Best sense of what’s going on (my info’s second-hand) is it would cost ~$600M to buy and distribute all of Serum Institute’s supply (>120M doses $3.90 dose +~$1/dose distribution cost) and GAVI doesn’t have any new money to do so. So they’re possibly resistant to moving quickly, which may be slowing down the WHO prequalification process, which is a gating item for the vaccine being put in vials and purchased by GAVI (via UNICEF). Natural solution for funding is for Gates to lead an effort to do so, but they are heavy supporters of the RTS,S malaria vaccine, so it’s awkward for them to put major support into the new R21 vaccine which can be produced in large quantity. Also the person most associated with R21 is Adrian Hill, who is not well-liked in the malaria field. There will also be major logistical hurdles to getting it distributed in the countries, and there are a number of bureaucracies internally in each of the countries that will all need to cooperate.
You have the facility to produce en mass, something that once given out will no longer make a profit, so there’s no incentive to make a factory, but you’re an EA true and true so you build the thing you need and make the doses. Now you have doses in a warehouse somewhere.
You have to take the vaccine all over the admittedly large state, but with a good set of roads and railroads, this is an easily solvable problem, right?
You have a pile of vaccine, potentially connections with Texan hospitals who thankfully ALL speak English and you have the funding from your company to send people to distribute the vaccine.
There may or may not be a cold chain needed so you might need refrigerated trucks, but this is a solvable problem right? Cold chain trucks can’t be that more expensive than regular trucks?
So you go out and you start directing the largest portion of vaccines to go to the large cities and health departments, just to reach your 29 million people that you’re trying to hit. You pay a good salary to your logisticians and drivers to get the vaccines where they need to go.
In a few days, you’re able to effectively get a large chunk of your doses to where they need to go, but now you run into the problem of last mile logistics, where you need to get a dose to a person.
That means that the public has to get the message that this is available for them, where they can find it and how they can do it. God forbid there be a party that is trying to PSYOP that your vaccine causes Malarial cancer or something because that would be a problem.
You’ll have your early adopters, sure but after some time the people that will follow prudent public health measures will drop off and the lines will be empty.
You’ll still have 14 million doses, which have they been properly stored? This is of course accounting for the number of Texans who just won’t get a vaccine or are perhaps too young.
So you appeal to the state government to pass a law that all 8th graders need to have this once in a lifetime vaccine and in a miracle, they make it a law. You move the needle a little bit. 7.5 Million Texans are under 18, but those might be the easiest to get as they’re actively interacting with the government at least in the capacity of education.
And as you might guess, this isn’t about Texas. This is every country.
FWIW I reached out to someone involved in this at a high level a few months ago to see if there was a potential project here. They said the problem was “persuading WHO to accelerate a fairly logistically complex process”. It didn’t seem like there were many opportunities to turn money or time into impact so I didn’t pursue anything further.
For the new R21 vaccine, WHO is currently conducting prequalification of the production facilities. As far as I understand, African governments have to wait for prequalification to finish for before they can apply for subsidized procurement and rollout through UNICEF and GAVI.
For both RTS,S and R21, there are some logistical difficulties due to the vaccines’ 4 dose schedule (First three 1 month apart—doesn’t fit all too well into existing vaccination schedules) cold-chain requirements, and timing peak immunity with the seasonality of malaria.
Lastly since there already exists cost-effective counter-measures, it’s unclear how to balance new vaccine efforts against existing measures.
Does anyone understand the bottlenecks to a rapid malaria vaccine rollout? Feels underrated.
Best sense of what’s going on (my info’s second-hand) is it would cost ~$600M to buy and distribute all of Serum Institute’s supply (>120M doses $3.90 dose +~$1/dose distribution cost) and GAVI doesn’t have any new money to do so. So they’re possibly resistant to moving quickly, which may be slowing down the WHO prequalification process, which is a gating item for the vaccine being put in vials and purchased by GAVI (via UNICEF). Natural solution for funding is for Gates to lead an effort to do so, but they are heavy supporters of the RTS,S malaria vaccine, so it’s awkward for them to put major support into the new R21 vaccine which can be produced in large quantity. Also the person most associated with R21 is Adrian Hill, who is not well-liked in the malaria field. There will also be major logistical hurdles to getting it distributed in the countries, and there are a number of bureaucracies internally in each of the countries that will all need to cooperate.
Here’s an op-ed my colleague Zach, https://foreignpolicy.com/2023/12/08/new-malaria-vaccine-africa-world-health-organization-child-mortality/
Here’s one from Peter Singer https://www.project-syndicate.org/commentary/new-low-cost-malaria-vaccine-could-save-millions-by-peter-singer-2023-12
Here’s an FAQ with more info—https://docs.google.com/document/d/1mgeU-efHzs83lQNR3ma3qvFd1xqvZJQSp-ut1VEPAUY/edit
Pretend that you’re a Texan vaccine distributor.
You have the facility to produce en mass, something that once given out will no longer make a profit, so there’s no incentive to make a factory, but you’re an EA true and true so you build the thing you need and make the doses. Now you have doses in a warehouse somewhere.
You have to take the vaccine all over the admittedly large state, but with a good set of roads and railroads, this is an easily solvable problem, right?
You have a pile of vaccine, potentially connections with Texan hospitals who thankfully ALL speak English and you have the funding from your company to send people to distribute the vaccine.
There may or may not be a cold chain needed so you might need refrigerated trucks, but this is a solvable problem right? Cold chain trucks can’t be that more expensive than regular trucks?
So you go out and you start directing the largest portion of vaccines to go to the large cities and health departments, just to reach your 29 million people that you’re trying to hit. You pay a good salary to your logisticians and drivers to get the vaccines where they need to go.
In a few days, you’re able to effectively get a large chunk of your doses to where they need to go, but now you run into the problem of last mile logistics, where you need to get a dose to a person.
That means that the public has to get the message that this is available for them, where they can find it and how they can do it. God forbid there be a party that is trying to PSYOP that your vaccine causes Malarial cancer or something because that would be a problem.
You’ll have your early adopters, sure but after some time the people that will follow prudent public health measures will drop off and the lines will be empty.
You’ll still have 14 million doses, which have they been properly stored? This is of course accounting for the number of Texans who just won’t get a vaccine or are perhaps too young.
So you appeal to the state government to pass a law that all 8th graders need to have this once in a lifetime vaccine and in a miracle, they make it a law. You move the needle a little bit. 7.5 Million Texans are under 18, but those might be the easiest to get as they’re actively interacting with the government at least in the capacity of education.
And as you might guess, this isn’t about Texas. This is every country.
FWIW I reached out to someone involved in this at a high level a few months ago to see if there was a potential project here. They said the problem was “persuading WHO to accelerate a fairly logistically complex process”. It didn’t seem like there were many opportunities to turn money or time into impact so I didn’t pursue anything further.
There’s a few I know of:
For the new R21 vaccine, WHO is currently conducting prequalification of the production facilities. As far as I understand, African governments have to wait for prequalification to finish for before they can apply for subsidized procurement and rollout through UNICEF and GAVI.
For both RTS,S and R21, there are some logistical difficulties due to the vaccines’ 4 dose schedule (First three 1 month apart—doesn’t fit all too well into existing vaccination schedules) cold-chain requirements, and timing peak immunity with the seasonality of malaria.
Lastly since there already exists cost-effective counter-measures, it’s unclear how to balance new vaccine efforts against existing measures.