'The challenge is real'
Experts weigh in on vaccine development in the CaribbeanSunday, July 25, 2021
BY ROMARDO LYONS
AMID the uncertainties surrounding COVID-19 vaccine supply and access globally, there is one recurring question being hurled at the Jamaican Government: “Why can't Jamaica produce its own vaccine?”
At the first in a three-part Your Health Your Wealth webinar series hosted by the Jamaica Observer last week Sunday, various players in public health explored the topic: 'Should more Caribbean countries explore vaccine development?', underscoring issues such as a lack of resources, personnel and investment.
Dr Adella Campbell, associate professor and head of the Caribbean School of Nursing at the University of Technology (UTech), Jamaica, said the global demand for COVID-19 vaccines is currently as much as five times the rate of production, and larger, wealthier countries have secured most of the early products.
“The challenge is real. However, let me hasten to say that the challenges encountered by Jamaica are very similar to those encountered by other countries in the region,” Dr Campbell said. “Based on the foregoing, one will agree on one hand that we should [develop our own vaccines], with benefits to include self-reliance, because it is important that countries in the region be prepared to respond to emerging trends; there will be long-term access, especially where the disruption in supply from other countries is inevitable; home-grown vaccines may boost the country's economy. Additionally, there may be future deadly outbreaks which may not be global, but can necessitate the development of a vaccine.”
At the same time, one may argue that a small country like Jamaica should focus on its strengths, she added, which, in this case, is tourism.
“There is the general lack of resources, to include human, material and money. For example, the last time I checked, we had approximately four virologists in Jamaica. We lack sufficient numbers of biotechnologists, especially specialists in molecular biology and molecular diagnostics,” Dr Campbell said.
Meanwhile, immunologist Dr Yohann White argued that vaccine development is not new to the Caribbean.
“Cuba, Jamaica and perhaps a number of other countries have been involved in multinational clinical trials with vaccines. So, it's not a new phenomenon for us,” he said.
In the same breath, Dr White pointed to the overwhelming need for Caribbean countries to build a research culture for the manufacturing of vaccines in the region.
“And, building a research culture for the manufacturing of vaccines in the Caribbean includes building the capacity for research, in general, because vaccine research has one of the highest safety thresholds,” Dr White said.
A benefit of this, the immunologist said, is that the Caribbean wouldn't be in a situation where it has to wait on entities like the World Health Organization (WHO) to evaluate vaccines before administration.
“If countries have strong vaccine development industries and systems, then individual countries or regions could go ahead and do that evaluation, and, perhaps, going ahead of multinational organisations that do not have the resources or the systems operating in an efficient way to be able to do those evaluations in a timely manner, especially in the setting of a pandemic when things are moving very fast.
“The rate of vaccination globally is lagging, and that creates an environment for mutants or variants to develop and then that becomes even more problematic,” Dr White said.
Nonetheless, Dr Campbell underscored the fact that whether Jamaica would be able to export locally developed vaccines to developing and developed countries is another factor with which to contend.
“By the same token, what role will large pharmaceutical countries play in the success of vaccine development in Jamaica and the region? Take, for example, our cannabis industry, we are unable to make inroads into the multi-billion-dollar global industry. What then is the way forward? One would agree that Caribbean people are resilient and ambitious; Jamaica, for example, has the potential for developing unique products for export trade,” she said.
With that in mind, the associate professor believes that vaccine development in the Caribbean could be pursued.
“It requires a plan. It requires bilateral agreements as well as public and private partnership among countries, entities, and the Diaspora. Grant funding by multi-billion-dollar industries and foundations will also play important roles. Partnership will be required to put the necessary research and laboratory infrastructure in place to facilitate the various processes,” she said, noting that vaccine development takes up to 10 years.
Dr Campbell pointed out, too, that there is also a need for trained personnel with knowledge of the requisite technology for vaccine production.
“As such, partnership with other countries such as Cuba could change this scenario. For example, there could be internships in facilities in Cuba with the goal being to build skills,” she said.
Dr White added: “Participant recruitment is another arm of vaccine development that is important. Where do you get the participants? Who are the correct participants to include in vaccine development? Other aspects include who are the foot soldiers. Who are physicians and nurses and community help aides who are going to go out and administer the vaccine or recruit persons for participation and following up persons?”
Suggestively, Dr Campbell said another option could be for Jamaica to recruit experts from Cuba — where vaccines have been in production since 1981 following the outbreak of dengue fever — to establish programmes and build capacity.
“Cuba is one of the most advanced countries in medical technologies and one which enjoys a high level of self-reliance. This will result in us having a cadre of biotechnologists, among other health practitioners, who will be able to advance the production of vaccines locally,” she reasoned.
Cuba has managed to develop five COVID-19 vaccine candidates in a “short time”, one of which has been approved for emergency use, because of what Dr Jose Armando Arronte Villamarin, national coordinator of the Cuban Medical Bridge in Jamaica, described as a unique biotechnology sector.
“It (biotechnology sector) is entirely State-owned and free of private interests, with innovation channelled to meet public health needs and no profit-seeking in the domestic market. Dozens of research and development institutions collaborate, sharing resources and knowledge instead of competing, which facilitates a fast-track from research and innovation to trials and application,” Dr Armando said, explaining the reasons behind Cuba's success.
“Cuba has the capacity to produce 60 to 70 per cent of the medicines it consumes domestically, an imperative due to the US blockade and the cost of medicines in the international market,” he added.
Further, Cuba vaccinates against 13 diseases with 11 vaccines. Eight of those vaccines are produced in Cuba.
“Six diseases have been eliminated as a result of vaccination schedules and vaccines produced with these technologies have been administered even to children in the first months of life,” added Dr Armando.
Meanwhile, Professor Peter Figueroa, chair of the Caribbean Immunisation Technical Advisory Group and professor of public health, epidemiology and HIV/AIDS at The University of the West Indies, Mona, said there's a challenge for low- and middle-income countries to access vaccines primarily because advanced countries are monopolising the vaccines through bilateral contracts.
“The COVAX facility has grave difficulty getting hold of vaccine that has been WHO [World Health Organization] pre-qualified and emergency use listed. And this has meant that many middle-income and low-income countries have had to use vaccine that has not yet been pre-qualified and emergency use listed by the WHO,” said Professor Figueroa, who is also a member of the WHO's COVID-19 Working Group on Vaccines.
If the countries did not do this, he added, they would not have been able to protect their people from COVID-19.
“There have been as many as one billion doses of vaccine that has been used prior to prequalification and emergency use listing. But, I'm hoping that the Cubans will share their data quickly with the WHO, so that a country like Jamaica will be able to benefit, because Jamaica has taken a policy decision not to use any vaccines that have not been pre-qualified and emergency use listed,” Professor Figueroa said.
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