Production For the Last Mile

We have plenty of COVID vaccines and doses. The real challenge now is delivering them the last mile.

Two years of unrivaled emergency actions, and eleven trillion dollars – yet humanity seems no closer in its efforts to control a virus than it was before.  Perhaps a step back and a re-appraisal of our thinking would be pertinent? Let’s be brave. 

No doubt, vaccines equal virus mitigation – but vaccine coverage is not equitable globally.  Every vaccine dose must be able to be injected – hoarding and booster-nationalism accusations are simply symptomatic of a larger failure to allow vaccines to work to their full advantage. 

To fight both COVID and future pandemics, vaccinations – not just vaccines – are the key. 

Vaccine dose donation programs’ blunt metrics show new thinking is needed.  Only 16% of people in low-income countries have received even one dose. Since these programs started in Spring 2020, we have seen deaths from COVID-19 climb from 65,000 to 6 million and WHO says the number may be more than 15 million. 

Why have the tried and tested tools of development and global response fallen so short? Precisely because we have not focused enough on local vaccine delivery. We must make a grand shift to local production and the final mile to fight the next variants or the next pandemic.  

What is more, funding and thinking have focused on longer term vaccine production, impolitely ignoring local production. While the African Union has called for huge improvements by 2040, these aspirational targets ignore two basic facts fundamental to local production’s success.   

First, an unavoidable hurdle: Price. Any new African manufacturing plant will be limited in scale by its competitiveness against large, traditional manufacturers in Europe, North America, India and China. When bird flu sparked a drive in 2006 to build new capacity for influenza vaccines, the new developing country's efforts were swamped by existing high production and lower prices, despite support from WHO and the global partners. However, these days regional economic blocks in Africa and Southeast Asia can ensure reasonable prices, by framing more coherent and higher volume markets. 

Second, local production cannot be limited just to producing bulk vaccines. Global leaders may mourn ongoing vaccine inequity – but availability of vaccine doses is no longer the issue. 320 vaccines currently in testing proves this.   

Over $100 billion (U.S.) has gone toward new COVID vaccines. But less than one percent of that has been spent on mending key gaps in supplies and staff for the last mile, including the filling and finishing of vaccines. More ominous still, high global demand and limited supply mean the world is now short of as many as 5 billion syringes, compounded by delays of at least 18 months for any new fill and finish in glass vials because of shortages.  

Building brand-new vaccine manufacturing facilities will take maybe a decade. But giving countries control of the crucial step on vaccine development programs, fill and finish, is achievable in less than two years. Building the future pandemic response and fixing today’s response would then be aligned. The key then for this consolidated thinking must be a truly global network of manufacturing centers enjoying national political support, that can compete on cost and increase confidence. Strengthening production and solving bottlenecks across the supply chain, as close to the last mile as possible, is our best hope for a sustainable path forward in pandemic preparedness.

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GLOBE is an outlet that allows colleagues and friends of the ApiJect Global Initiative to share their thoughts on matters related to global health and their ongoing work. Send questions or responses to media@apijectglobal.com.

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