Local distribution infrastructure and robust vaccine manufacturing facilities in LMICs should be prioritised to tackle ongoing and future pandemic risk

Reza, Hasan Mahmud; Sultana, Farhana; Bari, Razmin; Cole, Jennifer; Baqui, Abdullah H

doi:10.1016/j.lansea.2023.100158

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…A third of studies in this review addressed access to essential medicines, such as routine vaccines, during the COVID-19 pandemic. In May 2020, UNICEF called for support to clear the backlog in vaccine shipments from HICs where most vaccines are manufactured to LMICs for distribution [ 74 , 75 ]. This backlog was due to logistics challenges and increased transportation costs caused by the COVID-19 pandemic and caused a 70 to 80 per cent reduction in planned vaccine shipments [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review

Dalton,

Sanderson,

Robinson

et al. 2023

PLOS Glob Public Health

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Routine vaccines are critical to child health. The COVID-19 pandemic significantly impacted essential health services, particularly in low-and middle-income countries (LMICs). We reviewed literature to determine the impact of COVID-19 on service delivery and uptake of routine childhood immunisation in LMICs. We reviewed papers published between March 2020 and June 2022 using a scoping review framework, and assessed each paper across the World Health Organisation health system strengthening framework. Our search identified 3,471 publications; 58 studies were included. One-quarter of studies showed routine childhood immunisation coverage declined (10% to 38%) between 2019 to 2021. Declines in the number of vaccine doses administered (25% to 51%), timeliness (6.2% to 34%), and the availability of fixed and outreach services were also reported. Strategies proposed to improve coverage included catch-up activities, strengthening supply chain and outreach services. Re-focusing efforts on increasing coverage is critical to improve child health and reduce the likelihood of disease outbreaks.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review

Dalton,

Sanderson,

Robinson

et al. 2023

PLOS Glob Public Health

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“…Given the difficulty in maintaining cold chain storage in LMICs ( 30 ), we next examined the stability of the Lyo and SFD IBT-V02 formulations at varying storage times and temperatures, and compared the stability to the freshly prepared Liq formulation. First, we tested the storage stability of the IBT-V02 formulations at -20°C and 30°C for 1- and 3-month durations.…”

Section: Resultsmentioning

confidence: 99%

Dry and liquid formulations of IBT-V02, a novel multi-component toxoid vaccine, are effective against Staphylococcus aureus isolates from low-to-middle income countries

Wang,

Mukherjee,

Venkatasubramaniam

et al. 2024

Front. Immunol.

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Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTIs) in the U.S. as well as more serious invasive diseases, including bacteremia, sepsis, endocarditis, surgical site infections, osteomyelitis, and pneumonia. These infections are exacerbated by the emergence of antibiotic-resistant clinical isolates such as methicillin-resistant S. aureus (MRSA), highlighting the need for alternatives to antibiotics to treat bacterial infections. We have previously developed a multi-component toxoid vaccine (IBT-V02) in a liquid formulation with efficacy against multiple strains of Staphylococcus aureus prevalent in the industrialized world. However, liquid vaccine formulations are not compatible with the paucity of cold chain storage infrastructure in many low-to-middle income countries (LMICs). Furthermore, whether our IBT-V02 vaccine formulations are protective against S. aureus isolates from LMICs is unknown. To overcome these limitations, we developed lyophilized and spray freeze-dried formulations of IBT-V02 vaccine and demonstrated that both formulations had comparable biophysical attributes as the liquid formulation, including similar levels of toxin neutralizing antibodies and protective efficacy against MRSA infections in murine and rabbit models. To enhance the relevancy of our findings, we then performed a multi-dimensional screen of 83 S. aureus clinical isolates from LMICs (e.g., Democratic Republic of Congo, Palestine, and Cambodia) to rationally down-select strains to test in our in vivo models based on broad expression of IBT-V02 targets (i.e., pore-forming toxins and superantigens). IBT-V02 polyclonal antisera effectively neutralized toxins produced by the S. aureus clinical isolates from LMICs. Notably, the lyophilized IBT-V02 formulation exhibited significant in vivo efficacy in various preclinical infection models against the S. aureus clinical isolates from LMICs, which was comparable to our liquid formulation. Collectively, our findings suggested that lyophilization is an effective alternative to liquid vaccine formulations of our IBT-V02 vaccine against S. aureus infections, which has important implications for protection from S. aureus isolates from LMICs.

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“…Bottlenecks to sustainably sourcing COVID-19 vaccines have prompted new initiatives to broaden vaccine manufacturing, such as the US $1 billion African Vaccine Manufacturing Accelerator; this initiative aims to support sustainable manufacturing for vaccines, including producing a minimum 13-valent PCV in Africa [30], [31]. Simultaneously in Asia, Thailand has recently approved its first domestically produced COVID-19 vaccine, and advocates have highlighted the strong potential for regional vaccine manufacturing in neighboring countries [32], [33]. These approaches can be leveraged to find innovative approaches to support PCV introduction in MICs.…”

Section: Discussionmentioning

confidence: 99%

Policy perspectives on the sustainable introduction of pneumococcal conjugate vaccines in middle-income countries

Weeks,

Dhaliwal,

Huber

et al. 2024

Preprint

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Despite the well-documented life-saving potential of pneumococcal conjugate vaccines (PCV) and global efforts to widen vaccine availability, access to PCV in middle-income countries (MICs) has remained suboptimal due, in part, to vaccine pricing and limited external funding opportunities. To understand gaps and opportunities for improving vaccine equality, this qualitative study engaged government policymakers and program leaders from MICs that do not currently have PCV in their national immunization programs to explore their perspectives on decision-making contexts and constraints related to PCV introduction. In-depth interviews with 17 participants from Egypt, Jordan, Sri Lanka, and Thailand in 2023 documented that, despite high routine immunization coverage and commitment toward building equitable health systems, implementing new vaccines such as PCV has remained challenging. Among the six thematic areas that emerged, two were strong enablers to vaccine implementation: 1) the existence of strong primary healthcare systems; and 2) established policy processes for vaccine decision-making. Three themes that emerged have historically hindered PCV introduction, including; 1) limited information on disease burden and available vaccine products; 2) competing country health priorities; and 3) financing challenges. The interplay of these thematic areas has documented a paradox unique to MICs, further contributing to inequalities in vaccine access. While a subset of MICs recently became eligible for support from Gavi, the Vaccine Alliance for introducing new vaccines, the marketplace has historically lacked tiered vaccine pricing that MICs could sustain for the long term. This is despite the great need with existing inequities and a substantial proportion of the world’s low-income and displaced populations. Finally, participants pointed to opportunities to address barriers through support from global and regional actors providing technical capacity-strengthening, advocacy, and strategic financial support. These findings are informative for strengthening equality in access to vaccines and developing sustainable strategies to introduce and sustain life-saving childhood vaccines, including PCV.

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Local distribution infrastructure and robust vaccine manufacturing facilities in LMICs should be prioritised to tackle ongoing and future pandemic risk

Cited by 7 publications

References 11 publications

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review

Dry and liquid formulations of IBT-V02, a novel multi-component toxoid vaccine, are effective against Staphylococcus aureus isolates from low-to-middle income countries

Policy perspectives on the sustainable introduction of pneumococcal conjugate vaccines in middle-income countries

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