Robust vaccine supply chain is key to ending the pandemic by SAGARA Yoshiyuki

“API Geoeconomic Briefing” is a weekly analysis of significant geopolitical and geoeconomic developments in the post-pandemic world. The briefing is written by experts at Asia Pacific Initiative (API) and includes an assessment of burgeoning trends in international politics and economics and the possible impact on Japan’s national interests and strategic response. (Editor-in-chief: Dr. HOSOYA Yuichi, Research Director, API & Professor, Faculty of Law, Keio University)

This article was posted to the Japan Times on June 11, 2021:

API Geoeconomic Briefing

June 11, 2021

Robust vaccine supply chain is key to ending the pandemic

SAGARA Yoshiyuki,
Fellow, Asia Pacific Initiative (API)





As the nation furthest ahead with its COVID-19 vaccination program, Israel has almost completed the inoculation of its adults and is now regaining freedom of movement.

But the country has not lowered its guard against the virus. It has already set up orders for 2022 with Pfizer Inc. so that those who received two shots of the vaccine can get a third if necessary.

Meanwhile, the government of Japan has struggled to secure vaccine supplies, despite Prime Minister Yoshihide Suga’s view of the vaccine as a weapon to fight COVID-19 and his target of bolstering the nation’s vaccine rollout with the goal of one million doses administered per day.

To cope with the continuing threats of SARS-CoV-2 variants, Japan must act to reinforce its vaccine supply chain. A resilient supply chain for Japan will also give hope to emerging economies and developing countries struggling to vaccinate their people. It would also bring the world one step closer to ending the pandemic.

The population of Israel is about 9 million, roughly the same as that of Tokyo’s 23 wards.

The number of new daily cases in Israel exceeded 10,000 in January, but infections and deaths from COVID-19 dropped sharply after the country launched a massive vaccination drive. In late April, it reported no new coronavirus deaths in a day for the first time in 10 months.

Israel has seen the COVID-19 pandemic as a national crisis and has been actively pushing to control the disease.

In a bid to take the lead in the global competition for vaccines, Israeli Prime Minister Benjamin Netanyahu spoke directly with Pfizer CEO Albert Bourla dozens of times.

In negotiating with Pfizer, Netanyahu’s trump card was the provision of real-world data obtained through vaccinating citizens.

Israel went on to launch the “Green Pass” system, allowing vaccinated people to download an app to display as a vaccination certificate at such places as sports events or restaurants. The proof of vaccination provided has an expiration date, however, with its validity lasting through Dec. 31.


An end to the pandemic?

It is not yet certain how long COVID-19 vaccines will be effective in preventing infection.

Bourla said last month that people will likely need a booster dose within 12 months of getting two shots of Pfizer’s vaccine, and then an annual vaccination thereafter. And there are increasing numbers of cases of people who have been infected once getting infected again.

In other words, while infections may be contained as more people get vaccinated, it won’t bring an end to the pandemic.

Amid the rise of vaccine nationalism in many countries, competition is intensifying over how to excel in vaccination operations.

There is an urgent need to construct a sustainable vaccine supply chain which can recover quickly even in cases of sudden suspension of supply or threats of variants.

Effective and safe COVID-19 vaccines have been put to practical use at a remarkable speed. This was made possible as they were genetic vaccines, a new type of shot approved for the first time.

A messenger RNA (mRNA) vaccine that has been developed using gene therapy technology was authorized for emergency use first in the United Kingdom, followed by Israel, the United States and other European countries.

A few hours after Chinese scientists released the gene sequence data of the novel coronavirus in mid-January last year, German biotech venture firm BioNTech SE began developing its first vaccine candidate.

Pfizer had already been engaged in joint research of mRNA technology with BioNTech for cancer treatment, so the two firms immediately started working together to develop a COVID-19 vaccine.

On Dec. 8, the U.K. became the world’s first country to begin inoculating its citizens with a Pfizer-BioNTech mRNA vaccine.

To ensure a steady supply of vaccines, it is necessary to make sure all the links of a vaccine supply chain are securely connected — development, manufacturing, international shipping, domestic delivery to inoculation.

The chain will fall apart if just one link breaks.

Procuring syringes and needles is also vital, as is a cold chain since the mRNA molecule is very fragile and the vaccines need to be kept at ultra-cold temperatures.

There are few facilities that can manufacture mRNA vaccines developed by utilizing state-of-the-art biotechnology, and Pfizer is producing them in Belgium, Germany, and Michigan in the U.S.

Highly complex operations are required to connect supply chains and cold chains from manufacturing sites to vaccination sites.


‘The pharmacy of the world’

Amid growing attention on the significance of supply chains as part of economic security, the U.S. is strategically prioritizing the issue.

In February, U.S. President Joe Biden signed an executive order requiring a review of global supply chains to assess vulnerabilities in relation to four key items: rare earth minerals, semiconductors, large-capacity batteries and active pharmaceutical ingredients (APIs).

APIs are active ingredients in medications. China and India are the world’s major manufacturing bases of APIs, and India supplies over 40% of over-the-counter and generic prescription drugs used in the U.S.

India, dubbed “the pharmacy of the world,” is also the world’s top producer of vaccines.

Different types of vaccines mean different types of supply chains need to be adopted.

A vaccine jointly developed by the University of Oxford and AstraZeneca PLC is a viral vector vaccine that uses a modified harmless virus — the vector — to deliver genetic code for an antigen.

The Oxford-AstraZeneca vaccine is 70% effective at preventing symptomatic disease, somewhat lower than the 95% efficacy of Pfizer’s mRNA vaccine. Cases of blood clots have been reported as very rare side effects for the Oxford-AstraZeneca vaccine as well.

But viral vector vaccines have huge advantages over mRNA vaccines; they can be stored under refrigeration at around 2 to 8 degrees Celsius, so it is easier to secure cold-chain logistics. Moreover, it is relatively easy to mass produce undiluted solutions of the vaccines.

It was the Serum Institute of India (SII), the world’s largest vaccine manufacturer, that started mass producing AstraZeneca vaccines. SII produces more than 65 million shots of the vaccine, named Covishield, every month.

Japan, the U.S. and Australia, wary of China’s vaccine diplomacy, and the COVID-19 Vaccine Global Access (COVAX) facility, a global program to ensure fairer distribution of vaccines, all had high expectations for India’s vaccine production.

But the situation changed completely with a massive surge in infections in India, as the country’s vaccine manufacturers, including SII, started to prioritize supplying vaccines within the country.

A rapid increase in demand for vaccines in India came as a harsh blow to the supply chains of emerging economies and low- and middle-income countries.

This also posed a problem for industrialized nations where vaccine rollouts are underway, because the pandemic will not settle down as long as new variants continue to pop up around the world.

As the COVID-19 pandemic has progressed, new variants have been detected in various locations.

Yoshihiro Kawaoka, professor at the University of Tokyo’s Institute of Medical Science and a globally recognized virology expert who has also been engaged in the development of mRNA vaccines, wrote in a book published in Japan that humans only think they are battling COVID-19, as the virus is mutating randomly.

Mutations are not something that viruses choose as a means to survive, but occur simply due to errors during replication of genes.

Human beings will continue to be racked by the virus’ random mutations as long as the pandemic lasts.


Boosting Japan’s supply chain

On April 23, when Suga declared a third state of emergency, he described vaccines as a weapon with which the pandemic could be fought.

But Japan relies on imports to obtain that weapon. Therefore, the country is engaged in a fierce competition for vaccine supplies, just as it was with masks a year ago.

As for vaccine supply chains, Japan depends on other countries for development and manufacture.

The COVID-19 pandemic revealed the need for cooperation between governments, industries and academia beyond national borders to develop vaccines. But Japan lacked the sufficient resources and capacities to nurture biotechnology innovations, such as genetic vaccines.

A review report published in January by the Asia Pacific Initiative on the government’s response to COVID-19 pointed out that the Ministry of Health, Labor and Welfare, which is a regulatory authority, lacked an industrial strategy to support the development of vaccines as strategic resources.
The report cites a government source who said such a lack of strategy led the nation to be “three-and-a-half laps behind” in vaccine development.

In addition, it took Japan more time than other countries to approve vaccines. While the country requires domestic clinical trials, the number of infected people relative to the population has been remarkably small compared to those countries. This has delayed clinical trials.

Japan also doesn’t have a system like the Washington’s Emergency Use Authorization mechanism to facilitate the availability and use of vaccines.

Another bottleneck was the European Union’s tightening of its vaccine export control, but a massive amount of vaccine doses has finally arrived in Japan.

ANA Cargo, which undertakes the task of transporting Pfizer vaccines from Belgium to Japan, worked on getting the contract from May last year.

To prepare itself for vaccine distribution, the firm resumed flights linking Japan and countries that have vaccine manufacturing sites and revised flight schedules to allow planes to arrive in Japan in the morning, so that vaccines can be delivered further within the country on the day of arrival.

Japan also has a highly efficient last-mile delivery system, enabling swift distribution even to remote islands and mountainous areas.

But the new challenge is how quickly municipalities can vaccinate residents in cooperation with doctors and nurses.

It is necessary for the central and local governments to work together to build a vaccine rollout system and make constant improvements instead of resorting to makeshift measures.

Resilient supply chains serve as protection against the coronavirus, which randomly brings increased threats.

Protections can be more important than weapons to fight against COVID-19, which is hard to contain.

In terms of health security, an infectious disease crisis response should be considered as a national defense.

In fact, the U.S. invoked its Defense Production Act to help ramp up the supply of masks and respirators.

Japan needs to allocate a budget that is appropriate for health security, just as for defense buildup, to protect the lives and safety of its people in any infectious disease crisis.

The country has started offering assistance to developing nations to improve their cold-chain networks.

Mask diplomacy and vaccine diplomacy differ in terms of the level of trust needed in the products.

As vaccines are directly connected to people’s lives, countries would like to receive assistance from nations they can trust.

China’s daily administration of COVID-19 vaccine has topped 14 million doses and the country has already administered more than 480 million shots in total.

Building a resilient supply chain in Japan and the world to step up vaccinations is necessary to not only prevent the spread of infections but also stop the coronavirus from mutating.

This will be the key to restoring global freedom of movement and moving closer to the end of the pandemic.


Disclaimer: The views expressed in this API Geoeconomic Briefing do not necessarily reflect those of the API, the API Institute of Geoeconomic Studies or any other organizations to which the author belongs.