Research Fellow at Center for Strategic Studies of Fiocruz and Former Minister of Health of Brazil
As COVID-19 hits Brazil hard, the country’s public health institutions are well-positioned to develop, manufacture, and deploy eventual vaccines.
Over the past few weeks, the rate of infections and deaths due to SARS-CoV-2 has risen starkly in Brazil. The country now has the fourth highest death toll from this new coronavirus, and the number of infections is still sharply rising. Only the US has more infected citizens. This situation is challenging our health institutions to react in full force.
Fortunately, Brazil has a long history of responding to unprecedented public health challenges. It was 120 years ago that Fiocruz, the Oswaldo Cruz Foundation, was established to address health threats of that time. Since then, Brazil has developed a strong track record of responding to viral epidemics. In the 1990s, the country developed its landmark HIV/AIDS program, which demonstrated that it was possible to provide state-of-the-art treatment to all AIDS patients within the public health system. This program continues today despite multiple political transitions.
More recently, the country confronted the Zika virus outbreak and its consequences. In 2015, Brazil was the first country to detect and characterize the emergence of the Zika congenital syndrome and quickly enlisted its research community to generate evidence and contribute to the search for new tools to address this disease.
In addition to these domestic efforts, Brazil has engaged consistently in global health initiatives. The country had a key role in the creation of the World Health Organization (WHO) with a Brazilian as its second Director-General. We’ve championed the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which promotes access to medicines, hosted the first Global Conference on Social Determinants of Health in 2011, and helped launch UNITAID in partnership with France, Chile, Norway, and the UK.
A Focus on Vaccination
Throughout all of this, vaccines are at the center of Brazil’s public health tradition. The country has well-established domestic capacity for vaccine research and production, including two leading manufacturers: the Butantan Institute in São Paulo and Bio-Manguinhos, a unit within Fiocruz, in Rio de Janeiro.
Their production capacity has enabled the country to develop a robust immunization program with some of the highest routine immunization rates among middle-income countries. Vaccine expertise also gives Brazil the ability to quickly mobilize around outbreaks. Examples of this include the 2010 H1N1 vaccination campaign that reached 100 million people (50 percent of the population) with a vaccine manufactured at Butantan, and more recently, the response to yellow fever and measles outbreaks.
The combination of a Universal Health System – catering to 80 percent of the Brazilian population regardless of income – and multiple R&D institutes focused on vaccinology and local production has enabled the country to ensure a continuous supply of existing vaccines, adopt new vaccines, and expand coverage.
Brazil manufactures around 80 percent of all vaccines used in the country’s widespread immunization program. In 2018 alone, this program provided over 300 million doses of vaccines at a cost of US $1.2 billion – a fraction of what it would cost in high-income countries. This system was built on a strategic vision that included investment in infrastructure, expertise, and incentives for technology transfer agreements between Brazil’s public sector manufacturers and multinational pharmaceutical companies.
These technology transfer agreements have allowed the country to adopt and deploy new products shortly after they are licensed globally. Butantan’s agreement with Sanofi enabled the organization to fully incorporate seasonal influenza vaccine production, and a technology transfer of Merck’s human papillomavirus (HPV) vaccine is underway. Bio-Manguinhos established partnerships for the production of vaccines against rotavirus, pneumococcal pneumonia, and the combination measles, mumps, rubella, and varicella viruses. Bio-Manguinhos is also one of the four global suppliers of yellow fever vaccines that are prequalified by WHO and made available through Gavi in at-risk countries.
Applying this Expertise to COVID-19
This established technology transfer record may prove a valuable resource once a vaccine for COVID-19 shows promise in clinical trials. Both Butantan and Bio-Manguinhos are well positioned to absorb a novel product and help scale-up manufacturing quickly for use in low- and middle-income countries. At Bio-Manguinhos, there are ongoing discussions with partners to explore technology transfer arrangements as well as the possibility of acting as a contract manufacturing organization to speed up the supply of vaccines.
The R&D capacity at Brazilian scientific organizations is also being leveraged to support the development of SARS-CoV-2 vaccines, and some interesting examples are starting to emerge. Scientists at Bio-Manguinhos are collaborating with external partners to explore six different candidates, building on existing vaccine platforms as well as new approaches under accelerated development. Meanwhile, Butantan has recently announced efforts to develop a novel vaccine approach based on outer membrane vesicles.
Scientists at Fiocruz, the immunology lab of the Institute of the Heart, the Medical School of São Paulo University, and the Center for Vaccine Technology at the Federal University of Minas Gerais are partnering to develop two SARS-CoV-2 vaccine candidates that are included in the WHO landscape document of COVID-19 candidates.
Grounded on its history of innovation and commitment to domestic and global public health, the Brazilian vaccine community is prepared to respond to this pandemic by contributing to the development, manufacturing, and eventual deployment of affordable vaccines for the communities and countries that need them most.