Producing vaccines and getting them into people’s arms requires a carefully orchestrated global supply chain that starts with vaccine raw materials and ends with trained healthcare workers administering the vaccine to willing recipients [1]National Academy of Medicine; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;Board on Global Health; Committee on Addressing Issues of Vaccine Distribution and Supply Chains to Advance Pandemic and Seasonal Influenza Preparedness and Response. (Editors: Ashby E, Jefferson KMP, Yadav P et al) Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington (DC): National Academies Press (US); 2021 Nov 17. 4, Vaccine Distribution and Delivery.  [2]Bown CP, Bollyky TJ. How COVID-19 vaccine supply chains emerged in the midst of a pandemic. Peterson Institute for International Economics (October 12 2021). . Successful planning and execution of logistics can be the difference between the success and failure of vaccination campaigns. To be ready for infectious disease outbreaks and to improve coverage of routine childhood vaccination, we must make vaccine supply chains across all countries as robust as possible. While supply chains for all health products are complex [3]Yadav P. Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform. Health Syst. Reform. 2015; 1(2), 142–154. , vaccines have the added complexity of more geographically concentrated manufacturing; many inputs/raw materials needed for vaccine manufacturing; the need for cold chain infrastructure; guaranteeing synchronous availability of auxiliary material/immunization supplies such as vaccine-specific syringes; special immunization-related information systems; and the coordination of local, national and international vaccine shipments [4]Zaffran M, Vandelaer J, Kristensen D, Melgaard B, Yadav P, Antwi-Agyei KO, Lasher H. The imperative for stronger vaccine supply and logistics systems. Vaccine 2013; 31(Suppl 2), B73–B80. . When vaccine supply chains don’t work well, it can lead to stockouts of vaccine vials and immunization-related supplies, which can reduce vaccine coverage [5]Gooding E, Spiliotopoulou E, Yadav P. Impact of vaccine stockouts on immunization coverage in Nigeria. Vaccine 2019; 37(35), 5104–5110.  and increase vaccination program costs due to wastage or expedited deliveries. Considerable investments and efforts have been made to improve supply chains for routine childhood immunization across countries. However, the immunization supply chain is not ready to cope with significant demand surges such as those observed in the first wave of population-wide COVID-19 vaccination. To provide a comparison, the number of COVID-19 vaccine doses distributed in the 92 low- to middle-income countries (LMICs) was two to three times UNICEF’s annual supply of vaccines to LMICs. In addition, the routine immunization supply chain is largely geared towards childhood vaccination and does not have an apparatus designed for large-scale adult vaccination. Vaccine supply chains face numerous challenges, and their importance has been recognized in recent literature [4]Zaffran M, Vandelaer J, Kristensen D, Melgaard B, Yadav P, Antwi-Agyei KO, Lasher H. The imperative for stronger vaccine supply and logistics systems. Vaccine 2013; 31(Suppl 2), B73–B80.  [6]Lemmens S, Decouttere C, Vandaele N, Bernuzzi M. A review of integrated supply chain network design models: Key issues for vaccine supply chains. Chem. Engineer. Res. Des. 2016; 109, 366–384.  [7]Duijzer, Lotty Evertje, Willem Van Jaarsveld, and Rommert Dekker. Literature review: The vaccine supply chain. Euro. J. Operat. Res.  2018; 268.1, 174–192. [8]Lopes JM, Morales CC, Alvarado M et al. Optimization methods for large-scale vaccine supply chains: a rapid review. Ann. Oper. Res. 2022; 316(1), 699–721. . Similarly, the benefits of expanded regional manufacturing to improve access, and the need for greater investment in building such capabilities, have also been covered in recent literature [9]Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force. Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics. Lancet (London, England) 2021; 397(10274), 562–564. [10]Dzau V, Yadav P. The influenza imperative: we must prepare now for seasonal and pandemic influenza. Lancet Microbe. 2023, S2666–5247(23)00013-7..

To ensure vaccine supply chains worldwide are better prepared for large demand surges arising from pandemics, disease eradication efforts, or large disease outbreaks, we highlight five specific areas for concrete action (in addition to expanded regional manufacturing).

Adequate consideration of supply chain & logistics during vaccine development

Global logistical constraints around cold chain infrastructure, dosing schedule, and type of syringe/delivery device are important factors that must be taken into account when developing vaccines.

Pfizer/BioNTech’s mRNA vaccine, for instance, had a 0.3 mL dose in contrast with the more commonly used vaccine dosing of 0.5 mL, which required procuring specialized non-standard syringes in countries where injection safety mandates the use of auto-disable syringes [1]National Academy of Medicine; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;Board on Global Health; Committee on Addressing Issues of Vaccine Distribution and Supply Chains to Advance Pandemic and Seasonal Influenza Preparedness and Response. (Editors: Ashby E, Jefferson KMP, Yadav P et al) Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington (DC): National Academies Press (US); 2021 Nov 17. 4, Vaccine Distribution and Delivery. . As a result, 0.3 mL auto-disable syringes were in extremely short supply and presented procurement challenges for many countries. Admittedly, the tradeoff between speed of vaccine development, vaccine efficacy, and ease of supply chain/delivery is extremely complex. However, considerations such as thermostability, dose volume, number of doses, and type of syringe/device for administration should be given prominence in pre-pandemic R&D programs. Research into platform approaches to increase vaccine thermostability should be encouraged through large grant programs from R&D funding agencies globally. The development of varied vaccine delivery methods, including needle-free administration, which may be preferred by some vaccine recipients, may also create a more diversified supplier base and more diversity in terms of the syringe market’s raw material needs.

At the same time, agencies responsible for decisions regarding vaccine suitability for LMICs should view thermostability in a dynamic decision-making framework and acknowledge that as more information becomes available, thermostability capabilities may improve. Hence, access to some vaccines for LMIC populations should not be completely ruled out on the basis of initial thermostability and cold-chain distribution infrastructure considerations alone.

Stable & diversified supply of raw materials & components

It takes more than developing the right biological construct, plant, and equipment to produce vaccines on an industrial scale. Modern vaccines typically require about 9,000 different materials obtained from approximately 300 suppliers in some 30 different countries [1]National Academy of Medicine; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;Board on Global Health; Committee on Addressing Issues of Vaccine Distribution and Supply Chains to Advance Pandemic and Seasonal Influenza Preparedness and Response. (Editors: Ashby E, Jefferson KMP, Yadav P et al) Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington (DC): National Academies Press (US); 2021 Nov 17. 4, Vaccine Distribution and Delivery.  [11]World Trade Organization (WTO). Developing and delivering COVID-19 vaccines around the world. WTO (October 12, 2021). . Additionally, vaccine manufacturers need to procure more than 100 different critical components, including glass vials, culture media, filters of all kinds, tubing, stabilizing agents, resins, and disposable bags [12]Hatchett R, Saville M, Downham M et al. Coalition of Epidemic Preparedness Innovations. Towards vaccinating the world: Landscape of current COVID-19 supply chain and manufacturing capacity, potential challenges, initial responses, and possible “solution space”—A discussion document. (October 1, 2021). . Supply problems with any one of these components or input materials can halt production of a vaccine entirely [2]Bown CP, Bollyky TJ. How COVID-19 vaccine supply chains emerged in the midst of a pandemic. Peterson Institute for International Economics (October 12 2021). . While this is a challenge for all vaccine manufacturers, it becomes particularly pronounced for new manufacturers who do not have existing long-term relationships with suppliers of such materials. COVAX and its partners led by CEPI have developed a marketplace to match suppliers of critical inputs with vaccine manufacturers who urgently need them [13]The COVAX Marketplace. CEPI. . However, some manufacturers have expressed their dissatisfaction with the ability of this marketplace to solve their sourcing problems [14]Caryn Fenner. Sourcing quality raw & starting materials at a reasonable cost during the pandemic. Vaccine Insights 2022; 1(6), 315–318. . The governance structure, technical capabilities, and partnership modalities of such a marketplace need to be carefully configured [15]Prashant Yadav and Rebecca Weintraub. 4 Strategies to Boost the Global Supply of Covid-19 Vaccines. Harvard Business Review (May 06 2021).  and adequately resourced to solve the material sourcing problem for new and existing manufacturers, especially during a period of high demand and constrained supply. Careful consideration should be given to ensuring that such a marketplace can be maintained during inter-pandemic periods and that trade barriers do not stymie its usefulness during pandemics and large health emergencies.

Cold-chain investments as a long-term health system investment

Limitations in existing cold chain infrastructure were one of the biggest challenges for COVID-19 vaccine access and distribution. Limited cold chain capacity has long been recognized as a bottleneck in the vaccine supply chain [2]Bown CP, Bollyky TJ. How COVID-19 vaccine supply chains emerged in the midst of a pandemic. Peterson Institute for International Economics (October 12 2021). . The Cold Chain Equipment Optimization Platform (CCEOP) was set up by GAVI in 2015 to upgrade/install high-performance cold chain equipment (CCE) across LMICs, and to shape the CCE market for LMICs [16]Azimi T, Franzel L, Probst N. Seizing market shaping opportunities for vaccine cold chain equipment. Vaccine 2017; 35(17), 2260–2264. . It financed solar direct drive and off-electrical-grid refrigerators and freezers in several GAVI-eligible countries. CCEOP explicitly took into account the fact that cold chain capacity building in LMICs is not merely about installing fridges, and freezers. It also requires building an eco-system for preventive maintenance and repair of such equipment. However, CCEOP was geared mostly towards CCE for 2−8°C – the most used temperature range across vaccines in LMICs. mRNA vaccines for COVID-19 required ultra-cold chain storage for which much of this infrastructure was not suitable. COVAX was initially focused on expanding the normal 2–8°C cold chain capacity with the assumption that much of the early supply of vaccines to COVAX countries would be 2–8°C (based on the portfolio of vaccines that COVAX had contracted). With the large-scale donations of Pfizer/BioNTech vaccines to COVAX, much of the cold chain capacity at the national and regional level had to be readied for ultra-cold chain. While some such ultra-cold chain freezers are now in place as a result of these efforts, there is a need to redesign CCEOP and its market-shaping effort around two scenarios: a) future vaccines will have better thermostability, or b) future vaccines (and other medical countermeasures) will require ultra-cold chain capacity. The redesign of CCEOP should explicitly account for the fact that cold chain investments can help in preparing the health system not just for vaccines, but for other health products such as insulin, oxytocin, and new human immunodeficiency virus treatments.

The cold chain storage capacity required in a country also depends on the configuration of the in-country vaccine supply chain. Typically, vaccines are first transported from the airport of entry to the main national distribution center from where they go to regional and district distribution centers, and eventually to immunization service delivery points. Changing this configuration e.g., distributing more directly from national distribution centers to district or health clinics, or delivering more frequently between each stage, changes the total requirement of cold chain capacity and its location [17]Lee BY, Haidari LA, Prosser W et al. Re-designing the Mozambique vaccine supply chain to improve access to vaccines. Vaccine. 2016; 34(41), 4998–5004. Lee BY, Haidari LA, Prosser W et al. Re-designing the Mozambique vaccine supply chain to improve access to vaccines. Vaccine. 2016; 34(41), 4998–5004.  and may be more cost-effective and efficient. The lack of ultra-cold chain equipment at the subnational levels led to a more direct distribution system for some COVID vaccines. This more direct distribution model should be explored as a permanent option for routine vaccines. Besides improving efficiency and reducing cold chain requirements [17]Lee BY, Haidari LA, Prosser W et al. Re-designing the Mozambique vaccine supply chain to improve access to vaccines. Vaccine. 2016; 34(41), 4998–5004. Lee BY, Haidari LA, Prosser W et al. Re-designing the Mozambique vaccine supply chain to improve access to vaccines. Vaccine. 2016; 34(41), 4998–5004. , this would enhance operational readiness for fast response distribution during disease outbreaks or pandemics.

COVID-19 vaccine distribution in many countries also relied on special arrangements for shipment preclearance, airspace clearance, advance documentation sharing, and sharing assets across public and private agencies. There should be an assessment of whether the ad-hoc measures for the distribution of COVID-19 vaccine can be made more systematic. Overall, there is a need for a Project-Optimize [18]World Health Organization. Project Optimize. -type technical task force to focus on in-country vaccine supply chain redesign in light of many new developments and provide high-level inputs to the evolving global architecture for pandemic preparedness.

Immunization supply chain data systems, demand forecasting & tracking vaccine wastage

A robust system that provides real-time information about vaccine stock and temperature/conditions of storage throughout the supply chain is essential to the effective and efficient distribution of vaccines, both for routine immunization [20]Gilbert SS, Bulula N, Yohana E, Thompson J, Beylerian E, Werner L, Shearer JC. The impact of an integrated electronic immunization registry and logistics management information system (EIR-eLMIS) on vaccine availability in three regions in Tanzania: A pre-post and time-series analysis. Vaccine 2020; 38(3), 562–569.  and particularly during a pandemic. Such visibility not only improves supply chain performance but also has the potential to help identify locations with low vaccine uptake rates and dynamically allocate stock in ways that are best suited for the public health response when supplies are scarce [19]Li Z, Swann JL, Keskinocak P. Value of inventory information in allocating a limited supply of influenza vaccine during a pandemic. PLoS ONE 2018; 13(10), e0206293. . In many instances, the core information system that was in place for vaccine stock, flow, consumption, and temperature monitoring was expanded to include vaccination registration and scheduling. A prominent example is India’s COVID-19 Vaccine Intelligence Network (Co-WIN), which was developed as an extension of the existing electronic Vaccine supply chain Intelligence Network (eVIN) [26]Sgaier S. and Yadav P. How India Could Win Its COVID Vaccination Race, Project Syndicate. (Feb 24, 2021). .

Systematic collection of immunization supply chain data in real-time also facilitates better demand forecasting [20]Gilbert SS, Bulula N, Yohana E, Thompson J, Beylerian E, Werner L, Shearer JC. The impact of an integrated electronic immunization registry and logistics management information system (EIR-eLMIS) on vaccine availability in three regions in Tanzania: A pre-post and time-series analysis. Vaccine 2020; 38(3), 562–569. . Analytics around uptake at sufficiently high levels of granularity, allow an understanding of drivers of vaccine hesitancy, supply availability, and other health system factor that affect demand.

COVID-19 vaccine wastage rates of up to 30% have been reported in low-income, middle-income, and high-income countries [21]Lazarus JV, Abdool Karim SS, van Selm L et al. COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps. BMJ Glob. Health 2022; 7(4), e009010. Lazarus JV, Abdool Karim SS, van Selm L et al. COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps. BMJ Glob. Health 2022; 7(4), e009010. . Mature supply chain stock tracking systems can also provide granular data on COVID-19 vaccine wastage, which can help identify key drivers of wastage and help develop specific interventions to minimize such wastage [21]Lazarus JV, Abdool Karim SS, van Selm L et al. COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps. BMJ Glob. Health 2022; 7(4), e009010. Lazarus JV, Abdool Karim SS, van Selm L et al. COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps. BMJ Glob. Health 2022; 7(4), e009010. . These interventions could include assessing the stock of vaccines globally and distributing unused vaccines to areas in need.

Investing in the people who manufacture & deliver

In order to manufacture vaccines at scale, new vaccine plants need highly skilled staff in the areas of Chemistry, Manufacturing, and Controls (CMC), lab chemistry and analytical methods, regulatory processes, sourcing, and market dynamics [22]Peter J Hotez, Maria Elena Bottazzi, Prashant Yadav. Producing a Vaccine Requires More Than a Patent. Foreign Affairs (May 10 2021).  [23]Tarbet EB, Dorward JT, Day CW, Rashid KA. Vaccine production training to develop the workforce of foreign institutions supported by the BARDA influenza vaccine capacity building program. Vaccine 2013; 31(12), 1646–1649. [24]Kumraj G, Pathak S, Shah S et al. Capacity Building for Vaccine Manufacturing Across Developing Countries: The Way Forward. Hum. Vaccin. Immunother. 2022;18(1), 2020529. . In the period of a pandemic, the shortage of trained biomanufacturing staff can constrain vaccine production not only in new vaccine manufacturing regions, but even in established biomanufacturing clusters [12]Hatchett R, Saville M, Downham M et al. Coalition of Epidemic Preparedness Innovations. Towards vaccinating the world: Landscape of current COVID-19 supply chain and manufacturing capacity, potential challenges, initial responses, and possible “solution space”—A discussion document. (October 1, 2021).  [23]Tarbet EB, Dorward JT, Day CW, Rashid KA. Vaccine production training to develop the workforce of foreign institutions supported by the BARDA influenza vaccine capacity building program. Vaccine 2013; 31(12), 1646–1649..

Aside from the biomanufacturing workforce, vaccine distribution requires logisticians, supply chain managers, data system managers, warehouse, and transport staff at the national, district, and health facility levels [25]Kasonde M, Steele P. The people factor: An analysis of the human resources landscape for immunization supply chain management. Vaccine 2017; 35(17), 2134–2140. . While these staff cadres exist, in many instances weak organizational systems, processes, and working environments result in staff positions not being filled. Such positions require not only technical skills but also ‘social-creative’ skills to solve unique problems when they arise. Some of the supply chain skill sets that are in short supply in public sector vaccine supply chains exist in private companies with significant supply chain footprints in the countries concerned. Platforms such as the Africa Resource Center (ARC) for supply chain management can be utilized to bring supply chain human resource capacity in the private sector to meet short-term staffing gaps in the vaccine
supply chain.

In both the manufacturing and distribution areas of vaccine supply chains, it is necessary to bring together university curricula with practical internships and professional development opportunities for in-service staff. A number of initiatives are underway to address this issue, but the most important need is to establish a global network of different types of training and capability-building providers who have, or are willing to establish, an on-the-ground presence across LMICs.

Conclusion

The lessons learned from the COVID-19 pandemic provide a very clear set of priority actions to improve vaccine supply chains:

• The importance of considering logistics and supply chain early in the vaccine development process;
• Creating a better system for sourcing critical input materials;
• Investing in cold chain and data systems;
• Building human capital for biomanufacturing and supply chain.

The implementation of these actions will require national and global leadership, clear collaboration and coordination structures, and investment of financial resources according to needs that will vary in different settings. The new financial intermediary fund for pandemic prevention, preparedness, and response hosted by the World Bank, with technical leadership from WHO, should prioritize these action items in its financing to LMICs. Besides providing domestic financing for strengthening the vaccine supply chain, LMIC country governments should provide much-needed high-level ministerial attention to strengthening in-country vaccine supply chains.

References

1. National Academy of Medicine; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;Board on Global Health; Committee on Addressing Issues of Vaccine Distribution and Supply Chains to Advance Pandemic and Seasonal Influenza Preparedness and Response. (Editors: Ashby E, Jefferson KMP, Yadav P et al) Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington (DC): National Academies Press (US); 2021 Nov 17. 4, Vaccine Distribution and Delivery.  Crossref

2. Bown CP, Bollyky TJ. How COVID-19 vaccine supply chains emerged in the midst of a pandemic. Peterson Institute for International Economics (October 12 2021).  Crossref

3. Yadav P. Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform. Health Syst. Reform. 2015; 1(2), 142–154.  Crossref

4. Zaffran M, Vandelaer J, Kristensen D, Melgaard B, Yadav P, Antwi-Agyei KO, Lasher H. The imperative for stronger vaccine supply and logistics systems. Vaccine 2013; 31(Suppl 2), B73–B80.  Crossref

5. Gooding E, Spiliotopoulou E, Yadav P. Impact of vaccine stockouts on immunization coverage in Nigeria. Vaccine 2019; 37(35), 5104–5110.  Crossref

6. Lemmens S, Decouttere C, Vandaele N, Bernuzzi M. A review of integrated supply chain network design models: Key issues for vaccine supply chains. Chem. Engineer. Res. Des. 2016; 109, 366–384.  Crossref

7. Duijzer, Lotty Evertje, Willem Van Jaarsveld, and Rommert Dekker. Literature review: The vaccine supply chain. Euro. J. Operat. Res.  2018; 268.1, 174–192.  Crossref

8. Lopes JM, Morales CC, Alvarado M et al. Optimization methods for large-scale vaccine supply chains: a rapid review. Ann. Oper. Res. 2022; 316(1), 699–721.  Crossref

9. Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force. Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics. Lancet (London, England) 2021; 397(10274), 562–564.  Crossref

10. Dzau V, Yadav P. The influenza imperative: we must prepare now for seasonal and pandemic influenza. Lancet Microbe. 2023, S2666–5247(23)00013-7.  Crossref

11. World Trade Organization (WTO). Developing and delivering COVID-19 vaccines around the world. WTO (October 12, 2021).  Crossref

12. Hatchett R, Saville M, Downham M et al. Coalition of Epidemic Preparedness Innovations. Towards vaccinating the world: Landscape of current COVID-19 supply chain and manufacturing capacity, potential challenges, initial responses, and possible “solution space”—A discussion document. (October 1, 2021).  Crossref

13. The COVAX Marketplace. CEPI.  Crossref

14. Caryn Fenner. Sourcing quality raw & starting materials at a reasonable cost during the pandemic. Vaccine Insights 2022; 1(6), 315–318.  Crossref

15. Prashant Yadav and Rebecca Weintraub. 4 Strategies to Boost the Global Supply of Covid-19 Vaccines. Harvard Business Review (May 06 2021).  Crossref

16. Azimi T, Franzel L, Probst N. Seizing market shaping opportunities for vaccine cold chain equipment. Vaccine 2017; 35(17), 2260–2264.  Crossref

17. Lee BY, Haidari LA, Prosser W et al. Re-designing the Mozambique vaccine supply chain to improve access to vaccines. Vaccine. 2016; 34(41), 4998–5004.  Crossref

18. World Health Organization. Project Optimize.  Crossref

19. Li Z, Swann JL, Keskinocak P. Value of inventory information in allocating a limited supply of influenza vaccine during a pandemic. PLoS ONE 2018; 13(10), e0206293.  Crossref

20. Gilbert SS, Bulula N, Yohana E, Thompson J, Beylerian E, Werner L, Shearer JC. The impact of an integrated electronic immunization registry and logistics management information system (EIR-eLMIS) on vaccine availability in three regions in Tanzania: A pre-post and time-series analysis. Vaccine 2020; 38(3), 562–569.  Crossref

21. Lazarus JV, Abdool Karim SS, van Selm L et al. COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps. BMJ Glob. Health 2022; 7(4), e009010.  Crossref

22. Peter J Hotez, Maria Elena Bottazzi, Prashant Yadav. Producing a Vaccine Requires More Than a Patent. Foreign Affairs (May 10 2021).  Crossref

23. Tarbet EB, Dorward JT, Day CW, Rashid KA. Vaccine production training to develop the workforce of foreign institutions supported by the BARDA influenza vaccine capacity building program. Vaccine 2013; 31(12), 1646–1649.  Crossref

24. Kumraj G, Pathak S, Shah S et al. Capacity Building for Vaccine Manufacturing Across Developing Countries: The Way Forward. Hum. Vaccin. Immunother. 2022;18(1), 2020529.  Crossref

25. Kasonde M, Steele P. The people factor: An analysis of the human resources landscape for immunization supply chain management. Vaccine 2017; 35(17), 2134–2140.  Crossref

26. Sgaier S. and Yadav P. How India Could Win Its COVID Vaccination Race, Project Syndicate. (Feb 24, 2021).  Crossref

Affiliations

Prashant Yadav
Technology and Operations Management,
INSEAD, France
and
Center for Global Development,
Washington, DC, USA
and
Harvard Medical School,
Boston, MA, USA  

Carolina Batista
Médecins Sans Frontières,
Rio de Janeiro
Brazil
and
Baraka Impact Finance
Geneva, Switzerland  

Ravi Anupindi
Ross School of Business,
University of Michigan
Ann Arbor, MI, USA 

Sarah Gilbert
Pandemic Sciences Institute,
Nuffield Department of Medicine,
Oxford University,
Oxford, UK  

Bhavna Lall
Tilman J Fertitta Family College of Medicine,
University of Houston
Houston, TX, USA  

Shmuel Shoham
Johns Hopkins University School of Medicine,
Baltimore, MD, USA 

J Peter Figueroa
University of the West Indies,
Mona, Kingston, Jamaica 

Jerome H Kim
International Vaccine Institute,
Seoul, South Korea 

Heidi J Larson
London School of Hygiene & Tropical Medicine,
London, UK 

Mayda Gursel
Middle East Technical University,
Ankara, Turkey 

Nathalie Strub-Wourgaft
ISGlobal-Barcelona Institute for Global Health-Hospital Clinic,
University of Barcelona,
Spain
and
Drugs for Neglected Diseases Initiative,
Geneva, Switzerland

Samba O Sow
Center for Vaccine Development,
Bamako, Mali
and
University of Maryland,
MD, USA 

Yanis Ben Amor
Center for Sustainable Development,
Columbia University,
New York, NY, USA

Maria Elena Bottazzi
Texas Children’s Center for Vaccine Development,
Baylor College of Medicine,
Houston, TX, USA 

Peter Hotez
Texas Children’s Center for Vaccine Development,
Baylor College of Medicine,
Houston, TX, USA 

Mazen Hassanain
Managing Director,
SaudiVax 

Authorship & conflict of interest

Contributions: Yadav P wrote the initial draft. All other authors contributed equally. All named authors take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Acknowledgements: None.

Research ethics statement: This study did not receive nor require ethics approval, as it does not involve human & animal participants.

Disclosure and potential conflicts of interest: Yadav P discloses he has a Bill & Melinda Gates Foundation grant to study impact of supply chain investments on health outcomes. He is also on the Sustainability and Access Advisory Board at Novo Nordisk. Anupindi R discloses he is a member of the Board of Global Health of the National Academies of Science, Engineering and Medicine. Gilbert S discloses she has grants/contracts from CEPI, Engineering and Physical Sciences Research Council (UK), Bill and Melinda Gates Foundation and AstraZeneca for her institution and Medical Research Council (UK) for herself. She is an inventor/contributor to intellectual property licensed by Oxford University Innovation to AstraZeneca. She is also an inventor on patents covering ChAdOx1, ChAdOx1 nCoV-19 and the long CMV promoter from Oxford University. Lastly, she holds stock in Vaccitech as she is co-founder. Shoham S has grants/contracts from F2G, Cidara, Ansun, Zeteo and Emergent Biosolutions. He receives consulting fees from Celltrion, Adagio and Immunome. He also participates on a Data Safety Monitoring Board/Advisory Board at Adamis , Karyopharm and Intermountain Health. Lastly, he has stocks/stock options from Immunome. Figueroa JP discloses he participates on a Data Safety Monitoring Board/Advisory Board at PAHO TAG on Immunization (Chair), WHO TAG-CO-VAC (member), WHO TAG on COVID Vaccines (member). Kim JH receives consulting fees from SK bioscience and Moderna. He also participates on a Data Safety Monitoring Board/Advisory Board at Everest. Larson HJ discloses she has grants/contracts from GSK, Merck and Johnson & Johnson. Strub-Wourgaft N discloses she receives grants for her institution. She also discloses she is Chair of COPCOV Steering Committee and member of the crc19 Sterring Committee. Sow SO discloses that he is a developer of the RBD219-N1C1and RBD203-N1 technologies, and that Baylor College of Medicine (BCM) licensed RBD219-N1C1 to Biological E, an Indian manufacturer, for further advancement and licensure. Similar licensing agreements are also in place with other partners for both RBD219-N1C1 and RBD203-N1. The research conducted in this paper was performed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest . Bottazzi ME discloses she is a developer of a COVID-19 vaccine construct which is licensed by Baylor College of Medicine to commercial vaccine manufacturers for scale up, production, testing and licensure. Hotez P discloses he is a developer of a COVID-19 vaccine construct which is licensed by Baylor College of Medicine to commercial vaccine manufacturers for scale up, production, testing and licensure. Hassanain M discloses he is Managing Director of SaudiVax, a private biotech company. The other authors have no conflicts of interest.

Funding declaration: The authors received no financial support for the research, authorship and/or publication of this article.

Article & copyright information

Copyright: Published by Vaccine Insights under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Attribution: Copyright © 2023 Yadav P, Batista C, Anupindi R, Gilbert S, Lall B, Shoham S, Figueroa JP, Kim JH, Larson HJ, Gursel M, Strub-Wourgaft N, Sow SO, Ben Amor Y, Bottazzi ME, Hotez P, Hassanain M. Published by Vaccine Insights under Creative Commons License Deed CC BY NC ND 4.0.

Article source: Invited.

Revised manuscript received: Mar 9 2023; Publication date: Mar 22 2023