organization, the Health Emergency Preparedness and Response Authority, or HERA. This group will help find and fund public and private sector activities, including late-stage development and manufacturing in life sciences. This could be just the structure we need in Europe to understand the risks, survey global health dangers, share technology and knowledge, and fix the supply chain problems.
We also should pay attention to the shortage of medical staff and infrastructure, which was the main reason for the pandemic lockdowns. The shortages had different causes in different countries, such as budget cuts or brain drain, and these issues need to be carefully addressed on local, European and global levels. Investments in medical education and hospital infrastructure are crucial to prevent future emergencies and the need for lockdowns that limit our freedoms and hurt the quality of life.
Many people ask us what the Bank is doing for the coronavirus variants. We are constantly reaching out to BioNTech and other biotechnology companies to get their thoughts on the variants. As soon as a variant emerges, these companies test their vaccines for efficacy against it. For the moment, it does not look like we need to tweak the vaccines or conduct a lot of new trials for the variants, but we will wait and see.
The main challenge now is making sure more people are vaccinated, which will reduce the chances for more powerful variants. Vaccination levels on a global level are low. We need to keep supporting organisations like COVAX, which supplies millions of vaccines to low-income areas of the globe. The Bank has pledged €600 million for COVAX, which is the largest amount of financing the Bank has approved for a global public health programme.
Over the next several years, it would be great to see an explosion in investment for scientific research and innovation coming from the broader life sciences, as well as more support for medical education and healthcare. There are many health problems that need to be solved besides COVID-19. We need to support out-of-the-box thinking and take more leaps of faith. As scientists, this new appetite for risk excites us and makes our hearts beat faster. This will make the world a better place and save us from future crises that we cannot even imagine yet.
Cristina Niculescu and Nadya Velikova are life sciences specialists at the European Investment Bank