The Miracle of Vaccines in the Age of Polycrisis

The Miracle of Vaccines in the Age of Polycrisis
By Muhammad Ali Pate

I am truly honored to be the opening keynote speaker at this First Asia Pacific Summit on Infectious Diseases and Immunization, organized by the Asia Pacific Immunization Coalition (APIC).

I would like to express my gratitude to Prof. Tikki Pangestu and the Asia Pacific Immunization Coalition (APIC) for extending this invitation and entrusting me with the responsibility of contributing towards setting the tone for this vital gathering.

The overall theme of the summit, “Vaccination for All: Access, Confidence, and Equity (ACE),” could not have been more relevant or timely.

It strikes at the heart of some of the challenges we face in the 21st century.

It is a call to action, a reminder of the challenges we face, and an opportunity to reflect on the transformative power of vaccines in this our age of polycrisis.

The world is confronted by an array of multiple crises – from increasing infectious threats that culminated into the devastating COVID-19 pandemic,

to rising geopolitical tensions that are rapidly undermining the world order established more than 70 years ago,

several ongoing regional conflicts,

large displacements of populations,

to huge economic uncertainties facing rich and poor countries alike,

worsening inequities within and between countries,

and the wicked problem of climate change that is threatening our survival as a human species.

It is the compounding effect of these simultaneous crises all at once, termed as “poly-crisis”, originally coined by the French theorist of complexity, Edgar Morin.

In such a complex and interconnected world, where the environment, infectious agents, animals, and human beings are constantly interacting and evolving, where pathogen spillovers are increasingly likely, the role of vaccines is very strategic.

Vaccines have already had a profound impact on our world.

In just these past 25 years, when we witnessed impressive progress in global health, with increasing life expectancies in all regions of the world, increased global financing with the proliferation of public-private partnerships such as the Global Alliance for Vaccines Initiative (GAVI), innovations in biotechnology, favorably shifting market dynamics,

the expansion of global access to vaccines contributed immensely towards achieving significant milestones in reducing child mortality and curbing deadly infectious diseases, extending life expectancies across the world.

Most recently, when the COVID-19 hit and caused the largest contraction of output in the global economy, when almost $500 billion was lost per month due to lock downs globally, it is the miracle of vaccines that truncated that painful period and allowed us to reopen, travel, and interact again, enabling some rebound in our economies.

However, there are still major challenges to ensuring equitable access to vaccines by all people.

Globally, there are still at least 25 million children who have not completed their basic immunization series.

Many millions still lack access to newer vaccines. However, we are also witnessing threats and regressions in equitable access and confidence in vaccines, which demand our immediate attention.

Even with COVID-19 vaccines, despite the amazing speed of development and roll-out, there was a lag in COVID-19 vaccine coverage especially in the lower income countries.

Meanwhile, as we look forward some exciting developments are in the horizon. Malaria and RSV vaccines along with the prospect of vaccines for diseases like HIV, Lassa Fever, and others, tell us that much is ahead of us to see further miracle of vaccines.

Advancements in vaccinology, including mRNA vaccines and modular manufacturing, also additionally signal an exciting phase for the modern miracle of vaccines.

But we still find ourselves faced with critical challenges.

Emerging and re-emerging infectious diseases continue to pose threats. From Hendra virus in mid-1990s, Nippah virus in late 1990s, SARS-CoV in 2003, Pandemic flu 2009, MERS-CoV in 2012, Ebola West Africa 2014, Zika Virus 2017, and COVID-19 in 2020.

The human-animal-infectious agents’ interface is increasingly active and pathogen spillovers increasingly likely, in our intricately connected world.

At the same time the world is facing multiple crisis, multilateralism and true global solidarity are on a low ebb, and global health butts against other competing priorities.

These competing priorities constrain global health financing, for the poor countries, in an already fragmented landscape where inequality is widening. Prospects for increased external or domestic financing are low, given fiscal realities in many low and lower middle-income countries.

We are also facing an organized anti-science, anti-vaccine, and anti-globalization movement that is gaining strength, posing a serious challenge to our mission.

Let me now turn to the key themes of this summit –

First, the issue of access. Access to vaccines should not be a matter of privilege but a fundamental right for every individual, regardless of their socioeconomic status or geographic location.

Inequities in access have been exacerbated by the pandemic, but we must remember that the struggle for access is not a new one.

Immunization programs have historically faced obstacles, from inadequate infrastructure to vaccine supply chain disruptions.

We must renew our commitment to breaking down these barriers and ensuring that vaccines reach the most vulnerable in our communities.

To do so by integrating delivery of vaccines within national health systems delivered at the front ends, not stand-alone efforts.

When we integrate financing, management, using platforms for delivery of services, we can make vaccines arrow heads for enhancing access to other services.

Second, Confidence in vaccines.

Vaccine hesitancy is a complex challenge that transcends borders and societies.

Misinformation, fear, and skepticism erodes the trust that people have in vaccines.

It is our responsibility to combat these misconceptions with clear, evidence-based communication and to engage with communities to address their concerns.

Building confidence in vaccines is not just a scientific endeavor; it is a deeply human one. It requires empathy, understanding, and a willingness to listen.

In Nigeria now, we are in the middle of rolling out HPV vaccines to prevent cervical cancer.

While many parents are consenting for their children to be vaccinated, we are encountering deliberate misinformation being circulated on social media, many of them sourced from the developed world, discouraging parents, and sowing the seeds of distrust.

In the past we had encountered similar issues on polio eradication with the origin of the mistrust emanating from Western countries.

In those days we had to deal with it by domesticating the agenda, framing it to reconcile the global felt needs to eradicate polio with local needs to prevent and treat common diseases.

We used community leaders as trusted channels to inform and mobilize parents to allow their children to be immunized.

With these lessons, we are now forging ahead with integrating HPV vaccination into our routine immunization and activating our community leaders to address misinformation.

The third theme of this conference is equity.

Equity in vaccines access means that everyone, regardless of their background, should have a fair and just opportunity to access vaccines.

Achieving equity in access to vaccines demands not only addressing the existing disparities in healthcare systems within countries but also between countries.

Equity is the cornerstone of our journey towards a healthier, safer, and more just world. If we accept the world as it is, that half its population do not have access to basic life-saving health care, then we continue to have an unbalanced, insecure world.

When the COVID-19 pandemic hit, some countries adopted a me-first approach, but three years down the line I think with infectious diseases, me-first is not necessarily the best strategy.

With an evolving pathogen, even if you have vaccinated your population there is no certainty that a vaccine-evading mutant from another unvaccinated area cannot find its way. To be truly protected, everyone must be protected. We are as strong as our weakest links.

So, what can we do to ensure the miracle of vaccines prevails in the age of polycrisis?

First, as you outlined in the themes of this conference, we must work together, beyond borders and boundaries, to prioritize equitable access, rebuild confidence, and champion the cause of global health equity.

Governments, private sector, civil society, healthcare professionals, and researchers must unite to make sure that no one is left behind.

Second, in this ever-evolving landscape, we should also strengthen platforms whose primary focus is on childhood vaccines,

and begin to move them in the directions of a life-course vaccination approach, with many vaccines available for older age groups and in the events of major epidemics where vaccines are effective.

In other words, we should reassess our health services delivery platforms in the light of the evolving landscape of vaccines.

Third, we need to rethink vaccines research and development, in this era where biology is met by chemistry in discovery.

This means the era of large vaccines manufacturing plants in only a few wealthy countries is ending.

As such, further distribution of research and development capacities in networks, across different geographies is now more practical.

The capacities for product development, clinical trials to regulations, manufacturing, post-marketing surveillance, distribution, and integration within health systems and communities must be domesticated in regions and diverse countries.

Fourth, we must not forget that the progress made so far is fragile.

To protect the gains, we must revitalize existing multi-stakeholder partnerships, or create new ones where necessary, to extend the benefits of vaccination across the life-course and ensuring access for the poorest and most vulnerable populations.

This especially can serve as a means for Governments and multilaterals to re-energize the social contract with citizens, strengthening primary healthcare systems, and enhancing health security for everyone.

Fifth, we should, especially in this era of polycrisis, seek innovative approaches to mobilize global, regional, and local financing,

shape global, regional, and local markets, enable collaborations for decentralized vaccine manufacturing and tech transfers,

and rebuild resilient and equitable delivery mechanisms capable of responding to public health crises. With frontline health workers at the center.

Sixth, we should rethink our approaches to science communications considering the much better organized anti-science, anti-vaccines movement.

Instead of scientific communications focused on the elites, are there ways to further democratize relevant scientific communications in local languages and systematically engaging respected, influential community, national, or regional voices to enhance confidence of people on the benefits of vaccinations?

Given that infectious diseases respect no borders, or countries, or ethnicity, or religion, discovery, financing, and delivery of potent, safe vaccines, can provide a basis for unifying the world to address infectious diseases.

These are immense challenges, but also a tremendous opportunity. In this age of poly-crisis, access and delivery of vaccines can provide a rallying point for addressing multiple challenges in our world.

In closing, let us remember the miracle of vaccines: their power to protect, and to unite.

Let us stand together and face the challenges of our time with determination and resolve.

And as we embark on this First Asia Pacific Summit on Infectious Diseases and Immunization, let us work together to ensure that vaccines continue to be the beacon of hope in the age of polycrises.

Muhammad Ali Pate
Coordinating Minister of Health and Social Welfare
Federal Republic of Nigeria