The world has seen tremendous development and production in vaccines, therapeutics and diagnostics in the two years since COVID-19 was declared a pandemic. However, gross inequities in accessing essential health products persist across countries and regions. As global demand continues to outpace production and supply chain limitations constrain distribution, how do we weather the storm? Can regional collaboration in trade, investment, and research and development boost equitable and affordable access to these products? The upcoming Regional Conversation on Promoting Regional Cooperation for Enhancing Access to Essential Health Products on 23 March will address these questions and more.
Several challenges hinder the availability of essential health products in Asia and the Pacific. Research and production capacity is limited, especially for vaccines as they demand highly advanced research capabilities, complex manufacturing processes, and meticulous quality control. The capital and technology required are often beyond the reach of many countries and companies in the region, not least because of licensing obstacles by pharmaceutical firms in developed countries. More investment and technology transfer is urgently needed. Much has been discussed about a proposal to temporarily waive WTO TRIPS intellectual property protections governing COVID-19-related health products – a move that could significantly increase technology transfer and product access. However, negotiations remain stalled as opposing voices raise concerns that such a waiver could negatively impact pharmaceutical innovation.
In the absence of (sufficient) domestic production, trade becomes instrumental for countries to procure essential health products, but regulatory challenges and trade barriers have hampered this. Regulation of health products is complex and highly resource-intensive. Few national regulatory bodies – responsible for functions from pre-market approval to post-market monitoring – in the region are mature and able to operate efficiently and at high capacity. Furthermore, during the pandemic, many countries imposed trade barriers on essential health products, particularly after the delta variant emerged. These tariffs and non-tariff measures, such as export restrictions, impede trade in finished products, as well as inputs for their manufacture, administration, transport and storage. In some cases, legacy non-tariff barriers imposed before the pandemic have remained, even as the same countries implement trade-facilitating measures. In response to trade barriers, some countries have sought domestic alternatives, including local supplies of inputs, which further complicate regulatory approval and planning.
Countries have also faced hurdles on the logistical front such as complex customs processes, warehousing constraints, and inadequate transportation capacities. Distribution has been particularly challenging for Pacific Island countries, whose populations are spread across many, often-remote islands. When it comes to COVID-19 vaccines, many Asia-Pacific countries lack sufficient cold chain capacities (e.g., refrigerator trucks, freezer containers) for their transport and storage. Incoming vaccine shipments in Nepal, for instance, had to be delayed in late 2021 due to a lack of refrigeration facilities. Cold chain requirements are especially stringent for the mRNA vaccines, which must be stored at very low temperatures, putting them out of reach for many countries.
But alongside these challenges, there are new opportunities.
The region has performed relatively well as a source of development and production, as countries continue to participate in various stages of the value chains of essential health products. Notably, China, the world’s leading exporter of COVID-19 vaccines (by dose), has played a crucial role in supplying developing countries both within and outside the region. Over 1.6 billion doses of China’s Sinovac and Sinopharm vaccines have been delivered to more than 100 countries globally, with the bulk exported within Asia and the Pacific. As for India, local versions of AstraZeneca and Novavax made by The Serum Institute of India – the world’s largest vaccine manufacturer – have been exported within the region, including to Indonesia, Nepal and Tajikistan, and outside the region such as to Brazil and Mozambique. Bharat Biotech’s Covaxin, India’s first indigenous COVID-19 vaccine, is also being exported globally, and talks are underway regarding its provision to the COVAX global vaccine facility. Looking ahead, manufacturers in the region may be able to count on support from the World Health Organization’s global mRNA technology transfer hub, which was established last year to facilitate vaccine production in developing countries.
Sub-regionally, efforts by the Association of Southeast Asian Nations (ASEAN) indicate the potential of regional collaboration in the face of crisis. As early as January 2020, member countries initiated a collective response and two months later committed to reinforcing supply chain connectivity amid the unfolding coronavirus outbreak. ASEAN subsequently established, among other mechanisms, a COVID-19 response fund, a strategic framework on public health emergencies, and a regional reserve of medical supplies for such emergencies. These initiatives are underpinned by and complement existing working groups on public health emergencies and pharmaceutical products, and the ASEAN Joint Assessment Coordination Group. The latter two have, over the years, facilitated cooperation among member countries in regulatory coherence and regulatory approvals for medical products, thus contributing to the removal of technical barriers to trade for essential health products in the subregion.
As we enter the third year of the pandemic, how countries collaborate and leverage on these positive developments to tackle the myriad challenges – in cooperation with the private sector and other stakeholders – will be crucial in shaping the region’s continued fight against the virus and in building resilience for future crises.