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Insights from Fellows' Knowledge Café conversations on improving vaccine access through local solutions, partnerships, and networks
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The Knowledge Café is a structured conversational process for knowledge sharing in which groups of people discuss a topic at several small tables like those in a café. During the program "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-income Countries", these conversations centered around the overarching question of "What experiences of lead-user innovation can be transferred from other contexts into this critical arena where it would be a novel approach?" The three key takeaways from these conversations were to establish local or regional acquisition vehicles, plan contractual partnerships in advance, and sustain networks for speedy action in a potential future pandemic.
In a series of Knowledge Café discussions, Fellows explored the potential utility of local and regional acquisition vehicles aimed at bolstering vaccine access across African nations. The discussions were led by Abebe Geneto Bayih, Acting Lead for Partnerships for African Vaccine Manufacturing (PAVM) with the Africa CDC, who commented that “governments should be willing to pay a premium for locally manufactured vaccines as the benefit of local manufacturing goes beyond health”.
The imperative for securing funding for pooled procurement mechanisms (PPM) and aligning PPMs on regional, continental, and global levels emerged. Fellows cautioned that creating a sub-regional PPM would be counter-productive and it makes more sense to work together on a continental or regional level; regional PPMs should cultivate strong partnerships with the existing international PPMs.
The pros and cons of PPMs were discussed at length. While they offer the advantages of leverage, coordination, and speed, participants grappled with the risks of negotiating uniform prices across different economic landscapes. A suggestion by a Fellow on tiered pricing within PPMs sparked a conversation on the diverse financial realities of market segments. The discourse also underscored the need to differentiate between products with high and low production barriers, as a PPM is more appropriate for products with high production barriers.
Fellows emphasized the imperative of early involvement of lower and middle income countries in PPMs to avert their exclusion during emergencies. The group suggested outlining clear scenarios for countries to evaluate their needs in different situations and determine the use case of an African PPM. Tailored procurement strategies should be adaptable, from increasing existing vaccine production to starting new production in unforeseen emergencies. Advanced planning remains pivotal in pandemic preparedness, such as having procurement mechanisms and regional research and development organizations in place before a health emergency arises.
During the Knowledge Café, Fellows also learned about the corporate and legal sides of vaccine development. They discussed the many parties involved in producing a vaccine from the innovation stage to its development, such as industries, academia, and governments. Each has a distinct interest in vaccine development; for example, while governments are likely to prioritize the public good, industries and academia might prioritize profit and licensing revenue.
Planning these partnerships between various actors helps balance these interests and could be used to promote equitable access. Julie Barnes Weise, Executive Director of the Global Healthcare Innovation Alliances Accelerator (GHIAA), highlighted the importance of contracts in vaccine development. Contracts are enforceable instruments that can guarantee equitable access, ensuring parties know their rights and how to enforce them.
A challenge surrounding vaccine development is that the paperwork involved is often murky, as Julie noted that “Nobody really understands how much paperwork is involved in vaccine development”. She explained that planning partnerships would have a cascading effect throughout the different stages of vaccine development, from discovery to distribution and adoption. However, it is important to develop equitable access plans and objectives to ensure that a vaccine is affordable, available, and sustainable.
Fellows raised the issue that vaccines often reach low- and middle-income countries much later than their wealthier counterparts. This was the reality during the COVID-19 pandemic, as confirmed by data provided by Gavi, the Vaccine Alliance. Better preparation for another pandemic necessitates better vaccine development strategies, which is not possible without understanding and planning partnerships.
COVID-19 was a global challenge on an unprecedented scale, but great crises often create great opportunities. From health workers on the frontline to international institutions, the fight against COVID-19 created a network out of a vast sum of moving parts. Countless connections were established, and it was evident in the Knowledge Café discussion that sustaining these networks would be a pivotal prerequisite for a speedy response to the next pandemic.
All successful relationships in life are built on trust, and trust is built on successful collaborations. The critical question is: How? One Fellow explained that “collective experiences and shared success” are the key. Indeed, the pandemic has already established networks of diverse stakeholders united towards a common goal. Another Fellow referred to these as “reusable networks”.
Even though the pandemic has subsided, reusing, expanding, and strengthening these existing networks would naturally sustain them in preparation for the next pandemic by “maintaining the tempo”. Though the tempo has slowed compared to the frantic days of the pandemic, there is still a multitude of unmet health needs around the world that Fellows identified. Malaria, tuberculosis, Mpox, and Ebola all demand the world’s attention, and with the networks established through the COVID-19 pandemic, the world is already better poised to respond.
Specific to pandemics, Fellows also explored the possibility of utilizing established networks to set up “international fire brigades” or “fire drills” to better coordinate existing connections for the next pandemic. Through regular exercises, networks can identify the shared interests and the gaps between groups.
A Fellow added that the objective is to find the right contacts by “speaking to their area of expertise”. Successful networks depend as much on the unity of groups and the uniqueness of individuals. The pandemic has already mapped out precious networks. Now is the time to explore where they can take us.