G-Stic 2023: Panels discuss challenges in expanding access to vaccines

The challenges and perspectives for the development and expansion of local vaccine production were highlighted at the 6th Global Conference on Science, Technology and Innovation (G-Stic 2023) in the two panels held on February 14th and 15th, in Rio de Janeiro. The plenary sessions brought together representatives of public and private organizations, aimed at seeking synergies to advance the agenda to accelerate access to vaccines. In their presentations, the speakers reiterated the criticality of the current situation, especially in Latin America and in developing countries, in which unequal access and the increase in health emergencies make it even more important to find answers that are able to expand vaccine coverage.

Panels debated the challenges and prospects for the development and expansion of local vaccine production (photo: Eduardo Napoli / Gopala Filmes)

“There is a huge imbalance in the distribution and access to vaccines in the world. They are not only due to limitations of an economic or financial nature, but also due to political and social barriers. This context is aggravated by a very limited production capacity for vaccines worldwide”, notes James Fitzgerald, director of Health Services for Latin America at the World Health Organization (WHO). “Although there are hubs of excellence in some countries, Latin America is still heavily dependent on imports. Production is concentrated in three or four manufacturers. And when this concentration takes place at a time of restrictions or customs barriers, it generates cascading problems. Production capacity is also highly heterogeneous across Latin America”, he adds.

Although WHO has been making efforts since 1998 to expand the dialogue between the public and private sectors aimed at mitigating the main obstacles to local capacities for the production and distribution of vaccines, the organization is apprehensive about the gradual reduction in vaccine coverage, particularly observed more prominently in developing countries. “We have been working to bring the academic area, the research and development areas of private organizations closer to regulatory agents and political agents in order to expedite the approval process. This effort has been key to enabling the transfer of technology necessary to ensure speedy access to the development of messenger RNA vaccines, for example. However, if we are not able to address the issue of the drop in vaccination levels as soon as possible, the actions undertaken by us so far may not be enough to ensure greater effectiveness”, notes Fitzgerald.

Acting on a more organized terrain is also the concern of Ethel Maciel, secretary of Health and Environmental Surveillance of the Ministry of Health (MS). Maciel announced that the Ministry should start, on February 27th, a major publicity campaign to call upon the population and regain trust in the national vaccination program. The action should extend throughout the year, alerting the population regarding the importance of immunization.

Ethel Maciel announced that the Ministry should launch, on the 27th of February, a major publicity campaign to call the population and regain confidence in the national vaccination program (photo: Eduardo Napoli / Gopala Filmes)

“The lack of planning combined with the total lack of communication about the importance of the vaccine has led us to this place. We reached more than 90/95% vaccination coverage, and now we find that the country has fallen to 50/60% coverage. As there was a breach of trust in the federative pact, we now need to win back our regular partners and society as a whole”, explains Maciel. “We know that 2023 will be a transitional year. A moment of prompt demand for vaccines, and we are committed to recovering our role in the interlocution with federal entities. In Brazil, the success of the vaccination strategy is directly related to the ability of interlocution with the States and Municipalities”,she added.

Expansion of dialogue and interlocution for more efficiency in the vaccine coverage

Increasing dialogue and communication skills are also in the plans of the private sector. Pfizer and AstraZeneca representatives present at the panel on the 14th shared experiences and lessons learned from the COVID-19 pandemic. “We have provided voluntary access and found more than 20 partners around the world. Our vision was to develop a vaccine that was accessible and, with the efforts of local manufacturing and the will of all interlocutors, today we already have more than three billion doses applied all over the world”, recognizes Hugo G. da Silva, global head of vaccines at AstraZeneca.

“Facing a challenge on the scale of a pandemic brought us at least four important lessons. First, the importance of continuously fostering and increasing relationships with public institutions aimed at establishing partnerships with the pharmaceutical industry. Second, direct efforts that contribute to the multiplication or establishment of an adequate local production capacity. Moreover, contribute to the construction of data centers to guide the decision-making and to combat hesitation and misinformation about vaccination”, he highlighted.

Innovation manager at the Butantan Institute, Cristiano Pereira also agrees that the continuous search for partnerships is key to the development of innovation. “That is how we got to Sinovac, in a context where we needed a quick response in an environment where everything took a long time. The agreement with Sinovac allowed us to accelerate very critical clinical studies that helped us to subsequently accelerate the approval of the vaccine. But we still highly depended on imports. This motivated us to look for new partnerships with a view to local production, to the vaccination of children, to the reduction of the research time”, stated Pereira. “We understand that this is a necessary vocation for our laboratory. Local production faces many barriers such as import dependency, regulatory or intellectual property issues. That is why we need to rely on each other. It is not the vaccine that saves lives, it is vaccination. This collective work is very important”.

At the end of the first day of discussions, the director of Bio-Manguinhos/Fiocruz, Maurício Zuma, reiterated the role of partnerships in the strategy for the expansion of local production. “The partnership we made with AstraZeneca enabled us to deliver more than 230 million doses of a vaccine that is safe and as effective as all the others”, he highlighted. “The role we had was very effective, but none of this happens by chance. This is the result of our expertise, and the collaborations we have made with the major global pharmaceutical companies. This was, perhaps, the greatest lesson we learned from the pandemic”, stated Zuma.

Zuma highlighted that access to investment by public companies is very limited and, therefore, collaboration is essential. “While the whole country invests US$ 10 million, each private company alone can invest the same or, often, twice as much. In a recent event of ours, it was stated that more than 40 members from developing countries had access to less than 5% of all investments applied to the development of vaccines. Thus, it is necessary to believe more in these smaller laboratories that could cooperate with the large laboratories in the future as a way of expanding access to the entire population”, he emphasized.

The speech of the director of Bio-Manguinhos/Fiocruz is shared by another emeritus researcher at the institution, Akira Homma, senior scientific advisor at the Foundation's unit, speaking for the Project For the Regaining of the High Vaccination Coverage (Projeto Pela Reconquista das Altas Coberturas Vacinais – PCRV). Homma defends the immediate recovery of vaccination coverage as essential for the country to reestablish the capacity to manage a sustainable immunization system. “Before moving forward with discussions around new vaccine technologies, it is necessary to remember that we have more than 20 viable and approved vaccines that are not being used to their fullest potential. And part of this discussion is to recover the credibility of the vaccination process”, he explains.

The researcher recalls that the country had exceptional coverage for over 20 years. “Regional aspects contributed to our loss of this important asset, but misinformation, the false sense of security created in the population due to the control of some diseases, the loss of trust in vaccination, low-quality leadership, poor communication strategies and other issues, has further worsened the situation. However, we can address these issues by working intensively with local authorities, listening, learning and getting to know the causes of low coverage better to address the challenges with a better understanding of the problem”.

Homma defends the immediate recovery of vaccination coverage as essential for the country to re-establish the capacity to manage a sustainable immunization system (photo: Eduardo Napoli / Gopala Filmes)

The control of certain diseases has brought a false sense of security that negatively impacts some people. We need to look for ways to raise awareness and mobilize the population to vaccinate. The motto Vaccinate so as not to return, from the Project For the Regaining of High Vaccination Coverage (PCRV), was mentioned by Homma as a good practice.

Homma warned of the need to mobilize the population for cases like polio, which is almost under control. Akira shared the experience of the PNI pilot project in partnership with the Brazilian Immunization Society carried out in August 2021. The State of Amapá (which had the lowest vaccination coverage in the country) and 25 other cities in Paraíba were elected to participate in this pilot. “The strategy was to work closely with local health authorities and immunization professionals, seeking what they had to say about the causes of low immunization coverage. We seek to understand the causes, the roots of the problem, in order to have sustainable vaccination coverage”, he emphasized.

The implementation of the project was a success. “We reached vaccination coverage for children of 100% and 98% in Amapá and Paraíba, respectively, which just proves that when we encourage, recognize and motivate people, they feel respected, valued and heard, and then it just works”, he concludes.

Composition of the tables

The table Challenges and perspectives for the development and expansion of the local manufacture of vaccines was held throughout two days during the 6th Global Conference on Science, Technology and Innovation (2023 G-Stic). Participating in the first panel of the first day of the event were James Fitzgerald, director of Health Services for Latin America at the WHO; Hugo G. da Silva, global head of vaccines at AstraZeneca; Júlia Spinardi, senior director of Medical and Scientific Affairs at Pfizer; Cristiano G. Pereira, innovation manager at the Butantan Institute; Mauricio Zuma, director of Bio-Manguinhos/Fiocruz; Eder Gatti, director of the PNI of the Ministry of Health; and Ethel Maciel, secretary of Health and Environmental Surveillance of the Brazilian Ministry of Health. The panel was moderated by Mariangela Simão, executive director of the Todos pela Saúde Institute, and by Rachel Chikwamba, executive representative of Advanced Chemistry and Natural Sciences (CSIR).

On the second day, Akira Homma, senior scientific advisor at Bio-Manguinhos, responsible for the Project For the Regaining of the High Vaccination Coverage (PCRV) gave an opening lecture for this session. The table was composed by Tomás Pippo, regional advisor on Pharmaceutical Policies and Innovation at the Medicines and Health Technologies Unit of the Department of Health Systems and Services of the Pan American Health Organization (PAHO); Xiaolan Fu, economist at the Technology and Management Center for Development at the University of Oxford; Ike James, head of Technology Transfer for the Medical Patent Pool; Renata Reis, executive director at MSF Brazil; Jefferson Nascimento, Economic and Social Justice Coordinator at Oxfam Brazil; Leandro Safatle, researcher at Fiocruz's Antonio Ivo de Carvalho Center for Strategic Studies (CEE/Fiocruz) and member of the Research Group on Development, Economic-Industrial Complex and Innovation in Health (GIS/Ensp/Fiocruz); Carla Vizzotti, Argentinian Minister of Health; and Priya Basu, executive in charge of the World Bank's Global Pandemic Fund. This panel was moderated by Rodrigo Pereira, vice-president of Research and Biological Collections at Fiocruz, and Cristiana Toscano, professor at the Federal University of Goiás.