COVID-19 Lockdowns Leave Vaccine Campaigns On Hold; More Africans Could Die From Other Infectious Diseases, Warns GAVI, The Vaccine Alliance
One of the first children to receive the world’s first malaria vaccine in Ghana in April 2019. Photo: WHO/Fanjan Combrink

Routine vaccine campaigns, suspended worldwide in the wake of COVID-19 lockdowns, must be resumed immediately or else some countries could face a big surge in deaths from other preventable diseases, said Seth Berkley, CEO of Gavi, The Vaccine Alliance.

Speaking at a press briefing Thursday, Berkley warned that routine immunizations for other infectious diseases such as polio, measles, and rotavirus need to be resumed immediately in low- and middle-income countries. In Africa, deaths from other infectious diseases could outweigh COVID-19 fatalities by a factor of 100 to 1, he said, citing findings from a recent London School of Tropical Hygiene and Medicine study.

“I can’t emphasize enough [that halting routine immunization] is going to be a challenge, and we are going to see outbreaks, certainly for polio,” said the GAVI CEO. 

Berkley said the world needs to urgently “catch up” to bring previous levels of population immunity back up in areas where vaccines are now being neglected.

“If we don’t support those routine systems, those systems won’t be ready to move forward to roll out [existing and new] vaccines.” 

Berkley spoke at a GAVI press briefing today that laid out a vision for the organization’s work on vaccines in the coming months and years. The briefing also included Joe Cerell of the Bill and Melinda Gates Foundation and Gayle Smith, CEO of the ONE Campaign, a global health and development NGO.

Gavi Replenishment Drive, June 4, Aims to Raise US$ 7.4 billion for Routine Vaccines

GAVI aims to raise US$ 7.4 billion for its next five year plan for mass immunizations, in a virtual replenishment event to be hosted by the United Kingdom on June 4. The money will be used to immunize an additional 300 million children, over and above, the 760 million reached in the over the past two decade, preventing some 8 million deaths, Berkley said.

In parallel, Gavi, One Campaign and other partners are supporting a drive to raise another US$ 8 billion to fund R&D for development and manufacture of a COVID-19 vaccine, although this is only ‘part of what’s needed,’ said Smith, who is also a former administrator of the US Agency for International Development.

“For a global pandemic, we need a global response,” she said.

In a separate event, the WHO European Regional Office also warned that measles was already surging in Europe because of neglected routine vaccines during the crisis.  In just the first two months of 2020, over 6,000 people were infected with measles in the European region, said Hans Kluge, WHO European Regional Director. 

Said Kluge, “We cannot allow this situation to worsen. We should do everything within our powers to prevent children [from] becoming victims of this pandemic due to vaccine-preventable diseases such as measles, diphtheria, mumps, and rubella. Covid-19 cannot be permitted to claim this collateral damage.” 

As for low-income settings, Berkley cited past experience with the Ebola epidemic of 2018-20 in the Democratic Republic of Congo. While the world remained riveted to the Ebola emergency, two and a half times as many people died of measles.

Along with resuming routine vaccines, Berkley laid out four other key challenges associated with advancing development and rollout of a future COVID-19 vaccine, which said need “global coordination and leadership”, but also “transparency in R&D and manufacturing.” 

These challenges include: ensuring adequate production capacity of the vaccine; global leadership to identify and prioritize vaccine candidates; deployment of the vaccine; and protecting healthcare workers.

‘Vaccine Mortgages’ & Other Funding Innovations Could Help Boost Vaccine Development & Access

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

As the world struggles to finance vaccine development, countries or research institutions could be provided with money upfront to finance expedited R&D and pay it back later, just like a mortgage for a house, said Berkley. 

“In essence, it’s like buying a house where you have a mortgage payment you make out over 20 years, you can have that money up front. And that is something we’re looking at to support vaccine development.”

These so-called ‘vaccine mortgages’, more formally known as advanced market commitments (AMCs), have been successfully used by GAVI to support both development and scale-up of vaccines against bacterial pneumonia as well as the Ebola virus, with support from leading donors, including Norway, Canada, Italy, the Russian Federation and the United Kingdom. 

Prioritizing Vaccine Access: Health Workers, Hot Spots and Risk Groups  

When a new vaccine is rolled-out, it will have to be prioritized to key populations because production capacity will still take time to catch up with anticipated total demand. 

“It certainly won’t be on day one that enough doses are produced, no matter how big the [manufacturing] plants, no matter how much we prepare…We need to make sure that there is adequate production capacity for vaccines and that’s going to require working differently…we are going to have to prioritize [who gets the vaccine first].”

Before the vaccine is rolled-out in the general population, it must reach healthcare workers first, said Berkley, as they are the ones that will be most exposed to the virus. Healthcare workers may also spread the virus due to their contact with anyone seeking healthcare services, so they must be protected.

“We need to do everything in our power to protect healthcare workers.”

After reaching healthcare workers, the vaccine should be deployed in outbreak hotspots and then in at-risk groups. The world needs to discuss this issue and commit to such a priority list as soon as possible, he said.

“Discussions are going to have to happen and the thing that protects us the most is having the conversations before the issues occur,” he added, warning that otherwise huge distortions could emerge in available supplies, as per the experience with personal protective equipment (PPE).

Global Coordination To Pick The Best Vaccine: A Portfolio of Leading Candidates

Researchers are racing to find a vaccine for the novel coronavirus, 2019-nCoV; (Rendering/US CDC).

There are already some 90 COVID-19 vaccine candidates in the clinical trial pipeline, said Berkley, and he predicted there may be as many as 200 within a few months…

That’s all the more reason why the global community needs to collaborate closely to filter through the list, and pick the right lead candidates for further development, he and other panelists stressed.

“We’re going to need to down regulate [the large number of vaccine candidates] for the best potential products for the world and best means not only efficacious, but usable and scalable. That’s going to be critical,” said Berkley.

Not only does the ideal vaccine need to be selected based on its ability to mount an effective immune response, it also needs to be scalable – A vaccine portfolio can help the world pick the right vaccine.

“What you’re going to want is a portfolio of different types of approaches and ones that are scalable and manufacturable…the process that’s happening now is that people are beginning to [identify] what these criteria might be,” said Cerell.

Although some traditional vaccine approaches may seem slower to develop at first, they ultimately may be easier to scale, added Berkley. 

“You know the tortoise [traditional vaccine approaches] might win [the vaccine race], and the reason is that those vaccines may be better understood or simpler to use [or manufacture], needing only a single dose versus multiple doses.” 

Said Cerell, “We need much more coordination [at the global level] when it comes to narrowing down those [vaccine] candidates that show the most promise. We don’t want to have a lot of inefficient money being thrown out…We need to have a more coordinated approach to this [vaccine] portfolio management.” 

For coordination to be successful, transparency is also needed, said Cerell: “One of the ingredients is transparency. And right now the intentions are not in favor of transparency on a lot of these things [with respect to] pharmaceutical development.

– Tsering Lhamo contributed to this story.

Image Credits: WHO/Fanjan Combrink, WHO/Fanjan Combrink, US Centers for Disease Control and Prevention.