Unprecedented industrial collaboration and $20 billion is needed to rapidly increase Covid-19 vaccine production to meet the world’s needs
The world has come together and made extraordinary scientific achievements in the fight against the coronavirus pandemic. Normally it takes 10-15 years for a vaccine to be developed and approved.[1] The fastest ever was the mumps vaccine, which took four years to develop and approve in 1967. In sharp contrast - in the past eleven months, ten Covid-19 vaccines have been developed and approved. An additional 310 are in development. The rapid pursuit has hastened emerging mRNA and DNA vaccine platforms - which will be a key tool in the fight against the evolving SARS-CoV-2 virus. The vaccine pipeline is robust.
However, at the current rate, it could take four years for the world to be fully vaccinated. Making the feat of getting enough vaccine produced as soon as possible our most important challenge. It is why Heads of State, the Secretary General of the UN, the heads of WHO and UNICEF, the global public health community, and concerned people across the world - are all calling for urgent increases in vaccine manufacturing.
But we need a plan.
The current planned production capacity of approved Covid-19 vaccines is 8.4 billion doses: 2.7 billion of mRNA and DNA platforms (Moderna and Pfizer respectively) and 5.7 billion of viral vector and inactivated vaccine platforms. This falls short of the global need of 15 billion doses [2]. If planned production capacity of vaccines in Phase III or in licensing are added, the total increases to 12.6 billion doses. Of which 3.2 billion are mRNA and DNA platforms. Given the agility of the mRNA/DNA platform vaccine to be updated in response to variants, we estimate that two-thirds of total production capacity should be mRNA/DNA platforms, so around 10 billion doses. Which means the urgent need is for 6.8 billion doses of increased production capacity of mRNA/DNA vaccines.
Bold plans by AstraZeneca to scale-up production of the Oxford vaccine by partnering with local manufacturers across multiple countries are underway, including with Serum Institute of India, who Novavax has also partnered with for expanded production. Sinovac has plans to undertake the filling stage of vaccine production in Indonesia and elsewhere. CNBG plans to jointly produce in UAE [3]. Johnson & Johnson have signed with Aspen Pharmacare to produce in South Africa. Good collaboration is underway, but the mRNA/DNA manufacturers need to do similar. The collaboration between Sanofi and Pfizer/BioNTech [4] is a step in the right direction. Bavarian Nordic has offered the use of a factory to produce 240 million doses [5] and there are dozens of vaccine manufacturers across the world with know-how and capacity.
Countries have requested a waiver from the WTO of IP protections to enable vaccine scale-up. We do not see how a waiver alone would solve the situation. There needs to be unprecedented industrial collaboration - a working together to increase production capacity of mRNA/DNA vaccines by 6.8 billion doses by the end of the year.
Collaboration and urgency of the situation may spur new processes and technologies to increase scale and efficiency, such as the rapid fill/finish technology (Valor glass) already being supported by CEPI [6]. Diversifying production locations will de-risk the scale-up. Regionalizing parts of the production could also help answer a long-standing call from countries to have more local production of vaccines.
Taking into account existing contracts and push funding from the U.S., EU and CEPI, we estimate a cost of $4-10 per dose for development of manufacturing capacity, vaccine production, and a marginal profit (5%). While the costs vary, including due to manufacturing location, based on studies and existing contracts for mRNA/DNA vaccines, we use$6 per dose for the purposes of this analysis, giving a total need of $40.8billion.
As noted in Health Affairs,"Faced with a plethora of risks, vaccine producers have decided that potential returns from a Covid-19 vaccine are not worth the investment in the absence of government intervention.” All the more so if such decisions delay investments in more profitable business lines.
Therefore, to move quickly, at least 50% of the $40.8 billion should be issued in push contracts - with governments shouldering the risks and costs. In the paper Preparing for a Pandemic: Accelerating Vaccine Availability [7] Economics Nobel Laureate Michael Kremer puts forth that "buyers should contract directly for capacity." The push contracts should be for quantities that unlock equitable access. They should incentivise companies to move as quickly as possible – for example, include a financial bonus for speed as well as for collaboration. Terms could even be included for future use of the production capacity for other critical vaccines. The $20.4 billion could come from the U.S. and the EU, together representing nearly half of global GDP. Similarly, a recent Public Citizen analysis [8] finds that a $25 billion investment in COVID-19 vaccine production by the U.S. government would produce enough vaccine for developing countries, potentially shaving years from the global pandemic.
The remaining half could be recovered via an approx. $3 per dose price of produced vaccine. The majority of the production is needed by much of the 6.4 billion people in low- and middle- income countries. The purchase price could be financed via domestic resources, the World Bank, and other International Financing Institutions, and Gavi, the Vaccine Alliance.
While these amounts are large, they pale in comparison to estimates of economic loss - which are projected to be as high as $16 trillion for the U.S. alone (Cutler & Summers, 2020 [9]).They are also much lower than the $120 billion financial loss [10] incurred by the airlines industries in 2020 and the projections for this year.
Unprecedented industrial collaboration and collective financing are urgently needed to realise a sea change in production capacity. Let’s move from extraordinary scientific achievement to extraordinary industrial achievement and get enough vaccine for the world by the end of 2021.
[1] https://www.weforum.org/agenda/2020/06/vaccine-development-barriers-coronavirus/ and
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749647/
[2] Given variants and uncertainty on immunity duration, we assume that the entire world needs to be vaccinated. (Some people will not want to be vaccinated, perhaps one fifth[2], but for those that do, there should be enough available. We think wastage and other inefficiencies offset the doses that could be needed for those that opt-out.) We think a single dose, variant-specific booster shot may be sufficient after the initial cohort is vaccinated. But if variants continue, a full new two-dose course may be needed every few years.Therefore, using a two-dose course, we model that 15 billion doses in vaccine production is needed to vaccine the world’s 7.8 billion people.
[3]https://www.china-briefing.com/news/chinas-covid-19-vaccine-development-and-availability/
[4]https://www.sanofi.com/en/media-room/press-releases/2021/2021-01-27-07-30-00
[5]https://www.thelocal.dk/20210202/danish-company-offers-to-help-with-covid-19-vaccine-production
[6]https://www.corning.com/media/worldwide/cpt/documents/CPT_Valor_WhitePaper_Syntegon_June2020.pdf
[7] https://bfi.uchicago.edu/wp-content/uploads/2021/02/BFI_WP_2021-08.pdf
[8] https://www.citizen.org/news/public-citizen-analysis-25-billion-investment-can-vaccinate-the-world/
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604733/
[10]https://www.statista.com/statistics/268330/profit-of-airlines-worldwide/
