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Awaiting a chance to prove themselves, key technological advances that enabled swift development of vaccines against SARS-CoV-2 stood by for years before the pandemic struck. Chief among these were mRNA-based vaccines, which stalled in early-stage development. Research funders questioned the scientific merit of novel immunological approaches; major vaccine producers doubted their profit potential. Nevertheless, a handful of innovation-seeking public-private development partnerships, fueled by hard-won support, drove novel vaccine platforms forward just as SARS-CoV-2 gripped the world.As with much else, the COVID-19 pandemic upended vaccine research and development (R&D), leaving the world’s largest vaccine makers to play catch-up with smaller companies focused on vaccine innovation. Biotech start-ups capitalizing on cutting-edge technologies increasingly are driving vaccine development, which in turn is shedding its image as an investment backwater. Maintaining this momentum through ongoing investment in technological innovation can drive breakthroughs to thwart future pandemic threats, as well as endemic diseases that kill millions each year.During the early months of the historic rollout of vaccines to fight COVID-19, the Sabin Vaccine Institute’s Influenzer Initiative asked experts and innovators specifically to reflect on the past, present, and game-changing future of mRNA vaccine protection against a range of viral threats, including influenza. Exciting insights from these conversations are featured in the initiative’s latest video episode. As several of those interviewed attest, mRNA vaccines exemplify how basic discovery research coupled with targeted translational investments remain the engine of transformative innovations that save uncountable lives and immeasurably improve their quality. Eric Topol, founder of Scripps Research Translational Institute, observes that investments in immunology, virology, and molecular and structural biology provided the foundation for the rapid development of successful vaccines against SARS-CoV-2. David Topham, the founding director of the Translational Immunology and Infectious Diseases Institute at the University of Rochester, notes that vaccine platforms that have delivered us out of the current pandemic were enabled by targeted investments in nanoparticle technology.  Innovations like the COVID-19 vaccines provide benefits that extend far beyond their initial targets, such that every dollar spent on R&D yields five in return, notes economist Benjamin Jones of Northwestern University. In the case of mRNA vaccines, that beneficial ripple effect may include disarming the next pandemic threat. “Today we need methodologies that we can rapidly adapt so that when a new pathogen arises, we can make a vaccine against it,” says Teresa Lambe of Oxford University. That’s a key advantage of the mRNA platform, according to Topol. “mRNA does appear to have the ultimate flexibility,” he observes. “You go from sequence to template in a matter of hours.” SARS-CoV-2 demonstrates the value of this nimble technology, as the triumphant achievement of astonishingly effective vaccines remains threatened by the rise of potentially evasive variants—a long-standing challenge in building defenses against the next influenza pandemic.The challenges and consequences of inequitable access to vaccines has never been more sharply evidenced than by the current pandemic. The relative simplicity of mRNA vaccine manufacturing, as compared with that of traditional vaccine approaches, offers the potential to make vaccines when and where viral threats emerge and more readily available to the people who most need them. Vaccine manufacturing processes should be designed to be globally adaptable, Lambe argues. “All low- to middle-income countries, in fact all countries, should have the ability to make vaccines for themselves and to supply worldwide,” she says. Rajeev Venkayya, of Takeda Pharmaceutical Company, adds that decentralized vaccine production offers benefits beyond those provided by vaccines themselves. He describes how countries new to vaccine manufacturing could “leapfrog” into cutting-edge technology via mRNA vaccine production and build a new ecosystem for vaccine research, development, and distribution. The full potential of mRNA vaccines thus extends far beyond quashing pandemics. Developed and produced according to national or regional needs, mRNA vaccines can create innovative opportunity and healthier futures for people everywhere.Decades will be spent taking the measure of the COVID-19 pandemic: calculating its toll in multiple metrics, defining its vast and diverse lessons, and recognizing the changes it catalyzed. During that time, viruses with potential to cause even greater destruction will emerge. As the recent declaration of G7 leaders emphasizes, we must act now to develop transformative, adaptable, and affordable technologies to meet these threats—a declaration that George Gao, director of the Chinese Center for Disease Control and Prevention, insists must produce action. Among the pursuits he advocates is the exploitation of recently proven vaccine technologies to prevent another pandemic. “mRNA plus nanoparticle vaccines are two important routes for the development of novel influenza vaccines,” he says. Novel vaccines that enable robust, globally accessible disease prevention are within reach, according to Amesh Adalja of Johns Hopkins University. “I don’t think we’re going to be left in such a position with future emerging infectious disease emergencies,” he concludes. We take courage from these words, and those of Venkayya, who expressed his hope “that people will seize this moment to recognize that we could potentially avert the next pandemic.” 

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Leaders of G7 countries committed this weekend to sharing at least 870 million COVID-19 vaccine doses with countries around the world. More than half of the doses will come from the United States, which the Biden administration announced earlier in the week would buy 500 million Pfizer doses, 200 million of which will be distributed by the end of this year followed by 300 million by next June, all through the COVAX vaccine-sharing facility. The United Kingdom pledged to donate 100 million doses, the first 5 million of which will be shared in the coming weeks. France and Germany will each share at least 30 million doses. The announcement comes as inequities in vaccine supply around the world have become more pronounced, and G7 leaders have faced increased pressure to outline global vaccine-sharing plans.The COVID-19 vaccine developed by Johnson & Johnson appears to be effective against leading virus variants, according to a new study published in Nature last week that looked at immune responses in the blood of vaccinated individuals. While data did show a reduction in neutralizing antibodies to the Beta and Gamma variants, researchers also noted that there are several other types of immune responses, including binding antibodies, FC functional antibodies, and T-cell responses. T-cell responses, which are critical in keeping an infection from spreading, were not reduced to the Beta, Alpha, or Gamma variants, according to the research. Studies have shown similar results with the Pfizer/BioNTech and Moderna COVID-19 vaccines. Researchers are continuing to evaluate vaccine-induced immune responses against variants, including how long the T-cell response lasts.The use of Wolbachia-infected mosquitos reduced cases of dengue fever by 77 percent in a clinical trial conducted in Yogyakarta, Indonesia, new data shows. The findings also showed an 86 percent reduction in hospitalizations due to dengue fever. The trial, conducted by the World Mosquito Program, used mosquitoes infected with Wolbachia bacteria, which reduces virus replication inside mosquitoes, limiting their likelihood of passing on dengue infection. Wolbachia can also alter the fertility of their hosts to ensure they are passed on to the next generation of mosquitoes, providing continued protection against dengue infection. The trial will be expanded across the whole city and surrounding areas, with the aim of eradicating dengue in the region.

Editor’s update, June 17, 2021: At the G7 summit, member countries committed to sharing at least 870 million COVID-19 vaccine doses over the next year. While this pledge is welcome, it falls short of the 1 billion target touted in the lead-up to the summit and only a small fraction of the 11 billion doses still needed to vaccinate 70 percent of the global population. Additionally, no new financial commitments were made to the Access to COVID-19 Tools Accelerator, which is facing a US$18.1 billion funding gap. In a positive directional step, leaders promised to “explore options for building consensus this year, around sustainable global health and health security financing,” and affirmed that they “support efforts to accelerate manufacturing capacities of COVID-19 tools on all continents…and in particular will strive to support African efforts to establish regional manufacturing hubs.” However, there was no clear guidance on how the G7 will transform these high-level pledges into concrete action. Overall, member states affirmed the sustained importance of research and development for COVID-19, promising “to continue our investment in cutting edge research and innovation,” expand genomic sequencing and sharing, and build upon existing innovation and collaboration.This weekend, leaders from the G7 will come together in Cornwall, England, for the first in-person summit of this group in two years, after last year’s meeting was cancelled and high-profile geopolitical rows caused much acrimony at previous convenings. Leaders are seeking to revive multilateralism and highlight that this forum can still play a significant role in shaping and responding to major world events. Their most urgent task will be to tackle the global pandemic and particularly address the unequal distribution of COVID-19 tools, as well as start to build additional long-term infrastructure and capacities both regionally and globally to prevent future health outbreaks. Greater coordination around innovation and greater investment in research and development (R&D) capacities as part of health system strengthening and pandemic preparedness should play a crucial role in these discussions, and G7 leaders must seize the moment to take bold action and reimagine the future of global health security.G7 leaders take first steps to create improvements to the global health security architectureLast week, health ministers already took several steps toward scientific collaboration to address current and future health threats by making concrete pledges in their G7 Health Ministers’ Declaration. This included adopting a new therapeutics and vaccines clinical trials charter, which sets out shared principles to accelerate the speed with which clinical trials generate robust evidence and lead to quicker adoption of new tools in this and future pandemics. This charter will strengthen collaboration in large-scale international trials and enable greater diversity of participants, including pregnant people and children.Health ministers also agreed to develop a shared set of principles that could incentivize the development of and access to both novel and existing antimicrobial products and ensure a sustainable antimicrobial R&D ecosystem, including resilient and diverse supply chains and greater manufacturing capacity. They also underscored the important contributions of several initiatives and organizations, including the Global Antibiotic Research and Development Partnership as well as Global AMR R&D Hub, which push for accelerating the development of novel technologies to fight antimicrobial resistance.Scientific capabilities, including pathogen genomics, also have a vital part to play in surveillance and development of new tools, and leaders also sought to create platforms to enable greater collaboration through the United Kingdom’s New Variant Assessment Platform, as part of a focused global effort to strengthen surveillance of potential COVID-19 variants of concern and potential future priority pathogens.While these decisions represent progress and are welcome steps in the right direction, with the pandemic still raging in much of the world, both immediate COVID-19 needs and larger reform efforts will have to be addressed simultaneously during the Leaders’ Summit.The time for bold action is nowGlobal leaders must take immediate decisive action to fully fund the Access to COVID-19 Tools Accelerator (ACT-A) and fill urgent gaps for all aspects of the current global framework, including the diagnostics and therapeutics pillars. This means G7 leaders should pledge 60 percent of the US$19 billion required for ACT-A in 2021 during this weekend’s summit. This would ensure that organizations like the Coalition for Epidemic Preparedness Innovations are properly resourced to advance R&D, ensuring that vaccines are keeping up with variants and that diagnostics and other medical countermeasures are not neglected as part of the global response efforts.Testing, oxygen therapies, and therapeutics are central to combatting the pandemic and must be recognized through continued investment. This is especially relevant given that fewer than one in five health facilities across Africa had access to COVID-19 tests in 2020. To address these imbalances, further innovation is needed to ensure appropriate, high-quality rapid tests and other health tools are affordable and available everywhere. Donor countries must scale up the production of tests, treatments, and health commodities, including oxygen, and accelerate low- and middle-income country (LMIC)-led R&D to ensure greater equitable access globally.Many advocates are also expecting G7 leaders to finally deliver on vaccine sharing, release more vaccine doses to COVAX, and commit to a clear strategy for global vaccination. While the politics of prioritizing their own domestic populations represents a continuing factor for global leaders, especially with G7 countries not having reached herd immunity at home, there are clear epidemiological and ethical imperatives to accelerate the pace of vaccine shipments abroad. The Biden administration did take a major first step with the announcement that the US government will purchase 500 million doses for LMICs, with 200 million doses being shared by the end of this year. Now other donor nations must follow suit and raise their ambition at this forum and scale up their own dose sharing pledges and allocation strategies. G7 leaders should pledge 2 billion doses at the Leaders’ Summit, delivering 1 billion by the end of August and the second billion by the end of 2021, and as part of this delivery, ensure that 250 million additional people in LMICs have actually received their doses by the end of August in parallel with national vaccine rollout plans.Laying the groundwork for future pandemic response frameworksWe have seen during this pandemic how essential scientific collaboration has been, and how investment in R&D spurred unprecedented innovation of new vaccines and other health technologies in record time. These successes continue to be hampered by a lack of equitable access, unpredictable and insufficient funding, and a lack of clear coordination frameworks. G7 leaders have an opportunity this weekend to also start to outline a road map for the future and make concrete commitments to reform efforts for the pandemic preparedness ecosystem. This includes leveraging existing multilateral institution resources in new ways, unlocking sustainable financing for global health innovation by making R&D investments eligible for financing from the World Bank and other international financial institutions, and creating new financial mechanisms for pandemic preparedness. This new capital would support LMICs in securing new resources to strengthen their research, laboratory, surveillance, and manufacturing capabilities, and ensure that all countries have pathways to gain access to the innovations and health technologies they need to respond to health outbreaks.The pandemic has elevated and highlighted the importance of science, the power of partnerships, and the necessity of investing in R&D to ensure that countries are equipped with the vital tools to respond to major health outbreaks. G7 leaders must now ensure that the pressing challenge of global equity is addressed and use the political momentum to create the kind of game-changing reforms that enshrine greater scientific coordination and clear preparedness structures that allow for a more equitable and comprehensive global response to future health threats. This summit is a test for G7 leaders, especially for the United Kingdom as host, as the group must come together to ensure that any new commitments to strengthening the health security architecture do not come at the expense of decades of investments in other health R&D areas.