With the demand for COVID-19 vaccines exceeding the world’s supply, a frustrated public and policymakers want to know: How can we get more? Far more. Right Now.
The problem: “It’s not like adding more water to the soup,” said Maria Elena Bottazzi, a vaccine specialist at Baylor College of Medicine.
COVID-19 vaccine manufacturers need everything to go well, as they increase production by up to hundreds of millions of doses, and any small hiccups can cause a delay. Some of its ingredients had never before been produced in the large volume needed.
And seemingly simple suggestions that other factories should move on to developing new types of vaccines cannot be produced overnight. This week, French pharmacist Sanofi took the unusual step of announcing that it would help bottle and package a vaccine produced by competitor Pfizer and its German partner BioNTech. But those doses won’t start arriving until the summer and Sanofi only has room in a factory in Germany for its own vaccine to be delayed, bad news for the world’s global supply.
“We thought,‘ Well, okay, it’s like men’s shirts, right? I’ll just have another place to get it, “said Dr. Paul Offit of Philadelphia Children’s Hospital, a U.S. government vaccine advisor.” It’s just not that easy. “
DIFFERENT VACCINES, DIFFERENT RECIPES
The multiple types of COVID-19 vaccines used in different countries train the body to recognize the new coronavirus, primarily the ear protein that coats it. But they need different technologies, raw materials, equipment and experience to do so.
The two vaccines authorized in the United States so far, by Pfizer and Moderna, are made by placing a piece of genetic code called mRNA, the instructions for this cutting-edge protein, inside a ball of fat.
Making small amounts of mRNA in a research lab is easy, but “before that, no one made a billion doses or 100 million or even a million doses of mRNA,” said Dr. .
Enlarging doesn’t just mean multiplying the ingredients to fit a larger tub. The creation of mRNA involves a chemical reaction between genetic blocks and enzymes, and Weissman said enzymes do not work as efficiently at larger volumes.
The AstraZeneca vaccine, which is already in use in Britain and several other countries, and is expected soon from Johnson & Johnson, is made with a cold virus that sticks the ear protein gene into the body. It is a very different form of manufacture: the living cells of giant bioreactors grow this cold virus, which is extracted and purified.
“If the cells get old or get tired or start to change, you may have less,” Weissman said. “There’s a lot more variability and a lot more things you have to check.”
An old-fashioned variety – “inactivated” vaccines, such as the one made by the Chinese Sinovac, require even more steps and more rigid biosecurity because they are made with dead coronaviruses.
One thing all vaccines have in common: they must be made according to strict rules that require specially inspected facilities and frequent testing of each step, a necessity that requires time to rely on the quality of each batch.
WHAT ABOUT THE SUPPLY CHAIN?
Production depends on enough raw materials. Pfizer and Moderna insist they have reliable suppliers.
Still, a U.S. government spokesman said logistics experts are working directly with vaccine manufacturers to anticipate and resolve bottlenecks that arise.
Moderna CEO Stephane Bancel acknowledges that challenges still remain.
With shifts running 24 hours a day, 7 days a week, if one day “a raw material is missing, we can’t start making products and that capacity will be lost forever because we can’t make up for it,” he recently told investors.
Pfizer has temporarily slowed deliveries to Europe for several weeks, so it could upgrade its factory in Belgium to further manage production.
And sometimes batches fall short. AstraZeneca told an outraged European Union that it will also immediately deliver fewer doses than originally promised. The reason mentioned: “yields” or production lower than expected in some European factories.
More than in other industries, when brewing beer with organic ingredients, “there are things that can go wrong and go wrong,” said Norman Baylor, a former head of the Food and Drug Administration who considered it common. performance variability.
HOW MUCH IS ON THE WAY?
This varies by country. Moderna and Pfizer are on track to deliver 100 million doses to the U.S. by the end of March and another 100 million in the second quarter of the year. Looking even further ahead, President Joe Biden has announced plans to buy even more over the summer, reaching enough to end up vaccinating 300 million Americans.
Pfizer CEO Albert Bourla told a Bloomberg conference this week that his company will end up providing 120 million doses by the end of March, not for faster production, but because health workers can now take out an additional dose of each vial.
But getting six doses instead of five requires the use of specialized syringes and there are questions about the global supply. A spokesman for Health and Human Services said the U.S. is sending kits that include special syringes with each shipment from Pfizer.
Pfizer also said its factory upgrade in Belgium is a short-term pain for long-term gains, as the changes will help increase world production to two million doses this year instead of the 1.3 billion initially planned.
Moderna also recently announced that it will be able to supply 600 million doses of vaccine in 2021, above 500 million, and that it will expand its capacity in the hope of reaching 1 billion.
But possibly the easiest way to get more doses is if other ongoing vaccines are shown to work. U.S. data on whether Johnson & Johnson’s single-dose shoot protects are expected soon, and another company, Novavax, is also in final testing.
OTHER OPTIONS
For months, major vaccine companies lined up “contract manufacturers” in the United States and Europe to help them eliminate doses and then undergo the final steps of bottling. Modern, for example, works with the Swiss Lonza.
Beyond the rich nations, the Serum Institute of India has a contract to manufacture a billion doses of the AstraZeneca vaccine. It is the largest vaccine manufacturer in the world and is expected to be a key supplier to developing countries.
But some self-produced efforts to increase supplies appear sluggish. Two Brazilian research institutes plan to manufacture millions of doses of the AstraZeneca and Sinovac vaccines, but have been left behind by unexplained delays in shipments of key ingredients from China.
And Bottazzi said the world must simultaneously maintain vaccine production against polio, measles, meningitis and other diseases that still threaten even in the midst of the pandemic.
Penn’s Weissman called for patience and said that as each vaccine manufacturer has more experience, “I think each month they will make more vaccines than the previous month.”
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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.