As COVAX disappoints, countries turn to home-grown jabs

Low- and middle-income countries are turning to home-grown vaccinations against COVID-19 as the UN-backed COVAX facility fails to deliver.

From Egypt to Brazil, countries have started work on their own COVID-19 vaccinations in the face of a so-called vaccine apartheid, where rich countries have started rolling out booster shots while double vaccination rates remain under three per cent in many low-income countries.

COVAX, the facility set up by governments and donors to ensure fair and equitable access to vaccines, says it will miss its target to distribute two billion doses by the end of 2021.

According to the最新的供应预测issued on 8 September, the facility is now expecting 1.4 billion doses of the vaccine in 2021 – a shortfall of nearly a third.

The shortage is largely due to出口和制造约束and increasing demand from vaccine-producing countries. For example, India – a key producer – only delivered2800万of a promised 40 million doses in March as infections spiked due to the Delta variant.

“这种模式是完全成功的，因为它可以确保巴西具有向大陆国家供应疫苗的可持续性。”

Carla Domingues, coordinator of the National Immunization Program of the Brazilian Ministry of Health 2011-2019

In response, developing countries have taken steps for the manufacture of COVID-19 vaccines through two tracks, one of which is the manufacture of vaccines currently circulating through partnerships with international companies, and the other is through the development of new local vaccines.

Egypt, for example, has launched human trials for its home-made vaccine Covi-Vax, following successful laboratory tests.

“The Egyptian Medicines Authority gave its approval to manufacture the first batch of vaccine doses under the name ‘Covi-Vax’ for use in clinical trials,” Mohamed Ahmed Ali, professor of virology at the National Research Centre and head of the research team for the production of the vaccine, toldscidev.net。

他解释说，埃及疫苗在实验室试验中产生了良好的抗体反应，其中含有从病毒中采集的四种蛋白质。

Earlier this year, researchers in Saudi Arabia announced the start of early stage human trials on a vaccine developed by researchers at Imam Abdul Rahman bin Faisal University, using plasmid DNA technology.

一些巴西研究机构还押注了针对Covid-19的本土疫苗的开发。

One of them is the Butantan Institute, a public research centre in Sao Paulo, which is carrying out early stage human trials on Butanvac, a viral vector vaccine developed by the Icahn School of Medicine at Mount Sinai, USA, and an international consortium, and which can in the future be entirely produced in Brazil.

如果Butanvac成功，那么想法是开始将其出口到其他国家。

“The consortium and supporters behind Butanvac are concerned about low- and middle-income countries that are being underserved right now,” says Cristiano Gonçalves, innovation manager at Butantan.

“The idea is for Butanvac to serve the domestic market, and for Butantan to reserve part of its production for export.”

印度政府还计划与印度生物技术系合作，启动由私人公司Zydus Cadila生产的世界上第一种DNA疫苗Zycov-D。这将使现有疫苗接种计划的扩展包括儿童和青少年。

In Singapore, three mRNA vaccines developed by the US company Arcturus Therapeutics are undergoing mid-stage human trials to check their efficacy. MRNA vaccines effectively teach cells how to make a protein, or part of a protein, that triggers an immune response inside the body.

One jab targets the original Sars-CoV-2 virus and was developed together with the Duke-NUS Medical School in Singapore. Two other jabs have been designed to target the four variants of concern, Alpha, Beta, Gamma and Delta.

Manufacturing deals

The development of these home-grown vaccines follows a number of agreements where developing countries have begun to take on manufacturing of vaccines developed in Europe, the US or China.

在巴西，这是拉丁美洲最大的疫苗接种率之一，大约三分之二的人口至少接受了一种剂量，其中许多归功于巴西实验室与国际制药公司之间的技术转移协议。

When the first cases of COVID-19 emerged, Sao Paulo’s Butantan Institute contacted a number of Chinese companies, seeking to bring a vaccine to Brazil.

“We started talking to Sinovac, which we had visited in 2019, with the idea of bringing a vaccine here,” innovation manager Gonçalves toldscidev.net。

2020年7月，该研究所支持Sinovac冠状病毒疫苗的大规模人类试验。作为交换，中西诺瓦人致力于将技术转移到巴西研究所。

目前，丁丹（Butantan）从中国进口原料，并在巴西包装疫苗。对于技术转移协议的下一阶段，正在准备开始生产剂量的工厂。

Oswaldo Cruz基金会,一个联邦研究centre linked to the Ministry of Health, which includes a unit that produces vaccines, began negotiations with the vaccine-maker AstraZeneca in the first half of 2020.

As a result, the Anglo-Swedish drugmaker’s Covishield viral vector vaccine also underwent large-scale human trials in Brazil, and today it is being produced in the country with raw materials imported from abroad.

The technology transfer contract between the Oswaldo Cruz Foundation and AstraZeneca also provides for the fully Brazilian production of the vaccine in the future.

Over the past decade, such technology transfer agreements have become increasingly common in Brazil, during which time rotavirus, HPV, hepatitis, MMR vaccines, amongst others, have been incorporated into its national immunisation programme.

“This model is completely successful because it guarantees that Brazil has the sustainability of supplying vaccines to a continental country,” epidemiologist Carla Domingues, who coordinated the National Immunization Program of the Brazilian Ministry of Health between 2011 and 2019, tellsscidev.net。

Similar agreements have helped to plug the vaccination gap in many other low- and middle-income countries, such as Egypt which has already started local production of Sinovac’s vaccine.

In September this year, the Egyptian Minister of Health, Hala Zayed, announced an ambitious plan to produce more than 1 billion doses of the jab annually, thereby becoming “the largest producer of vaccines in Africa and the Middle East”, she said.

Morocco has also launched a project to produce China’s Sinopharm jab locally. The state-owned Moroccan Press Agency announced on 5 July that Rabat plans to produce 5 million doses per month.

Indonesia is also in talks with the WHO as well as six drug companies to become a global hub for manufacturing vaccines, according to health minister Budi Gunadi Sadikin.

However, Amjad Al-Khouli, an epidemiology consultant at the WHO’s Regional Office for the Eastern Mediterranean, pointed out that technology transfer deals are dependent on existing capacity and can be overshadowed by intellectual property concerns.

“This still requires agreements to transfer vaccine manufacturing technology, solve the issue of intellectual property, and a strong drug manufacturing structure, which is not available in most developing countries,” Al-Khouli tellsscidev.net。

然而，富裕国家正在介入以帮助建立关键的疫苗制造基础设施。

例如,塞内加尔正在等待首次剂量of a locally manufactured COVID-19 vaccine in the first quarter of 2022, after President Macky Sall inked a deal to create a large-scale vaccine manufacturing facility with the European Commission, the European Investment Bank, and the United States in July.

European Commission PresidentUrsula von der Leyensaid the agreement was part of a “much broader Team Europe initiative to support the production of medicines and vaccines across Africa”.