Much like the ‘global north’, Southeast Asian countries are in the race for Covid-19 vaccines.
Singapore, Malaysia and Indonesia rely on international procurement, while Thailand and Vietnam seek the local route for its vaccine procurement. Given the varying economies, health systems and diverse political landscape, vaccine development and procurement in Southeast Asia is nowhere near a straightforward task. Though Southeast Asia has worked to develop its indigenous sectors to fill a need for more traditional vaccines, the Covid-19 pandemic has exposed the morally corrupt practice of vaccine nationalism.
Much like the rest of the world, rights to manufacture are held solely by a few companies. Most Southeast Asian countries, which previously relied on this to be able to afford vaccines, resort to international mechanisms such as COVAX to aid vaccine procurement. Whilst this takes off some of the burdens, experts foresee a delay in vaccines distribution.
The challenges that the vaccines industry is facing in Southeast Asia can be summarised into three categories: underinvestment, unsustainable financing, and concentrated vaccine manufacturing capacity.
The pandemic now lays bare an opportunity for governments and market players to rethink their public health efforts to ensure future vaccine access barriers are addressed efficiently and sustainably.
Traditionally, the international vaccine market is dominated by a few multinational companies (MNCs) from Western nations such as Merck, GlaxoSmithKline, Pfizer and Sanofi Pasteur. These companies are responsible for 80% of the vaccines supply in the world, and though emerging markets have made dramatic improvements to their own capacity to develop biotechnology, the largest research and development (R&D) units and manufacturing plants are concentrated in Europe and North America.
Even so, it would be false to say that Southeast Asia isn’t making strides in vaccine development. The region now features several home-grown biotechnology companies, including those developing their own vaccines for Covid-19, and despite the generally stronger research and development power of wealthier regions, the Global South has carved out its own niche in production.
Much of that is based on simple price points. In the 1980s and 1990s, major pharmaceutical companies began spinning off the less-lucrative vaccine business in favour of more high-value products, such as biopharmaceuticals for chronic diseases.
That offshoring saw the easing of a manufacturing bottleneck, creating a global distribution of producers that planted several shares of the global vaccine supply chain in emerging markets. As the field developed, the Developing Countries Vaccine Manufacturing Network (DCVMN) was established in 2000 to encourage public-private-partnership. That was a key step in enabling Southeast Asian businesses with technical prowess to pursue vaccine development, but limited resources to lower the risk of their operations by winning government funding.
Vaccine manufacturers in India, Thailand and Indonesia are all on the DCVMN list and are today responsible for the success of a 60% increment in global vaccine supply. Much of this success is due to technology transfer and having the rights to license.
More recently, the pandemic has invited a significant number of Chinese largesses to invest in vaccine development in Southeast Asia, offering substantial endowments to local research and development groups. Biotech companies aren’t the only ones to gain from this investor boom – so too have the various other pieces of the pharmaceutical industry, including contract manufacturing organisations, clinical trials groups and licensure businesses, all pulling together at the moment to drive vaccine development.
Such foreign investment is helping to boost an industry that’s already matured through decades of globalised trade. Greater industry capacity, fostered by local competition and increasingly efficient production methods, has dramatically cut lead times while reducing production costs. In this light, and thanks to the growing economic power of the Global South, vaccine equity has become an achievable target.
Under Investment & Unsustainable Financing
However, that’s not to say vaccine equity will be an easily achieved target.
While the private sector has more capacity than ever before to produce vaccines, the demand in some of the world’s poorest populations remains high and is likely greater than the ability to supply with local means.
Besides private actors, there are major philanthropic groups such as Clinton Health Access Initiative (CHAI), Bill and Melinda Gates Foundation and the Vaccine Alliance working to bring these drugs into Southeast Asian countries, particularly to the most vulnerable patients.
While this provides much-needed options to those who would otherwise go without, it does raise the issue of an overreliance on international financial support through philanthropic incentives and pooled procurement schemes. Historically, these have given disproportionate attention to a few infectious diseases, especially those with a significant potential return on investment such as malaria and polio.
To be clear, these are terrible diseases, and the targeted focus on eradicating them has saved many lives. But their oversized presence has contributed to market gaps and, as a result, vaccine options for dengue, tuberculosis, chikungunya and other deadly infectious diseases remain poorly explored, leaving few commercially available solutions for those in need.
This serves as a reminder to policymakers that vaccines are not only to safeguard the unwell, but also the healthy population. It is down to them to mobilise resources to ensure future vaccine access for many is secured
To fill such gaps, Southeast Asian policymakers must adopt a sustainable, self-financing pathway for vaccine development that addresses some root economic causes.
There are four first-steps for policymakers to evaluate vaccine development economics: determine the weight of disease burden, the presence or absence of prevention and control strategies, evaluate a vaccine’s economic and financial attributes, and consider the country’s capability to introduce and deliver vaccines in the long-term. Collectively, these attributes can justify necessities and gravitas towards introducing new vaccines.
Another potential solution to this financial equation is to increase national revenue. At the most basic level, the central government can raise or repurpose its funds collected from the general tax and public earnings. However, this option can be a politically challenging exercise with the effects of pandemic-induced global economic shutdown looming.
The second option is to adopt a sector-wide approach in which resources given by donors are left to the receiving country to organise its own priority vaccine development projects. The concept is for donors to provide an external scaffold to the vaccine goals set forth by countries, with monitoring and guidance to ensure countries can meet their desired goals.
Alternatively, Southeast Asian policymakers can opt for a national trust fund to support a specific purpose. A national trust fund is an excellent avenue for a country to become self-sufficient. However, a mutual agreement of responsibilities – goals attained, organisations created, reporting and reviews – must be established to ensure the trust fund’s development and use.
With today’s vaccine nationalism linking with more historic patterns of the global pharmaceuticals market, in which the greatest production power is held in Europe and North America, the DCVMN pathway is left unrealised to lift the manufacturing burden presented by a pandemic.
This serves as a reminder to policymakers and business leaders that vaccines are not only to safeguard the unwell, but also the healthy population. It is down to them to mobilise resources to ensure future vaccine access for many is secured.
Nur Izzaty Badrol Hisham is an independent writer focusing on vaccines development, policies and global health. She has volunteered for the Institute of Chemical Engineers’ COVID19 Vaccine Workstream since 2020 and holds a Masters in Biochemical Engineering with a minor in Public Policy from University College London.
