Vaccines have been thrust into the spotlight like never before during the pandemic. Suddenly, we are all talking about them – how they are created, how they are tested and when the rollout came, which one we had.

The focus during this pandemic is on vaccines for one disease, COVID19, understandably so. But the UK’s vaccination programme includes free vaccination against 21 infectious diseases, including COVID-19. 

The programme as a whole saves untold lives and NHS resources beyond COVID every day and we should never forget its value, which has been demonstrated over many years. 

Implementation of a national programme

In 1941 in England, there were 50,804 cases of diphtheria. Vaccination was introduced in 1942 and has continued ever since, now given as part of the childhood immunisation programme. In 2019 in England, there were only 10 cases reported. 

In 1956 in England, there were 92,410 cases of whooping cough, a disease which can be dangerous for young babies. Vaccination was introduced in 1957, and in 2019 there were 3,994 cases – not perfect, but a huge improvement.

Vaccination has prevented more serious diseases than any other advance in recent medical history, helping to reduce the burden on the NHS and ultimately saving many lives.

The value of vaccines continues to be demonstrated today. Take the shingles vaccine for older people. In the first five years of the shingles vaccine programme, there were 49,000 fewer GP visits, 1,800 fewer hospitalisations for shingles and its complications, that saved the NHS an estimated £10.5 million. 

A study published in the Lancet recently reminded us all of the importance of the HPV vaccine. It showed that HPV vaccination is cutting cases of cervical cancer by nearly 90%. Cervical cancer is the fourth most common cancer in women around the world, killing more than 300,000 globally each year. This study demonstrates that the vaccine is clearly saving women’s lives.

Most successful medical advancement 

Vaccination has prevented more serious diseases than any other advance in recent medical history, helping to reduce the burden on the NHS and ultimately saving many lives. 

Today, the COVID-19 vaccine programme remains an essential tool in our armoury against SARS-COV-2. 

As you get your COVID-19 booster or flu vaccination this winter, don’t forget that in addition to helping us fight this pandemic, researchers around the world are also developing vaccines to help fight as many diseases as possible, to help save lives around the world.

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A new ceramic skin patch is being used as a rapid response to control outbreak situations. It is also helping deliver vaccinations more easily and efficiently.

Mike de Leeuw, CEO of MyLife Technologies, the pharmaceutical company which has created the ceramic skin patch for vaccine delivery says: “With only five grams of mRNA-vaccine, basic field labs can produce up to one million vaccine patches within a few days to protect healthcare workers as a virus outbreak unfolds, anywhere in the world. Today, with standard jabs, that is less than 50,000.”

MyLife Technologies has partners in a clinical trial using an approved mRNA COVID-19 vaccine. It is demonstrating the benefits of their patches with HPV vaccines for low-and-middle-income countries; and it is accelerating scale-up to full-scale manufacturing.

These microneedles are like a ceramic sponge, yet are very strong and can carry, stabilise and quickly release most types of vaccines. They are applied within 30 seconds like any other skin patch.

Alternative vaccine delivery

The ‘patch’ is smaller than a fingertip and features a hundred, minute ceramic microneedles. De Leeuw says: “These microneedles are like a ceramic sponge, yet are very strong and can carry, stabilise and quickly release most types of vaccines. They are applied within 30 seconds like any other skin patch. The microneedle tips never touch a nerve or a blood vessel, making vaccination painless.”

Microneedle patch-technology is listed number one for the future of global vaccination by VIPS, the largest NGO-consortium evaluating vaccine technology. This is because top layers of the skin contain specialised immune cells that process vaccines against viruses and bacteria. Delivering vaccine in the first 150-400 micron of skin is much more efficient than vaccination with jabs into muscle tissue, where these cells are not found normally.

The company has shown efficacy in Influenza-A trials in animals, and it successfully demonstrated safety/tolerability with human volunteers. Various clinical trials with different vaccines have shown that skin vaccination requires 5-20 times less vaccine to achieve equivalent protection compared to standard jabs.

De Leeuw concludes: “We offer our patches for NGO-backed projects to speed-up vaccinations in LMIC’s. Our ceramic patches avoid needle stick anxiety and can eliminate expensive cold chain distribution. Especially with HPV, the cause of many smaller cancer diseases, this can help to raise the vaccination rate in adolescents worldwide.”

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Inequitable vaccine distribution has exacerbated the COVID-19 crisis for the world’s poorest populations and prolonged the pandemic. Regional vaccine self-sufficiency will boost global health and economic security.

Astonishingly effective vaccines against COVID-19 were created, tested and manufactured in an all-out push to stop the pandemic. That effort has fallen short in part because wealthy countries locked up access to an outsized share of those vaccines and not for the first time: a similar scenario occurred during the 2009 H1N1 influenza pandemic. To meet future pandemic threats that inevitably will arise—as well as pressing local needs—every global region must gain the ability to discover, develop, manufacture and distribute vaccines.

Recognising the value of vaccines

A growing body of evidence shows that vaccines offer far more than disease protection. Vaccinated populations enjoy increased educational economic productivity and financial security, along with reduced healthcare expenditures and pressure on health systems. Vaccines therefore not only improve the lives of the individuals who receive them, but also their households, their communities and the whole of society. Gaining these benefits requires investment in vaccine R&D infrastructure to serve the entire world, not just wealthy countries. It is time to build capacity in every global region—and especially in the Global South—to deliver vaccines tailored to local needs that are safe, effective and affordable.

Expanding vaccine access

Today, vaccine R&D largely happens in the high-income countries from which vaccine makers reap most of their profits. There has been little private-sector interest in pursuing vaccines against diseases such as malaria and tuberculosis that mainly threaten low- and middle-income countries. Similarly, there is little profit incentive in designing vaccines for places that lack refrigeration, or where needle injections are culturally unacceptable or difficult to administer safely.

These constraints limit the benefits of vaccination in much of the world and, in the COVID-19 pandemic, have contributed to the loss of lives and livelihoods, as well as to the rise of variant viruses. We are learning the hard way that infectious diseases can spread anywhere unless they are stopped everywhere.

We are learning the hard way that infectious diseases can spread anywhere unless they are stopped everywhere. 

Creating regional vaccine ecosystems

To increase vaccine access, effectiveness and uptake worldwide, we must abandon the “one size fits all” approach to vaccine R&D and make it more regionally responsive. That means building the entire vaccine ecosystem—spanning discovery through development, clinical trials, manufacturing, distribution and administration—to meet the specific needs of each region, along with the necessary infrastructure and workforce.

Establishing vaccine ecosystems in each global region will make the whole world healthier, safer and more prosperous. Estimates of the investment necessary to accomplish this comprise a tiny fraction of what COVID-19 has already cost the global economy. Now is the time for national governments, donors, and development banks to recognise the value of regionally responsive vaccine ecosystems and to provide the ongoing investment necessary to create and sustain them.

Building back better

While COVID-19 exposed gaps in global pandemic preparedness, it also proved the value of several novel vaccine technologies, most notably the potentially adaptable mRNA platforms.

The “plug-and-play” design of mRNA vaccines, and their relative simplicity of manufacture, puts them within reach of countries that now lack vaccine infrastructure. It also makes possible the production of vaccines to stop viral threats whenever and wherever they emerge, forestalling future pandemics.

mRNA vaccines and other advances spurred by the COVID-19 experience offer the technical means to better prepare the world for pandemics to come. When regionally responsive vaccine ecosystems exploit such breakthroughs to protect local populations from a myriad of viral threats, we truly will have “built back better.”

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Real-time temperature data monitoring of vaccine storage fridges is a critical step towards more effective immunisation programmes in low-and-middle- income countries.

Reliable data is a key component in helping achieve greater vaccine equity. Central to that is access to and utilisation of real-time data to ensure vaccines are always stored at the correct temperatures so they remain effective and deliver immunity.

Temperature monitoring

As donations of COVID-19 vaccines to poorer countries continue, there remains a gap between distribution and effective delivery of doses. This is according to non-profit technology company Nexleaf Analytics, which partners with countries to make sure they have the data they need to improve the health of their people.

Nexleaf has created a real-time temperature monitoring device that alerts health officials to fridges that are too warm, or if there are power outages, which could see vaccines kept at the wrong temperature, rendering them less effective, or ineffective. ​​The data is stored on a dashboard, allowing health staff to remotely monitor the performance of cold chain equipment and effectively plan for fridge maintenance or replacements.

The company’s CEO and Co-Founder, Nithya Ramanathan, underlines the importance of strong data systems to monitor vaccine cold chain temperatures and also help in better planning and execution of vaccine distribution and delivery in low-and-middle-income countries.

Our goal is vaccine equity and having strong data systems and infrastructure in place is absolutely necessary for achieving that.

Sustainable solutions

With increased global investment in vaccine systems in response to COVID, now is a critical time to ensure that these investments not only benefit the current delivery of COVID vaccines but for a range of vaccines needed for existing and potential future conditions.

Vaccine equity

Ramanathan also emphasises that the needs of low-and-middle-income countries have to be listened to, enabling them to take ownership of their data and health resources with sustainable country-led solutions.

She points to Kenya’s success in delivering 1.1 million doses of COVID vaccine across the country in two months, achieved by having access and ownership of its cold chain management and vaccine distribution data to find and use existing fridges that worked.

“Our goal is vaccine equity and having strong data systems and infrastructure in place is absolutely necessary for achieving that,” says Ramanathan.

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Cohesive and coordinated partnerships across governments, industry and healthcare were a critical facet of the race to develop and deliver vaccines during the COVID-19 pandemic.

As COVID-19 swept the globe, an urgent drive was launched to implement restrictions to slow the spread and join the race for a vaccine.

Yet beyond ground-breaking research and science to develop the vaccine, there were logistical issues of manufacturing, distributing and delivering the vaccine across populations. Global med-tech company Becton Dickinson (BD), the world’s largest manufacturer of syringes, was among industry partners involved in aspects of the vaccine development.

Vaccine response

Tony Kirk, BD’s Country Business Leader for Medication Delivery Solutions (UK and Ireland), explains the company provided products for the research process, clinical trials, developed point-of-care diagnostic tests, as well as supporting delivery of vaccinations.

Underlining the importance of collaboration in the process of an effective vaccine response, he says: “Collaboration is paramount. In the COVID pandemic, if we did not have collaboration, we would not have achieved what we did, at the pace we did in the past 18 months.

Collaboration from government, health-tech, [pharma], and the NHS and HSE to vaccinate patients has been an incredible success story.

“There was a call to action globally to develop a vaccine in record time. We have been able to produce that in terms of developing a vaccine and then delivery into patients and as a company, I feel we have really contributed to that.”

To date, BD has produced two billion syringes which have been distributed globally to support vaccination programmes, with over 102 million syringes for the vaccination programme in the UK and Ireland.

“I think collaboration from government, health-tech, [pharma], and the NHS and HSE to vaccinate the patients has been an incredible success story.”

But he stresses the need for further development in terms of more efficient vaccines and better delivery of those vaccines to patients, including via the use of pre-filled syringes.

Openness and transparency

Alongside collaboration, he emphasises the need for transparency, openness, forward-planning and information sharing at a time of pandemic.

“One of the key lessons learned from COVID is the need for governments to engage early with med-tech to identify the most effective way to deliver vaccines, but also in terms of capacity and supply-chain resilience,” adds Kirk.

“We know that there have been some challenges in terms of vaccines and volume required but globally, the response to the pandemic was a remarkable success. Although there are learnings we need to take away, particularly in terms of speed of decision making and transparency.

“But partnership and collaboration with government and drug companies is key in the future of handling these pandemics.”

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The biopharmaceutical industry stands ready to partner in current and future efforts for pandemic preparedness.

It is difficult to predict the nature of the next health threat. We do not know where, how or when it will hit. What we know is that playing catch is a lost battle.

In a matter of months, vaccine developers and manufacturers have developed multiple COVID-19 vaccines and forged collaborations to ramp up production. Decades of scientific exploration and investment enabled technologies such as mRNA and viral vector COVID-19 vaccines. But next time we can be even faster, if there is sufficient, sustainable financing and technical assistance to support early procurement and country readiness.

Building back better

The world must be prepared to prevent the next “Disease X” from becoming a pandemic. The G7 agreed to a vision for a 100-day response to an emerging threat, shrinking the already unprecedented 326 days achieved for first COVID-19 vaccine approval.

The biopharmaceutical industry has committed to invest in R&D on pathogens with pandemic potential and to build a portfolio of promising candidate vaccines. It will also continue to invest in “established” and new mRNA technologies, seeking ways to strengthen immune response and duration of protection whilst looking at reducing manufacturing complexity.

In a matter of months, vaccine developers and manufacturers have developed multiple COVID-19 vaccines and forged collaborations to ramp up production.

Industry will play its part alongside other key stakeholders to be as well prepared as we can be. It will require a multi-layered effort to build systems, infrastructure and an effective global governance to ensure relevant stakeholders are utilised, coordinated and integrated around agreed shared objectives. A comprehensive multilateral commitment for immediate sharing of pathogens and data is needed to ensure that no time is lost, alongside global clinical trial infrastructure, regulatory convergence and reliance.

Upscaling vaccines for pandemic preparedness

In building back better, we aim for enough vaccines to be produced for deployment around the world within the first 100 days of a pandemic. A strategic vision and roadmap for flexible, sustainable global manufacturing capacity needs to be developed with relevant public and private stakeholders, accounting for the extensive COVID-19 vaccine production capacity, location of new capacity across all regions and expert staff ready to deliver surge volumes when needed. 

Creating demand for vaccine manufacturing capacities during inter-pandemic times

The goal should be to achieve a healthy market dynamic over time, including in inter-pandemic periods that provides appropriate incentives to balance global access and innovation. Demand for lifelong immunisation will not only improve health and wellbeing but will also build the needed vaccine delivery infrastructure and sustain manufacturing capacity.

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Becky Rice

Head of Health at Policy Connect

The COVID-19 vaccination programme provides important policy lessons about how to promote vaccine uptake and reduce inequalities in access.

The COVID-19 vaccination programme – the first ever to vaccinate the entire adult population of the UK – may be the start of a new era of how we regard vaccines as a public health tool. However, policy makers need to learn the correct lessons from the successes and challenges encountered in COVID-19, particularly around how to maximise uptake, reduce misinformation and promote confidence in vaccines as a standard public health measure. 

Vaccine mandates 

For some workers, the Government has found it appropriate to mandate vaccines: care home staff already need to be vaccinated against COVID-19 in order to continue working, this will also apply to NHS staff from April 2022. Other measures including restrictions on travel and company policies may also act as indirect vaccination mandates for some occupations. 

An initial assessment suggests that creating financial consequences for those who refuse vaccination has the benefit of increasing uptake, but can also embed opposition and does nothing to address underlying vaccine suspicions and hesitancy.

Improving health literacy over time needs more than one-off public health campaigns: the evidence is clear that in many communities, their impact is minimal and short-lived.

Sustained programme of education 

While mandating vaccination may be needed in a crisis, an overall lesson is that there should be a sustained programme of education about vaccines to promote uptake. Improving health literacy over time needs more than one-off public health campaigns: the evidence is clear that in many communities, their impact is minimal and short-lived. 

Tackling misinformation 

Health information about vaccinations has to contend with misinformation that is hard to track and counter. If uptake is to be increased against a background of conspiracy theory and mistrust, policy makers do need to be honest about the potential downsides (side effects) as well as benefits of vaccines and to develop risk language that can be understood. Furthermore, information must be personalised for the communities and individuals in an evolving landscape of anti-vaccination messaging. 

Reliable sources 

The accessibility of vaccines, and trust in who is delivering them, is another important factor. COVID-19 demonstrated that vaccine uptake is improved when delivered by a trusted source and in a local setting. The engagement of local leaders, industry, volunteers and doctors – all of whom are more trusted than national figures – in messaging and vaccine delivery has proved a key factor in increasing confidence.None of this can be done without directing effort and money towards the right part of the public health system. This will benefit the NHS and the economy through increased vaccination uptake and improved public health.

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Dr Kate Emary

Clinical Research Fellow

Much of the discussion on ‘vaccine nationalism’ has been focussed on the vaccine supply ‘winners’ and ‘losers’, but the voices of public opinion have been more limited. To understand this better, we surveyed and interviewed participants in the Oxford-AstraZeneca vaccine trial.

Trial participants favoured a COVID-19 vaccine allocated according to need worldwide. Despite national pride in the Oxford-AstraZeneca vaccine, participants did not think this outweighed their desire for the global greater good. The participants were proud of the UK’s achievement but also believed the vaccine should be a shared global good and wanted to end the pandemic globally. They spoke about helping the most vulnerable and where need was the greatest.

We need to internationalise COVID-19 vaccines and get them to the places and people that need them most.

The importance of vaccines for all 

Our study showed that participants felt conflicted about how the resulting successful vaccine would be used. The participants spoke very strongly about their hopes that they were doing their part for the most vulnerable across the world, not just the UK. A smaller number hoped that the UK would receive the vaccine first, often due to the use of taxpayer money, local facilities and talent, admitting that they just wanted their lives to go back to normal. However, this did not mean the lives of others elsewhere in the world felt less important to them. 

“I think it should just go to globally whoever is going to benefit from it the most… I think it should be key workers around the world, the people that need it the most around the world,” said one participant.

Another agreed: “The idealist bit of me would just want a global approach to [the vaccine rollout] really, because that’s the only way we’re going to solve [the pandemic] properly.”

Public support for equitable access 

Public support is key to ensuring that global equitable vaccine access is achieved. We have shown that the support is there if governments and the pharmaceutical industry are willing to listen. Initiatives like COVAX and the G7’s pledge of 1 billion vaccine doses for poorer countries reflect the ambitions we have seen from participants and the public statements of those involved in vaccine development. 

We need to internationalise COVID-19 vaccines and get them to the places and people that need them most. However, the reality is that the outcomes in practice are still falling far short of the vision. More than 95% of people in low-income countries are yet to receive their first dose meanwhile, some high-income nations are offering ‘booster shots’ to the fully vaccinated.

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Equitable access to vaccines is key to stop the spread of COVID-19, yet just 4% of people in low-income countries are vaccinated.

To save lives around the world, COVID-19 vaccines must be shared more equitably and become widely available in low- and middle-income countries. However, obtaining enough vaccines is only the first hurdle. To get shots into arms rapidly, developing countries have to be prepared and equipped for mass vaccination. Following a needs assessment conducted in more than 140 countries, the World Bank committed USD 20 billion to help countries purchase vaccine doses and strengthen their health infrastructure to prepare for vaccination rollout. 

A complex and massive task

Large-scale immunisation campaigns involve complicated operations from the moment vaccines arrive at the border until they reach their intended recipients. After identifying the most vulnerable people and setting priorities, countries need to boost their health infrastructure, equip health centres, expand storage and cold chains while also training the health workers who will carry out the vaccination. Transport to remote areas often requires complex logistical planning.

By explaining the benefits of vaccination, countries can combat misinformation and improve vaccination uptake.

Supporting countries and addressing specific needs 

Beyond access to vaccines, needs vary from one country to the next. In Ecuador, for example, the World Bank financing is helping the country to purchase vaccines, manage supply chains and logistics for storage and handling, and provide PPE for health workers. In Nepal, World Bank financing helps strengthen the health system and procure diagnostic tests, laboratory equipment and therapeutics. The country is also expanding surveillance and monitoring – crucial to track vaccination progress – using digital technology. 

Overcoming vaccine hesitancy

Community engagement and outreach are critical to the success of COVID-19 vaccination campaigns. By explaining the benefits of vaccination, countries can combat misinformation and improve vaccination uptake. After early immunisation efforts faced resistance, Cote d’Ivoire launched an awareness-raising drive, enlisting the help of media influencers, religious and community leaders and local elected officials to reach the population. Within a few weeks, daily vaccination rates increased tenfold. With just 4% of people vaccinated in low-income countries, efforts to prevent the spread of COVID-19 and mitigate its impact are still ongoing. We will continue to work with countries and partners like the COVAX facility and the Africa Vaccine Acquisition Trust to make life saving vaccines available to all everywhere.

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Lower income countries are in desperate need of access to life saving vaccines, but with cuts to the overseas aid budget, the hoarding of vaccines and broken promises, millions of lives are being threatened.

The eradication of smallpox and near eradication of wild polio are testament to the efficacy of vaccines in protecting us from life-changing or fatal diseases. Their importance has been amplified with the spread of COVID-19.

Lower income countries are in desperate need of access to life saving vaccines.

The success of the COVID vaccine roll out

In late 2020, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) gave the green light to the use of the Pfizer and AstraZeneca vaccines. The health services of the four UK nations subsequently rolled out the vaccines at an incredible pace and achieved very high coverage, a scientific and logistical endeavour that deserves high praise. 

Lack of access for lower income countries

Last spring, as the warm words emanating from the international community combined with the billions invested by governments into vaccine R&D, hopes were high that the COVID-19 pandemic would inspire an equitable global response. High international vaccine coverage was rightly determined to be key in ending the pandemic. 

However, the successful vaccine rollout in the UK contrasts with a lack of access for lower income countries, where only 2% of the population have been vaccinated. Expressions of solidarity have been undermined by rich countries, including the UK, hoarding vaccines and failing to fulfil their promises to donate excess doses. Shockingly, only 6% of the 80 million doses promised by the UK, through the WHO’s COVAX mechanism, have been distributed so far.

Although dose sharing is necessary, it is also vital to expand overall global production if we are to vaccinate the world’s population and limit the pandemic. Unfortunately, the UK is among the countries limiting the sharing of intellectual property and technology which would allow manufacturing to be significantly scaled up.

A call for action

While the UK and other wealthy countries enjoy access to life saving vaccines, both for COVID-19 and other vaccine-preventable diseases such as polio and tetanus, the lack of sustainable access in many low-income countries puts millions of lives at risk. The UK has consistently championed the improvement of health globally through vaccination, but the ongoing cuts to the overseas aid budget, such as the 95% cut to polio-eradication funding, are undermining that reputation. 

The failure of the international community to ensure equitable dose sharing and massive expansion of production will result in the COVID-19 virus continuing to circulate in unvaccinated populations. Our actions directly threaten the lives of millions of people and risk the emergence of further vaccine-resistant variants.

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