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For the past few months, the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, where we work, has been developing this, with leaders from the African Union and in global health. [...]one of us (J.N.) was working in Côte d'Ivoire as part of a US Centers for Disease Control and Prevention project that was struggling to combat HIV in the country without access to medicine. The World Bank estimates that economic growth in sub-Saharan Africa will decline from 2.4% in 2019 to between -2.1 and -5.1% in 2020, the first recession in the region in 25 years. In August, the African Union Bureau of Heads of State and Government endorsed the strategy put forward by Africa CDC, reiterating how past experience in global health shows that Africa must move decisively, effectively and collectively to secure access to vaccines and life-saving therapy.

Katalin Karikó and Drew Weissman laid the groundwork for immunizations that were rolled out during the pandemic at record-breaking speed. Katalin Karikó and Drew Weissman laid the groundwork for immunizations that were rolled out during the pandemic at record-breaking speed. Credit: PixelPro/Alamy Drew Weissman, (left) MD, PhD, seated beside Katalin Karikó,(right) PhD.

Our viewpoint focuses on the paradox that Africa represents 25 % of total global vaccine usage, yet 99 % of these vaccines are manufactured overseas. In view of the iniquitous supply and distribution of COVID-19 vaccines to Africa during the pandemic, we emphasize the need for scaling up local vaccine manufacturing capacities across Africa. We review current vaccine manufacturing capacities within Africa, highlight priority vaccines needs, and describe opportunities and challenges of advancing local manufacturing capacities within Africa. Of 11 manufacturers in Africa, ten have operational formulation/fill/finish capacities. However, capacities to produce active vaccine components locally are very limited and leveraging of vaccine technology platforms such as live-attenuated virus, inactivated virus, and mRNA remain scanty. South Africa and Senegal are the only countries with end-to-end manufacturing capacities. Based on market demand, manufacturing complexity, target population, disease burden and vaccination regimen, the top 5 priority vaccines identified for local manufacturing in Africa were measles-rubella, yellow fever, cholera, rotavirus, and meningococcal vaccines. Enablers identified for Africa's vaccine manufacturing initiatives include: a preferential procurement of African-made vaccines for sustainable and reliable volumes through GAVI and UNICEF; deal preparation to target investments avoiding overproduction; technology transfers; regulatory systems strengthening; R&D capacities and infrastructure. Thus, African vaccine manufacturers and all stakeholders should focus taking forward the portfolio of activities required for continental vaccine manufacturing, including regulatory strengthening capacities, training and workforce development, rather than only focus on efforts that benefit a particular manufacturer or country. Optimism for advancing vaccine manufacturing in Africa comes from the announcement in December 2023 by GAVI for the establishment of the African Vaccine Manufacturing Accelerator, a financing mechanism of USD 1 billion aimed at creating a sustainable vaccine manufacturing industry in Africa. However, many challenges need to be overcome including that of having secure funding for sustaining what is developed.

[...]they have limited scope for use in older adults in order to limit COVID-19 morbidity and mortality. [...]influenza vaccination could prevent 20% to 60% of influenza infections and thereby potentially a similar percentage of influenza-attributable COVID-19 morbidity and mortality (Table 1). [...]PPV23 use in older adults could prevent up to 33–40% of pneumococcal disease and thereby potentially pneumococcal-attributable COVID-19 morbidity and mortality (Table 1). Despite a potential collateral reduction in influenza and pneumococcal circulation due to contact reducing interventions, in countries where the COVID-19 pandemic coincides with the season of high risk for pneumococcal and/or influenza disease, vaccination at high coverage will have added benefits: minimising the number of pneumococcal and influenza hospital admissions reduces the resources needed to care for non-COVID-19 patients and minimises the risk of health-care acquired COVID-19 infection.

•The addition of flu could cripple the health care system during the COVID-19 pandemic.•Fears of coronavirus have intensified the shortage of flu vaccine in developing countries.•We present an optimization model for equitable flu vaccine distribution.•The model utilizes an equitable objective function to distribute vaccines to high-risk people.•We present a case study to exhibit efficacy and demonstrate the model’s applicability. The addition of other respiratory illnesses such as flu could cripple the healthcare system during the coronavirus disease 2019 (COVID-19) pandemic. An annual seasonal influenza vaccine is the best way to help protect against flu. Fears of coronavirus have intensified the shortage of influenza shots in developing countries that hope to vaccinate many populations to reduce stress on their health services. We present an inventory-location mixed-integer linear programming model for equitable influenza vaccine distribution in developing countries during the pandemic. The proposed model utilizes an equitable objective function to distribute vaccines to critical healthcare providers and first responders, elderly, pregnant women, and those with underlying health conditions. We present a case study in a developing country to exhibit efficacy and demonstrate the optimization model’s applicability.

For human vaccines to be available on a global scale, complex production methods, meticulous quality control, and reliable distribution channels are needed to ensure that the products are potent and effective at the point of use. The technologies used to manufacture different types of vaccines can strongly affect vaccine cost, ease of industrial scale-up, stability, and, ultimately, worldwide availability. The complexity of manufacturing is compounded by the need for different formulations in different countries and age-groups. Reliable vaccine production in appropriate quantities and at affordable prices is the cornerstone of developing global vaccination policies. However, to ensure optimum access and uptake, strong partnerships are needed between private manufacturers, regulatory authorities, and national and international public health services. For vaccines whose supply is insufficient to meet demand, prioritisation of target groups can increase the effect of these vaccines. In this report, we draw from our experience of vaccine development and focus on influenza vaccines as an example to consider production, distribution, access, and other factors that affect vaccine uptake and population-level effectiveness.

Microneedle patch (MNP) technology is designed to simplify the process of vaccine administration; however, depending on its characteristics, MNP technology may provide additional benefits beyond the point-of-use, particularly for vaccine supply chains. Using the HERMES modeling software, we examined replacing four routine vaccines – Measles-containing vaccine (MCV), Tetanus toxoid (TT), Rotavirus (Rota) and Pentavalent (Penta) – with MNP versions in the routine vaccine supply chains of Benin, Bihar (India), and Mozambique. Replacing MCV with an MNP (5 cm3-per-dose, 2-month thermostability, current single-dose price-per-dose) improved MCV availability by 13%, 1% and 6% in Benin, Bihar and Mozambique, respectively, and total vaccine availability by 1% in Benin and Mozambique, while increasing the total cost per dose administered by $0.07 in Benin, $0.56 in Bihar and $0.11 in Mozambique. Replacing TT with an MNP improved TT and total vaccine availability (3% and <1%) in Mozambique only, when the patch was 5 cm3 and 2-months thermostable but increased total cost per dose administered by $0.14. Replacing Rota with an MNP (at 5–15 cm3-per-dose, 1–2 month thermostable) improved Rota and total vaccine availability, but only improved Rota vaccine availability in Bihar (at 5 cm3, 1–2 months thermostable), while decreasing total vaccine availability by 1%. Finally, replacing Penta with an MNP (at 5 cm3, 2-months thermostable) improved Penta vaccine availability by 1–8% and total availability by <1–9%. An MNP for MCV, TT, Rota, or Penta would need to have a smaller or equal volume-per-dose than existing vaccine formulations and be able to be stored outside the cold chain for a continuous period of at least two months to provide additional benefits to all three supply chains under modeled conditions.

The past two decades have seen important progress in access to timely, reliable, affordable, and quality-assured supplies of vaccines of global public health importance. The new vaccines developed are powerful tools to fight killers such as pneumonia, diarrhea, and cervical cancer. Global and regional financing and pooled procurement haveshortened the lag between access in high- andlower-income countries. The COVID-19 pandemic has shown that by addressing shortcomings and seizing opportunities, we can do even more. In response to COVID-19, vaccine development and access shifted from a sequential, risk-averse paradigm to a rapid approach with maximum compression of time to market while ensuring quality. Vast public investments and innovative technologies were key facilitators. The pandemic has shown that governments play a crucial role in investing in new vaccines and manufacturing capacity and sharing risks with industry. Despite impressive progress, equity in access remains elusive with important moral, economic, and health-related consequences. Global leaders are working on a new International Treaty for Pandemic Prevention, Preparedness, and Response. To apply the lessons of COVID-19, that treaty should include a new paradigm for access to vaccines in which governments agree to:(1)establish early sharing of information about emerging outbreaks and early, evidence-informed strategic goals and leadership that serve the collective global health interest.(2)shoulder risks and invest aggressively to address the needs of today and prepare for future emergencies.(3)strengthen market preparedness by investing in new vaccine technologies, regional research, development and manufacturing hubs, and insurance; by enabling regulatory harmonization; by driving market transparency and oversight; and by ensuring that where public funds are invested there is a contractual obligation to ensure access.(4)define principles and operational details for collaboration in times of scarcity that enable countries to protect their own citizens while ensuring that no country is left behind.This would ensure that COVID-19 catalyzes a shift toward greater access for all under Immunization Agenda 2030.

The recent pandemic caused by COVID-19 is considered an unparalleled disaster in history. Developing a vaccine distribution network can provide valuable support to supply chain managers. Prioritizing the assigned available vaccines is crucial due to the limited supply at the final stage of the vaccine supply chain. In addition, parameter uncertainty is a common occurrence in a real supply chain, and it is essential to address this uncertainty in planning models. On the other hand, blockchain technology, being at the forefront of technological advancements, has the potential to enhance transparency within supply chains. Hence, in this study, we develop a new mathematical model for designing a COVID-19 vaccine supply chain network. In this regard, a multi-channel network model is designed to minimize total cost and maximize transparency with blockchain technology consideration. This addresses the uncertainty in supply, and a scenario-based multi-stage stochastic programming method is presented to handle the inherent uncertainty in multi-period planning horizons. In addition, fuzzy programming is used to face the uncertain price and quality of vaccines. Vaccine assignment is based on two main policies including age and population-based priority. The proposed model and method are validated and tested using a real-world case study of Iran. The optimum design of the COVID-19 vaccine supply chain is determined, and some comprehensive sensitivity analyses are conducted on the proposed model. Generally, results demonstrate that the multi-stage stochastic programming model meaningfully reduces the objective function value compared to the competitor model. Also, the results show that one of the efficient factors in increasing satisfied demand and decreasing shortage is the price of each type of vaccine and its agreement.

Researchers warn production constraints and hoarding could limit SARS-CoV-2 vaccine supplies. Researchers warn production constraints and hoarding could limit SARS-CoV-2 vaccine supplies.