How to deliver 10 billion COVID-19 vaccines at warp speed

This article was exclusively written for The European Sting by Ms. Luiza Vieira Marconi, a twenty-year-old and currently a third year medical student at the Faculdade de Ciências da Saúde de Barretos, in the city of Barretos/São Paulo – Brazil. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

• The US government’s Operation Warp Speed (OWS) initiative showed how successful public/private collaboration can be in rolling out a mass vaccination programme.
• It provides a blueprint for how to build supply, regulate and distribute COVID-19 vaccines on a global scale.
• This kind of approach would focus on building capacity, supporting production in emerging or developing countries and encouraging rapid testing while vaccine production is underway.

Operation Warp Speed (OWS), the US government initiative to accelerate the development, trials and production of COVID-19 vaccines, has been a spectacular success. It showed that the state could work effectively with private firms to promote innovation and provide a powerful weapon against the virus. It consisted of early and massive funding of R&D and investment in production of various vaccine candidates, as well as coordinating the value chain and addressing all regulatory and logistical hurdles. The result: several vaccines available within a year and widespread vaccination in most advanced countries.

OWS showed that the state could effectively work with private firms to promote innovation and provide a powerful weapon against the virus.—Reda Cherif & Fuad Hasanov, IMF; David Adler, The Common Good Foundation (UK)

However, the pandemic is far from over. It is still raging in the developing world. The official global death toll has passed 4 million people while The Economist has estimated 7-13 million excess deaths, most of which are outside advanced countries. New, more contagious variants are also affecting a younger population, implying that many poorer countries may not be protected by the youth of their populations anymore.

An OWS for the World is needed. Given the many uncertainties and risks about vaccine production and supply, regulation, distribution, and virus variants, the market will most likely fail to provide the necessary volume of vaccines. This will lead to long delays in reaching global herd immunity. OWS represents a blueprint of effective industrial policy in action.

Speed is of the essence in the face of a pandemic

While the development of a vaccine has been an amazing feat, vaccination campaigns in many parts of the world have been dismal. By mid-June, about a billion people globally have had at least one dose of a vaccine (with more than 2.3 billion doses administered), and most of them reside in advanced countries. Africa has so far inoculated less than 30 million people, little more than 2% of its population. The US, in comparison, has vaccinated more than 170 million people, more than half of its population.

The G7 leaders have committed to provide 1 billion vaccine doses by end-2022. The US has pledged to buy a total of 500 million doses from BioNTech/Pfizer to provide to poor countries by mid-2022 (with 200 million doses by end-2021). Although these initiatives show that the race against time to vaccinate the world has started, many campaigners argue these commitments fall short of what is needed to end the pandemic as fast as possible. To vaccinate the world, another 10 billion doses are urgently required. Waiting until end-2022 would still wreak havoc on many parts of the world.

Delivering 10 billion vaccines in a year

A recent IMF proposal to end the pandemic within a year called for donations of extra doses, financing of vaccines for poor countries, and investments to increase vaccine manufacturing capacity by 1 billion doses by early 2022. Moreover, many downside risks considered in the proposal, such as export restrictions and supply chain bottlenecks, have already materialized. The EU and others have called for scaling up and diversification of production as a result.

This kind of risk-based approach calls for further global action along the lines of OWS to ensure the delivery of 10 billion doses within a year, accounting for extra capacity and redundancy. This would involve three main steps:

• Purchasing the required capacity from key vaccine manufacturers directly – essentially building capacity, if necessary – to send the needed doses to other countries;
• Facilitating building or expanding vaccine production in emerging and developing countries, including through partnerships such as that of Senegal’s Institut Pasteur and a Belgian biotech firm; and
• Producing and distributing rapid tests for widespread testing while vaccines are on the way.

Building capacity, facilitating collaboration and rapid testing

Creating extra production capacity to produce hundreds of millions of doses a month within a year is feasible and would cost a fraction of advanced countries’ foreign aid budget. Producing 8 billion doses of mRNA vaccines would cost between $10 billion (BioNTech/Pfizer) and $25 billion (Moderna) and could be done within a year, according to recent research from Imperial College London. Procurement alone is likely to take longer than desired. Buying or building capacity is what OWS did, and is what economists such as Nobel laureate Michael Kremer have advocated.

Coordinating all stakeholders and clearing bottlenecks would be key to the success of OWS for the World. It could be done by the US Biomedical Advanced Research and Development Authority (BARDA), in coordination with an EU or UK vaccine taskforce and WHO, or any other global task force. As we argue in the context of industrial policy against pandemics and OWS as a model, this task force needs to set up relevant objectives, clear resulting hurdles – whether in supply chain, distribution, or communication – and coordinate across government agencies, manufacturers, and in this case, global users. The EU vaccine task force has already mapped, tracked, and cleared bottlenecks. It retrofitted a German dengue vaccine bottling factory for Johnson & Johnson’s vaccine, for example.

At the same time, advanced countries need to help others build their own production facilities and supply chains to manufacture vaccines and rapid tests. Indeed, this would create a more resilient vaccine production system globally, mitigating against uncertainties and risks when providing booster shots and other vaccines in the future for developing countries.

Since vaccine production may take longer, producing rapid tests, which could be easier and faster, is a hedge against delays in vaccine production. Finally, while awaiting vaccines, many countries need to conduct universal or widespread testing to prevent outbreaks.

Creating extra production capacity to produce hundreds of millions of doses a month within a year is feasible and would cost a fraction of advanced countries’ foreign aid budget.—Reda Cherif & Fuad Hasanov, IMF; David Adler, The Common Good Foundation (UK)

Last year, we argued that testing would end the pandemic within a few months, but only a few countries experimented with it. Rapid worldwide vaccination could do the same. Reducing the length of the pandemic, even by days, would save lives and is worth the investment. It is not too late to act.

About the author

Luiza Vieira Marconi is a twenty-year-old and currently a third year medical student at the Faculdade de Ciências da Saúde de Barretos, in the city of Barretos/São Paulo – Brazil. Member of the International Federation of Medical Students Association in Brazil (IFMSA-BRAZIL), Luiza is committed to feminist concerns and believes in the active fight for equality.