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"contents": "<img loading=\"lazy\" src=\"https://syndicate.app/st.php\" />\r\n<script async=\"true\" src=\"https://syndicate.app/st.js\" type=\"text/javascript\"></script>\r\n\r\n<span style=\"font-weight: 400;\">The $5-billion (about R92-billion) needed every year for the next four years for tuberculosis (TB) vaccine research is the only way to give future generations a shot at ending the disease, experts at the </span><a href=\"https://conf2023.theunion.org/programme/\"><span style=\"font-weight: 400;\">World Conference on Lung Health</span></a><span style=\"font-weight: 400;\"> in Paris </span><a href=\"https://theunion.floq.live/kiosk/worldconf2023/dailyprogramme?objectClass=timeslot&objectId=64ef5819e0400915b209e2a5&type=detail\"><span style=\"font-weight: 400;\">said</span></a><span style=\"font-weight: 400;\"> on Thursday. </span>\r\n\r\n<span style=\"font-weight: 400;\">United Nations member states, including South Africa, pushed for this in their declaration at the UN General Assembly in September.</span>\r\n\r\n<span style=\"font-weight: 400;\">And with the world having recorded the most new TB cases in almost three decades in 2022, according to the new </span><a href=\"https://iris.who.int/bitstream/handle/10665/373828/9789240083851-eng.pdf?sequence=1\"><span style=\"font-weight: 400;\">Global TB report</span></a><span style=\"font-weight: 400;\">, there’s all the more reason for speeding up the quest for a new jab.</span>\r\n\r\n<span style=\"font-weight: 400;\">A vaccine that is even just 50% effective – </span><a href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1909953\"><span style=\"font-weight: 400;\">like the promising M72/AS01E candidate</span></a><span style=\"font-weight: 400;\"> – can save 76 million people from getting ill with the disease</span> <span style=\"font-weight: 400;\">in 25 years, </span><a href=\"https://iris.who.int/handle/10665/365230\"><span style=\"font-weight: 400;\">a 2022 analysis by the World Health Organization</span></a><span style=\"font-weight: 400;\"> showed. One that is 75% effective can push the number up to 110 million. </span>\r\n\r\n<span style=\"font-weight: 400;\">At the moment, the </span><a href=\"https://www.cdc.gov/tb/topic/basics/vaccines.htm\"><span style=\"font-weight: 400;\">bacille Calmette-Guérin vaccine</span></a><span style=\"font-weight: 400;\"> is the only one we have. It sits in the </span><a href=\"https://commed.vcu.edu/IntroPH/Communicable_Disease/usedofbcgaprprvchitb06.pdf\"><span style=\"font-weight: 400;\">75% efficacy sweet spot</span></a><span style=\"font-weight: 400;\"> – but the snag is that it has to be given to children who don’t have the TB germ (in South Africa all babies get the jab at birth) and lasts only for about 15 years. This means it</span><a href=\"https://www.who.int/teams/global-tuberculosis-programme/research-innovation/vaccines\"> <span style=\"font-weight: 400;\">doesn’t protect adults and teens</span></a><span style=\"font-weight: 400;\"> – who make up most of the world’s TB cases. </span>\r\n\r\n<a href=\"https://bhekisisa.org/article/2023-07-25-m72-three-things-you-need-to-know-about-a-tb-jab-that-might-work/\"><span style=\"font-weight: 400;\">Earlier this year</span></a><span style=\"font-weight: 400;\">, the Bill & Melinda Gates Foundation and the Wellcome Trust announced that </span><a href=\"https://www.gatesfoundation.org/ideas/media-center/press-releases/2023/06/funding-commitment-m72-tb-vaccine-candidate\"><span style=\"font-weight: 400;\">they will jointly give more than R10-billion</span></a><span style=\"font-weight: 400;\"> to get </span><a href=\"https://www.who.int/publications/m/item/m72-as01e-tuberculosis-vaccine-candidate\"><span style=\"font-weight: 400;\">M72/AS01E</span></a><span style=\"font-weight: 400;\"> tested on thousands of people in clinical trials – a move that could get the world a step closer to a new jab. </span>\r\n\r\n<span style=\"font-weight: 400;\">Having different vaccine options to choose from is important, though, because some may only work on a certain group of the population and so having more than one leaves a larger number of people protected. </span>\r\n\r\n<span style=\"font-weight: 400;\">A small pharmaceutical start-up in Cape Town is helping. </span>\r\n\r\n<span style=\"font-weight: 400;\">In October, Petro Terblanche, head of </span><a href=\"https://www.afrigen.co.za/\"><span style=\"font-weight: 400;\">Afrigen Biologics</span></a><span style=\"font-weight: 400;\">, told </span><i><span style=\"font-weight: 400;\">Bhekisisa</span></i><span style=\"font-weight: 400;\"> at the </span><a href=\"https://www.grandchallenges.org/annual-meeting\"><span style=\"font-weight: 400;\">Grand Challenges Annual Meeting</span></a><span style=\"font-weight: 400;\"> in Dakar, Senegal, that they and a team of South African scientists are working on a new TB shot using mRNA technology. They’re building on what they’ve learnt about making an mRNA vaccine against Covid, similar to the one developed by US-based pharma company Moderna. </span>\r\n\r\n<span style=\"font-weight: 400;\">But figuring out how to make this type of vaccine from scratch isn’t easy. Terblanche shared five lessons with us that they learnt over the past two years. </span>\r\n<h4><b>Be willing to adapt your plans </b></h4>\r\n<a href=\"https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html\"><span style=\"font-weight: 400;\">mRNA</span></a><span style=\"font-weight: 400;\"> is the genetic code that tells a cell in your body how to make proteins. If used in a vaccine, it can prompt the body to make antibodies against an infection. </span>\r\n\r\n<span style=\"font-weight: 400;\">Using mRNA to design a new jab against a disease makes the development process – which can usually take up to 15 years – much faster. Moreover, producing such code-based vaccines </span><a href=\"https://bhekisisa.org/article/2022-10-14-inside-sas-mrna-hub-what-it-looks-like-and-how-it-works/\"><span style=\"font-weight: 400;\">doesn’t need large labs</span></a><span style=\"font-weight: 400;\">, which makes the technology a good option to help poorer countries set up facilities for manufacturing shots themselves. </span>\r\n\r\n<span style=\"font-weight: 400;\">To help with that, Afrigen was chosen to head the WHO’s </span><a href=\"https://www.who.int/initiatives/the-mrna-vaccine-technology-transfer-hub\"><span style=\"font-weight: 400;\">mRNA vaccine tech transfer hub</span></a><span style=\"font-weight: 400;\"> in mid-2021. </span>\r\n\r\n<span style=\"font-weight: 400;\">But overcoming intellectual property laws is a nightmare, says Terblanche. That’s because they apply to </span><i><span style=\"font-weight: 400;\">everything</span></i><span style=\"font-weight: 400;\"> that goes into producing, say, a vaccine or a medicine (like this </span><a href=\"https://bhekisisa.org/article/2023-05-09-the-anti-hiv-injection-will-be-made-in-sa-it-could-cost-between-r600-and-r800-a-pop/\"><span style=\"font-weight: 400;\">new anti-HIV shot</span></a><span style=\"font-weight: 400;\">), not just the final product. </span>\r\n\r\n<a href=\"https://www.who.int/health-topics/intellectual-property#tab=tab_1\"><span style=\"font-weight: 400;\">Intellectual property</span></a><span style=\"font-weight: 400;\"> laws govern how companies can market the goods they invent. For example, a </span><a href=\"https://www.wipo.int/patents/en/#:~:text=A%20patent%20is%20an%20exclusive,technical%20solution%20to%20a%20problem.\"><span style=\"font-weight: 400;\">patent</span></a><span style=\"font-weight: 400;\"> can give a single company exclusive rights to make and sell a product in a country without competition – </span><a href=\"http://www.thedtic.gov.za/wp-content/uploads/publication-Intellectual_Property.pdf\"><span style=\"font-weight: 400;\">for up to 20 years</span></a><span style=\"font-weight: 400;\">. To make the final product pharma companies either have to sign a </span><a href=\"https://www.knowledgeportalia.org/voluntary-licencing\"><span style=\"font-weight: 400;\">voluntary licence</span></a><span style=\"font-weight: 400;\">, in which the </span><a href=\"https://msfaccess.org/sites/default/files/2020-10/IP_VoluntaryLicenses_summary-brief_Oct2020_ENG.pdf\"><span style=\"font-weight: 400;\">patent holder gives them permission</span></a><span style=\"font-weight: 400;\"> – for a fee – to manufacture the drug based on their method, or be sure to get all the ingredients and equipment from suppliers who aren’t bound by the patent and develop the method themselves.</span>\r\n\r\n<span style=\"font-weight: 400;\">Afrigen had to overcome this hurdle early on in developing their Covid vaccine candidate. They needed to order a chemical used to make </span><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238147/\"><span style=\"font-weight: 400;\">lipid nanoparticles</span></a><span style=\"font-weight: 400;\">, a fatty substance in which the fragile bits of genetic code are wrapped to help to </span><a href=\"https://www.nature.com/articles/s41578-021-00358-0\"><span style=\"font-weight: 400;\">get them into the body’s cells without breaking down</span></a><span style=\"font-weight: 400;\">. </span>\r\n\r\n<span style=\"font-weight: 400;\">But because another vaccine manufacturer holds the patent in South Africa for this essential material used in making this type of jab, Afrigen wasn’t allowed to buy it to make their own product – which derailed their development process, says Terblanche.</span>\r\n\r\n<span style=\"font-weight: 400;\">So they had to rethink their process and search for an alternative.</span>\r\n\r\n<span style=\"font-weight: 400;\">This led them to a Chinese supplier of the chemical needed to make the tiny fat droplets and who has freedom to operate because the patent for the Covid vaccine and the materials needed to make it doesn’t apply in China. </span>\r\n\r\n<span style=\"font-weight: 400;\">The product was just as good as the one they could have bought locally – with the bonus of being much cheaper. </span>\r\n\r\n<span style=\"font-weight: 400;\">Says Terblanche: “Be prepared to find alternatives.” </span>\r\n<h4><b>Tap into a network of experts</b></h4>\r\n<span style=\"font-weight: 400;\">When Afrigen’s scientists started setting up their lab, they had to learn fast how mRNA technology works. They had lots of experience in working with vaccines – but none in using mRNA to make a jab.</span>\r\n\r\n<span style=\"font-weight: 400;\">Having a network of experts is crucial when deciding to begin producing vaccines, says Terblanche. “If you're a start-up company, and you don’t have an ecosystem around you, it’s very difficult.”</span>\r\n\r\n<span style=\"font-weight: 400;\">In Afrigen’s case, their support system is made up of contacts both within and outside the hub, such as the </span><a href=\"https://www.samrc.ac.za/\"><span style=\"font-weight: 400;\">Medical Research Council</span></a><span style=\"font-weight: 400;\">, local vaccine manufacturer </span><a href=\"https://www.biovac.co.za/\"><span style=\"font-weight: 400;\">Biovac</span></a><span style=\"font-weight: 400;\"> and the </span><a href=\"https://medicinespatentpool.org/\"><span style=\"font-weight: 400;\">Medicines Patent Pool</span></a><span style=\"font-weight: 400;\">. They also work closely with research institutes such as </span><a href=\"https://www.wits.ac.za/agtru/\"><span style=\"font-weight: 400;\">a group at Wits University</span></a><span style=\"font-weight: 400;\"> and biotech companies like </span><a href=\"https://www.univercells.com/\"><span style=\"font-weight: 400;\">Univercells</span></a><span style=\"font-weight: 400;\"> in Belgium. </span>\r\n\r\n<span style=\"font-weight: 400;\">By drawing on knowledge from different experts in their network, Afrigen was able to learn how to use the tech. Taking part in online webinar workshops every week, scientists at the Cape Town lab were taught how to use the mRNA platform. They also learnt how to successfully get millions of copies of short strings of mRNA by growing bacteria in a special tank, called a bioreactor. (The bacteria contain tiny rings of genetic material for making mRNA and their multiplying in the bioreactor creates something of an mRNA factory.) </span>\r\n\r\n<span style=\"font-weight: 400;\">As part of a deal with </span><a href=\"https://quantoom.com/\"><span style=\"font-weight: 400;\">Quantoom Biosciences</span></a><span style=\"font-weight: 400;\"> in Belgium, </span><a href=\"https://quantoom.com/first-ntensify-system-for-mrna-manufacturing-at-afrigen-biologics/\"><span style=\"font-weight: 400;\">Afrigen is testing a new way of getting mRNA ready for use in vaccines</span></a><span style=\"font-weight: 400;\"> – at a fraction of what the method used by other manufacturers of these types of jabs cost while maintaining the same quality, says Terblanche. </span>\r\n\r\n<span style=\"font-weight: 400;\">They also drew on researchers at universities, such as a</span><a href=\"https://www.wits.ac.za/agtru/\"> <span style=\"font-weight: 400;\">group from Wits</span></a><span style=\"font-weight: 400;\"> who has worked with mRNA technology in </span><a href=\"https://cansa.org.za/files/2014/07/CANSA-Detectives-Booklet-4-Gene-Therapy-for-Cancer-Treatment-Prof-Arbuthnot.pdf\"><span style=\"font-weight: 400;\">developing gene therapy for cancer</span></a><span style=\"font-weight: 400;\">. Both experienced academics and postgraduate students in fields like biochemistry, microbiology, genetics and processing engineering were recruited from some of the local universities to be part of Afrigen’s project. </span>\r\n\r\n<span style=\"font-weight: 400;\">Says Terblanche: “The fact that we [South Africa] invest in building [scientific] research and development skills at our universities, allowed us to pull people into the [vaccine manufacturing] industry.”</span>\r\n<h4><b>Be prepared for the unexpected</b></h4>\r\n<span style=\"font-weight: 400;\">When Afrigen was awarded the bid to host the hub in June 2021, the initial plan was for them to get tech transfer from an international drugmaker who was already making mRNA Covid vaccines. This meant they would get all the tools they’d need to rapidly develop the final product, such as equipment lists, instructions on how to set up a lab and the methods to make the jabs. </span>\r\n\r\n<span style=\"font-weight: 400;\">But the Ikea-like flat pack didn’t materialise.</span>\r\n\r\n<span style=\"font-weight: 400;\">In October 2021, they were told they’d have to go it alone. “We were working under time pressure: We had to build a facility, qualify it [which means the building has to be certified to develop the product], make the vaccine and train people, all at the same time,” explains Terblanche.</span>\r\n\r\n<span style=\"font-weight: 400;\">This meant they had to use information such as patents and research articles that were available publicly and work back to figure out their own way to make the vaccine. Despite many unexpected hiccups, they managed this in three months after opening the doors of their facility in December 2021. By February the following year, they had produced the </span><a href=\"https://www.who.int/news/item/20-04-2023-mrna-technology-transfer-programme-moves-to-the-next-phase-of-its-development\"><span style=\"font-weight: 400;\">first batch of a lab-scale vaccine</span></a><span style=\"font-weight: 400;\"> (this is a small amount of the drug that can be tested in the lab to see if it works as planned).</span>\r\n\r\n<span style=\"font-weight: 400;\">Tests in mice show that the vaccine candidate — which they called AfriVac 2121 – stops the SARS-CoV-2 virus (the germ that causes Covid) from multiplying in lung tissue </span><a href=\"https://medicinespatentpool.org/news-publications-post/afrigen-presents-advances-in-mrna-vaccine-technology-for-global-health\"><span style=\"font-weight: 400;\">just as well as current commercial vaccines</span></a><span style=\"font-weight: 400;\"> and was better at prompting the animals’ immune systems to produce antibodies (which fight infections) than the jab it was compared to. </span>\r\n<h4><b>Don’t be afraid to do new things </b></h4>\r\n<span style=\"font-weight: 400;\">A Pfizer/BioNTech collaboration resulted in a successful mRNA Covid shot being produced in </span><a href=\"https://www.pfizer.com/news/articles/shot_of_a_lifetime_how_pfizer_and_biontech_developed_and_manufactured_a_covid_19_vaccine_in_record_time#:~:text=Over%20the%20next%20nine%20months,vaccine%20in%20the%201960s10.\"><span style=\"font-weight: 400;\">just nine months</span></a><span style=\"font-weight: 400;\"> – much faster than the </span><a href=\"https://www.cdc.gov/vaccines/basics/test-approve.html\"><span style=\"font-weight: 400;\">conventional cycle of vaccine development</span></a><span style=\"font-weight: 400;\">. Producing a shelf-ready product so quickly came off the back of about </span><a href=\"https://www.biontech.com/int/en/home/about/who-we-are/history.html\"><span style=\"font-weight: 400;\">15 years</span></a><span style=\"font-weight: 400;\">’ experience in working with mRNA technology for making cancer drugs.</span>\r\n\r\n<span style=\"font-weight: 400;\">Although it took Afrigen three months to develop a vaccine candidate that was worth taking further because of promising early lab results, the team was navigating uncharted territory in getting to a jab that would be ready for clinical trials in humans. </span>\r\n\r\n<span style=\"font-weight: 400;\">South Africa has never had facilities that produced vaccines from development to manufacturing, so getting a licence for this from the country’s medicines regulator, </span><a href=\"https://www.sahpra.org.za/\"><span style=\"font-weight: 400;\">Sahpra</span></a><span style=\"font-weight: 400;\">, was an unknown, says Terblanche.</span>\r\n\r\n<span style=\"font-weight: 400;\">The </span><a href=\"https://www.sahpra.org.za/wp-content/uploads/2020/02/Government_Gazette_Medicines_and_Devices_Act_Jun_2017-1.pdf\"><span style=\"font-weight: 400;\">Medicines and Related Substances Act</span></a><span style=\"font-weight: 400;\"> says that to produce vaccines for humans a manufacturer needs to have a</span><a href=\"https://sahivsoc.org/Files/4.01_sa%20guide%20to%20good%20manufacturing%20practice_jul19_v7.pdf\"> <span style=\"font-weight: 400;\">Good Manufacturing Practice (GMP)</span></a><span style=\"font-weight: 400;\"> certificate. Having these credentials means the facility and all the processes used in making the product are of high enough quality to be sure it’s </span><a href=\"https://www.who.int/news-room/questions-and-answers/item/medicines-good-manufacturing-processes\"><span style=\"font-weight: 400;\">safe for human use</span></a><span style=\"font-weight: 400;\">. </span>\r\n\r\n<span style=\"font-weight: 400;\">To scale up from being a lab – which can only produce proof-of-concept vaccines – to a GMP-certified facility that can make commercially shelf-ready jabs, there are more than “700 standard operating procedures, the use of 402 pieces of equipment and 270 quality control assays [</span><a href=\"https://extranet.who.int/lqsi/sites/default/files/attachedfiles/LQMS%206%207%208%20Quality%20Control.pdf\"><span style=\"font-weight: 400;\">checks</span></a><span style=\"font-weight: 400;\"> to make sure a substance if of high quality]” that need to be developed and vetted to get the sign on the wall, says Terblanche. </span>\r\n\r\n<span style=\"font-weight: 400;\">Afrigen has already started upgrading their laboratory by ordering specified pieces of equipment and installing utilities such as steam gas lines, which they aim to have completed by July 2024, to allow them to produce a vaccine that can be used for clinical trials in humans.</span>\r\n\r\n<span style=\"font-weight: 400;\">Says Terblanche: “We didn’t get the methods; we had to develop and validate them ourselves. So I said to my team: ‘Start reading and learning.’ Realising that you have to expose your team [to new things] is definitely one of the lessons we learnt.”</span>\r\n<h4><b>Know how to manage your money</b></h4>\r\n<span style=\"font-weight: 400;\">Funding is an integral cog in the machine that is vaccine manufacturing.</span>\r\n\r\n<span style=\"font-weight: 400;\">In the early stages of the Covid pandemic, vaccines could be developed rapidly because </span><a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9975718/\"><span style=\"font-weight: 400;\">there was no shortage of funding for their development</span></a><span style=\"font-weight: 400;\">.</span>\r\n\r\n<span style=\"font-weight: 400;\">“It’s difficult to innovate and perform without funding,” says Terblanche. And, she adds, once you’ve secured the money, things can change unexpectedly, which affects a project’s budget. So managing finances and having security are important parts of successfully developing a vaccine. </span>\r\n\r\n<span style=\"font-weight: 400;\">The hub’s initial budget from funders, </span><a href=\"https://medicinespatentpool.org/what-we-do/mrna-technology-transfer-programme/mrna-funders\"><span style=\"font-weight: 400;\">including</span></a><span style=\"font-weight: 400;\"> the African Union, the South African government as well as those of France and Canada, was based on their receiving full tech transfer. The money was to go towards scaling up their labs, training partners in other low-income countries and then rapidly developing the jabs.</span>\r\n\r\n<span style=\"font-weight: 400;\">But things changed when they didn’t get the promised package and they needed to pivot to developing the technology from scratch while sticking to the original budget. On top of that, they had to find new suppliers for raw materials or be prepared to pay more – both options could have depleted the initial kitty of funds. For example, if Afrigen was not able to find a different supplier for the raw material needed for the lipid nanoparticle, it might have needed to pay more than planned. </span>\r\n\r\n<span style=\"font-weight: 400;\">You also need to budget for upscaling your team, says Terblanche. Afrigen’s team grew more than tenfold – from 12 people to 134 – in 18 months.</span>\r\n\r\n<span style=\"font-weight: 400;\">“We learnt how to deliver </span><span style=\"font-weight: 400;\">a huge scope of work under time pressure within tight budgets.” </span><b>DM</b>\r\n\r\n<i><span style=\"font-weight: 400;\">This story was produced by the</span></i><a href=\"http://bhekisisa.org./\"><i><span style=\"font-weight: 400;\"> Bhekisisa Centre for Health Journalism</span></i></a><i><span style=\"font-weight: 400;\">. Sign up for the</span></i><a href=\"http://bit.ly/BhekisisaSubscribe\"><i><span style=\"font-weight: 400;\"> newsletter</span></i></a><i><span style=\"font-weight: 400;\">.</span></i>\r\n\r\n<img loading=\"lazy\" class=\"alignnone size-full wp-image-791463\" src=\"https://www.dailymaverick.co.za/wp-content/uploads/MC-Bhekisisa-Logo.jpg\" alt=\"\" width=\"720\" height=\"161\" />",
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