BHEKISISA | How SA’s mRNA hub is teaching the world about preparing for the next pandemic

Political leaders gathering at the  UN's first high-level discussion on pandemic preparedness in New York will on Thursday have one more chance to put measures in place to prevent the catastrophes that played out during the Covid-19 pandemic being repeated. 

Heads of states and foreign and health ministers are meeting for a day to discuss — and hopefully adopt — a political declaration to get around the inequities between countries in the Global North and South in getting vaccines and other medicines during Covid-19.    

But a more controversial World Health Organisation (WHO) pandemic agreement, with binding commitments for countries who sign on, is still outstanding — the goal is to finalise negotiations by May. 

The accord asks states to commit to rules and cross-country support to ensure the world’s next pandemic is handled better. 

With climate change, more urbanisation and increasing wildlife trade making it easier for germs to jump between animals and people, experts have warned Covid-19 is just a glimpse of what we can expect in future.

The treaty requires countries to commit to sharing how medicines are made during pandemics, for richer countries to help poorer governments to become ready to make their own medicines and that pharmaceutical companies should be more flexible with intellectual property rights during pandemics.

Thursday's political declaration, which is less prescriptive and binding than the WHO accord, asks countries to acknowledge that jabs were unfairly distributed during the pandemic, with high-income countries, where drugmakers were based, receiving vaccines first and being allowed to hoard medicines while people in low-income countries were stuck without medicines and dying as a result. By December last year, the agreement notes, three-quarters of people in richer countries were fully vaccinated against Covid-19, compared with less than a quarter (22%) in lower-income states.

The declaration says lessons should be learnt from Covid-19 by “turning temporarily scaled up capacities into permanent capacities” and “best practices”. 

One such example is the WHO’s mRNA vaccine technology transfer hub,  launched in Cape Town in July 2021.

On Monday, experts from the hub reported back on the progress they’ve made with the locally made jab called Afrivac2121. 

But with the  Covid-19 pandemic no longer a public health emergency, will the centre become a white elephant?

Not so, say the hub’s scientists — but only if programmes like this keep on running beyond an immediate crisis.  

We caught up with the scientists and break down how powerful acting on Covid-19 lessons can be. 

Starting from scratch

From an Excel spreadsheet and an empty lab to producing a vaccine that works as well as commercially available ones in lab animals — that’s what a South African biotech company managed to do in just two years, scientists involved in the mRNA vaccine hub, based at a pharma start-up in Cape Town, Afrigen Biologics and Vaccines, announced on Monday.

It’s no mean feat, considering companies such as Germany-based BioNTech (who developed the tech for the Pfizer Covid-19 shot) had been working on getting the platform right for making this type of vaccine for close to 15 years by the time the pandemic hit.  

A vaccine tells the body’s cells to make antibodies that will fight a germ, such as the virus causing polio or measles, when it’s encountered. But conventionally, this process can take between 10 and 15 years.

An mRNA vaccine is different, though, because instead of using the actual micro-organism to prompt the body’s immune system, it uses only a section of genetic code, which signals how a specific protein of the germ that attacks your cells looks. 

This means it becomes easier (read: faster) to find the trojan protein that will give the germs access to your cells and make you sick, because all that has to change in the development system is the code that needs to be plugged in and the necessary quality checks — everything else stays the same. With an mRNA platform vaccine designers can therefore “plug and play” without having to figure out the process from scratch every time.

Because of this “plug and play” approach, mRNA vaccines can help us prepare better for dealing with pandemics in the future — which is what’s on the table at Thursday's high-level discussions at the UN General Assembly meeting. Experts agree infectious disease outbreaks, especially those caused by germs that usually infect animals, will become more common in the coming years because as climate changes, the population grows and people need more space, humans and wild animals start living closer and closer together. 

The virus that causes Covid-19 and which brought the world to a standstill for three years is thought to have been transmitted from an animal (this is called a zoonotic disease).

More prepared = less dependent

The Covid-19 pandemic made it uncomfortably clear that Africa needs the skills and facilities to prepare itself for future pandemics. By late 2020, Canada had paid for enough jabs to vaccinate their population almost five times over, yet the first doses for Africa were bought only early in 2021 — and were only enough to vaccinate  about 9% of the people.

Hardly any of the jabs used in Africa are made here; vaccine production on the continent is mainly to “fill and finish”, which means local manufacturers buy the final product from elsewhere, put it into vials and label them, ready for sale.

As part of the WHO's plan to help poorer countries become more self-sufficient, the mRNA vaccine hub is meant to develop the know-how for making such jabs and then share it with partner countries — which international pharmaceutical companies mostly refuse to do — so that they can produce vaccines themselves.  

Having a locally made Covid-19 jab, despite the urgency for it having fizzled, is important not only because it shows potential buyers such as governments and global aid organisations (for example Unicef) that the continent can make safe and effective medicines, but also because it will help us respond faster to a future health crisis, says Patrick Tippoo, chief science and innovation officer at Biovac, the local pharma company that will handle large-scale production of the vaccines developed by the hub.

“Now is not the time to go back to how things were before. We need to learn from the Covid-19 experience and say, ‘we're not going to be caught like this again’.”

The long view

The hub has already started sharing the know-how for making mRNA vaccines with its partners in countries such as Brazil, Argentina and Senegal (this is called tech transfer), and so even if there aren’t orders for vaccines now, the centre “won’t be an expensive project with potential that didn’t work out”, says Tippoo. 

With the knowledge and facilities in place in these countries, they can work towards securing orders by partnering with vaccine developers. 

In Brazil, for example, a local drug maker called Bio-Manguinhos  uses knowledge they’ve gained through being one of the hub’s partners to make jabs for childhood diseases and other medicines for the local ministry of health, said Sotiris Missailidis, innovation director at the Brazilian company, at Monday’s event.

But for local production to get off the ground — and keep going — there should be a demand for jabs and committed investment from government, explains Tippoo. This is because new, small-scale manufacturers have to balance costs and compete with international companies who can already make large volumes of their products and so produce them cheaper. 

It’s the long view, though. 

An analysis by McKinsey & Company shows it initially costs less to import a finished product than making one from scratch, as lots of money goes into building facilities such as laboratories, installing hi-tech equipment, buying raw materials (such as specially formulated chemicals and biological molecules) and running clinical trials. 

Once this manufacturing ability is in place, though, it becomes cheaper to produce vaccines locally using only imported raw materials.

But to ensure there’s a market for the products — which will allow the facility to keep going — orders have to come from the host country itself. 

'Political will is just as important'

Countries in Africa now get vaccines by buying them directly from drugmakers or through health partnerships such as Gavi, the Vaccine Alliance.

The alliance negotiates directly with pharmaceutical companies to help countries buy vaccines at affordable prices and also get funding from donors to help cover some of the costs. During the pandemic, for example, Gavi was part of the COVAX partnership, which supplied vaccines to poorer countries. 

Even if governments get their jabs from Gavi, they can still ask that the products come from a local manufacturer.

Since 2003, Biovac has been supplying South Africa’s health department with jabs for their nationally run childhood vaccination programme in which babies and toddlers get vaccinated against diseases such as measles, hepatitis B and tetanus.

As part of this drive, babies also get three shots of a pneumococcal vaccine between the age of six weeks and nine months to stop them from getting pneumonia, an infection that causes fluid to build up in the lungs. 

But in April, the health department awarded the tender to provide these vaccines to Cipla, an India-based pharma company with plants in South Africa, despite Biovac having been the provider from 2009 to 2020.

Why? Mainly because of cost, it seems.

When deciding on who gets a tender, the health department uses a procurement policy  designed to promote national goals, such as employing citizens and people disadvantaged by discrimination so that bidders based in South Africa will be favoured. 

The policy uses a 100-point grading system made up of two parts. Each bidder gets scored out of 80 or 90 based on the total value of the tender (80 is used for contracts below R50m while the 90-point score is used for those above R50m) and the price at which they can supply their vaccines. The remaining 10 or 20 points are awarded based on a goal specified in the tender, for example a company’s broad-based black economic empowerment status, which looks at things such as the entity being locally owned and the number of women or people with disabilities employed at the firm. 

In the case of the tender for the pneumococcal vaccine, this part counted for 10 points, while price made up 90 points. The department said that Biovac’s price was almost double that of Cipla’s. 

Buying medicines needs to offer value for money, they said, and though they “strive to look at practical ways to support local investment and production”, they also needed to “balance this with the available financial resources”.

This creates a catch-22 in a way, as getting the best value for vaccines doesn’t necessarily promote building the ability for local manufacturing. 

Said Charles Gore, executive director of the Medicines Patent Pool at Monday’s event: “Getting the technology is fine, but the political will is just as important.”

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.