When the vaccine does not reach you, do it yourself. In a couple of warehouses in Cape Town that have been transformed into a labyrinth of air-locked sterile rooms, a group of young researchers assemble and calibrate the equipment needed to reverse a coronavirus vaccine that has not yet reached South Africa and most of the world’s poorest people.
The energy in the shiny laboratories matches how urgent their mission is to limit vaccine differences. By working to replicate Moderna’s COVID-19 shots, researchers are effectively ending an industry that has given high priority to rich countries over poor ones in both sales and manufacturing.
And they do so with the extraordinary support of the World Health Organization, which coordinates a vaccine research, education and production hub in South Africa together with an associated supply chain for critical raw materials. It’s a last resort to make doses for people who are without, and intellectual property rights are still murky.
“We’re doing this for Africa right now, and it’s driving us,” said Emile Hendricks, a 22-year-old biotechnologist for Afrigen Biologics and Vaccines, the company trying to reproduce the Modern Jab. “We can no longer trust these great superpowers to come in and save us.”
Some experts see reverse technology – the re-creation of vaccines from fragments of publicly available information – as one of the few remaining ways to address the power imbalances in the pandemic. Only 0.7% of vaccines have so far gone to low-income countries, while almost half have gone to rich countries, according to an analysis by the People’s Vaccine Alliance.
The fact that the WHO, which relies on the goodwill of the affluent countries and the pharmaceutical industry for its continued existence, is leading the attempt to reproduce a proprietary vaccine shows the depth of the supply.
UN support for leveling out global vaccine distribution, known as COVAX, has failed to alleviate serious shortages in poor countries. Donated doses come in at a fraction of what is needed to fill the gap. At the same time, pressure for pharmaceutical companies to share, including demands from the Biden administration at Moderna, has led nowhere.
Until now, the WHO has never directly participated in replicating a new vaccine for current global use over the original developers’ objections. The hub in Cape Town is intended to expand access to the new messenger RNA technology that Moderna, as well as Pfizer and German partner BioNTech, used in their vaccines.
“This is the first time we are making it to this level, because of the urgency and also because of the novelty of this technology,” said Martin Friede, a WHO vaccine research coordinator who helps steer the hub.
Dr. Tom Frieden, former head of the US Centers for Disease Control and Prevention (CDC), has described the world as “held hostage” by Moderna and Pfizer, whose vaccines are considered the most effective against covid-19. The novel mRNA process uses the genetic code for the nail protein of the coronavirus and is thought to elicit a better immune response than traditional vaccines.
The Biden administration has claimed that US taxpayers largely funded Mother’s vaccine development and has insisted that the company must expand production to help developing countries. The global deficit until 2022 is estimated at 500 million and 4 billion doses, depending on how many other vaccines come on the market.
“The US government has played a very important role in making Moderna the company it is,” said David Kessler, director of Operation Warp Speed, the US program to accelerate the development of the COVID-19 vaccine.
Kessler would not say how far the administration would go to pressure the company. “They understand what we expect to happen,” he said.
Modern has promised to build a vaccine factory in Africa at some point in the future. But after appealing to drugmakers to share their prescriptions, ingredients and technical know-how, some poorer countries have waited.
Afrigen CEO Petro Terblanche said the company in Cape Town aims to have a version of the Moderna vaccine ready for testing in humans within a year and scaled up for commercial production not long after.
“We have a lot of competition from Big Pharma. They do not want to see us succeed,” said Terblanche. “They are already starting to say that we do not have the ability to do this. We will show them.”
If the team in South Africa succeeds in making a version of Moderna’s vaccine, the information will be published for use by others, Terblanche said. Such division is closer to an approach advocated by US President Joe Biden in the spring and strongly opposed by the pharmaceutical industry.
Commercial production is the point where intellectual property rights can become a problem. Moderna has said it would not take legal action against a company for infringing on its vaccine rights, but it has also not offered to help companies that have voluntarily made their mRNA shot.
Chairman Noubar Afeyan said that Moderna decided that it would be better to expand production itself than to share technology and plans to deliver billions of extra doses next year.
“Within the next six to nine months, the most reliable way to make high-quality vaccines and effective will be if we make them,” Afeyan said.
Zoltan Kis, an expert on messenger RNA vaccines at the University of Sheffield in the UK, said reproduction of Moderna’s vaccine was “feasible”, but the task would be much easier if the company shared its expertise. Kis estimated that the process would involve less than a dozen major steps. But some procedures are tricky, such as sealing the delicate messenger RNA in lipid nanoparticles, he said.
“It’s like a very complicated cooking recipe,” he said. “Having the recipe would be very, very helpful, and it would also help if someone could show you how to do it.”
A UN-backed public health organization still hopes to convince Moderna that its approach to providing vaccines to poorer countries is missing the mark. Medicines Patent Pool was established in 2010 and initially focused on convincing pharmaceutical companies to share patents on AIDS drugs.
“It’s not about outsiders helping Africa,” said CEO Charles Gore of the vaccine hub in South Africa. “Africa wants to be empowered, and that’s what this is about.”
It will eventually fall to Gore to try to resolve the issue of intellectual property. The work to recreate the Mother’s COVID-19 vaccine is protected as research, so a potential dispute would bypass steps to sell a replicated version commercially, he said.
“It’s about convincing Moderna to work with us rather than using other methods,” Gore said.
He said that Medicines Patent Pool repeatedly tried but failed to convince Pfizer and BioNTech – the first companies with an effective vaccine – to even discuss sharing their formulas.
Rep. Raja Krishnamoorthi, who is among the members of Congress who supports a bill calling on the United States to invest more in making and distributing COVID-19 vaccines in low- and middle-income countries, says reverse technology will not happen fast enough to prevent the virus mutates and spreads further.
“We have to show some life. We have to show a sense of urgency, and I do not see that urgency,” he said. “Either we end this pandemic or we jingle through.”
Campaigns claim that the small amount of vaccines available to poorer countries through donations, COVAX and purchases indicates that the Western-dominated pharmaceutical industry is broken.
“The enemy of these companies is losing their potential profits in retrospect,” said Joia Mukherjee, chief physician of the global health organization Partners in Health. “The enemy is not the virus, the enemy does not suffer.”
Back in Cape Town, the promise to use mRNA technology against other diseases motivates young researchers.
“The excitement is about learning how to use mRNA technology to develop a COVID-19 vaccine,” said Caryn Fenner, Africa’s Chief Technology Officer. But more important, Fenner said, “is not just using the COVID mRNA platform, but COVID for longer.”