Executive Summary
Over the coming years there will be a range of new vaccines not only for pathogens like Covid-19, but also for tuberculosis, malaria, HIV/AIDS, dengue and other diseases. Given recent advancements in the development of therapeutics, we should also push the traditional definition of a vaccine to include preventative injectables for conditions including HIV, cardiometabolic disease and common cancers.
At least 10 million deaths per year are attributable to diseases with existing or forthcoming adult vaccines and preventative injectable therapies – deaths that could also be reduced through a system of adult public-health interventions.
But Covid-19 has exposed some chronic deficiencies in the global architecture for delivering such a huge programme. Though vaccine production to fight the virus proceeded at a pace remarkable in comparison to conventional vaccine development, the world still paid a heavy price for not accelerating it further. The distribution of vaccines has been plainly inequitable. And some countries have been unable to absorb the vaccines received. We will squander the public-health opportunity presented by new vaccines and therapeutics unless we find a better way to develop, manufacture and distribute them in the future.
The potential economic benefits are also compelling. In this paper, we have rethought the traditional investment case for vaccines by assessing them together as part of a structured programme; further, by considering the impact of preventing the next pandemic, modelling conducted exclusively for this paper suggests that such a programme could have more than $3.4 trillion in value for the global economy, including $1 trillion for developing countries. Should a future pandemic affect younger, less vulnerable, working-age populations, this value could be above $7 trillion.
This paper sets out how – through a global adult-vaccination programme underpinned by strong Global South input and leadership – this goal can be achieved. By strengthening Global South leadership in this effort, the world can achieve improved global population health, economic benefits and increased autonomy for developing countries.
An endeavour of this magnitude will require a partnership with mutual responsibilities for both Global North and South so that such a programme can be fully effective, and we set out the following recommendations for achieving this:
Multilateral organisations including Gavi, the Vaccine Alliance; the World Health Organisation (WHO); the Global Fund; the Coalition for Epidemic Preparedness Innovations (CEPI); the World Bank and others, and donors such as the Bill & Melinda Gates Foundation, should mobilise resources, infrastructure and expertise, building on lessons learned, to either take on or support the development of this programme. Regional organisations in the Global South, potentially including the Africa Centres for Disease Control and Prevention (Africa CDC), the Pan American Health Organisation (PAHO) and the Association of Southeast Asian Nations (ASEAN), should drive Global South leadership by coordinating supply and demand, allocating financial resources and harmonising regulations.
Governments receiving support should agree to make the preparations for the demand that will be driven by the approval of new life-saving vaccines and injectables, and should sustain and develop their Covid-19 vaccine-deployment and manufacturing infrastructure for long-term use. They should also invest in scalable digital infrastructure to support registration, distribution and the collection of real-world evidence.
Scientific experts should collaborate to develop global eligibility and dosing guidelines for an adult-vaccination programme.
The private sector should ensure availability and affordability of vaccines for developing countries as they come to market through appropriate pricing schemes and intellectual-property arrangements.
There should be an oversight body comprising the key partners in conjunction with scientific experts to ensure that the obligations of the parties are fulfilled in terms of the supply of vaccines and injectables, the best protocols for dosing and the necessary infrastructure in participating countries to allow effective use of supply.
This programme will only work based on mutual responsibility. Wealthier countries must provide the resources, the private sector the intellectual property. And every country has a responsibility to make the changes in infrastructure and policy that would allow the resources to be used effectively. All of this must be overseen in an objective way by key stakeholders and experts.
Building a permanent adult-vaccination programme as a positive legacy of the Covid-19 crisis will have a profound impact on global public health and prevent the premature deaths of millions of people each year.