A conversation with Trevor Mundel: Ensuring affordable COVID-19 vaccine doses reach low-and middle-income countries

There are essentially two reasons. The first one is scale-up.

Several vaccines are showing promise in clinical trials, but no one knows which or how many of them will be safe and effective. We can’t afford to waste time. The world has to start preparing many different kinds of manufacturing facilities right now. That way, no matter which vaccine candidates receive approval, manufacturing plants have already started the manufacturing process.

This collaboration pushes us toward that goal. It ensures that the Serum Institute has upfront capital to begin manufacturing up to 100 million vaccine doses.

The second reason is where those vaccine doses will go: Low- and middle-income countries (LMICs).

This pandemic will only end once everyone—not just people in wealthy countries—have access to vaccines. And that’s what this collaboration helps provide: It reserves up to 100 million doses for Gavi, the Vaccine Alliance to procure at an affordable price (up to $3 per dose), on behalf of LMICs. Part of the beauty of the collaboration is that it includes organizations that are very experienced making and delivering vaccines. The Serum Institute of India is a company with a long history of supplying vaccines to LMICs. And Gavi has spent the past 20 years helping immunize more than 760 million children in lower-income countries—work that has saved more than 13 million lives.

As for the foundation, our mission has always been to help the most under-resourced and vulnerable people live healthy, productive lives—so we’re focused on using our resources to ensure that future COVID-19 vaccines reach the most at-risk people in LMICs. This starts with ensuring that some of the vaccine manufacturing capacity is reserved specifically for these countries.

Governments have taken positive steps to put significant money at-risk for development of vaccine candidates (meaning, they are putting money into candidates that may not prove safe and effective or receive regulatory approval). While these efforts are often attached to reservations of supply for their national populations, the R&D will ultimately benefit everyone.

The challenge becomes not just if LMICs will eventually have access to safe and effective vaccines, but when. If a few wealthier countries reserve most of the manufacturing capacity for doses that could be ready next year, other countries will need to wait for subsequent phases of manufacturing in 2022, 2023, or even 2024. That means several more years of the virus circulating in LMICs, traveling across borders, and threatening to reemerge globally.

That’s why this collaboration accelerates the timeline to ensure that LMICs can access low-cost, safe, and effective vaccines as soon as possible. In the best-case scenario, pending individual vaccine clinical study results and regulatory approval, doses could be delivered sometime in the first half of 2021.

$150 million of financing for this collaboration will come from the Gates Foundation’s Strategic Investment Fund (SIF). Can you explain what SIF is and what this money is being used for?

The Strategic Investment Fund is a team at the foundation that uses innovative financial tools other than grants—like equity investments or loans—to advance the foundation’s charitable objectives. You can think of them as a venture capital fund that invests in things that benefit those living in poverty—things that otherwise wouldn’t receive funding because they’re unlikely to be profitable. The other difference between SIF and a venture capital fund is that any financial returns generated by SIF are re-invested in the foundation’s charitable programs.

Boosting manufacturing capacity for future vaccines is actually a great use case for SIF. Usually, vaccines are manufactured once they have gone through clinical trials and received regulatory approval. However, the urgency of the pandemic requires compressing this process and manufacturing vaccines before it is known which ones will work—and then producing them in larger quantities once clinical trials show they are both safe and effective. This is a huge financial risk for vaccine manufacturers to take on, and without external capital, there is little incentive for them do so. By providing upfront capital, we are using high-impact financial tools to stimulate private sector activity—and hopefully incentivize others to follow suit.

This announcement is a small part of a much broader effort. The Access to COVID-19 Tools Accelerator (or, ACT-A) is a global effort with a Vaccines Pillar aimed at delivering two billion doses of COVID-19 vaccines around the world, including LMICs, by the end of 2021. This will require enough funding to get promising vaccine candidates through clinical trials, manufactured at scale, and delivered all over the world. While the exact price tag remains unknown, the number will likely be in the tens of billions of dollars.

Governments will likely need to look at resources beyond traditional development budgets, as this global crisis calls for a global mindset with new approaches to funding. We know that the return will be seen through faster economic recovery—and most importantly, in lives saved.