⛓️Let's talk about vaccine supply chains! (yay!) 💉🌍✌️

If we are to make 11bn doses of vaccine this year, there is an urgent need to address supply chain issues or we will not be able to make all these doses. 🧵
⛓️Recap: in March many firms in the sector met at Chatham House and talked about their concerns over vaccine supply chains.

At the time there were no stated impacts on covid vaccines but the signs were ominous. (Problems on lines that make drugs using the same equipment.)
⛓️Concerns were focused on, but not limited to, America's use of the Defense Production Act which was already having a knock-on impact on lead times for key ingredients.
⛓️Then April 15th @adarpoonawalla of @SerumInstIndia tweeted a plea @POTUS.

I wrote about this the next day, explaining that the...

💉@AstraZeneca & 🇮🇳
💉@Novavax lines were threatened and that 37 items had been requested from the US government. 🇮🇳

⛓️(This piece was updated for print on 22nd and now appears online as this piece.)
economist.com/science-and-te…
⛓️Since then there has been more news. Lots of it.

May 4th: Germany 🇩🇪

💉@CureVacRNA the German maker of a promising new mRNA vaccine says its rollout is threatened by US export restrictions.

reuters.com/business/healt…
⛓️May 7th: South Africa 🇿🇦

💉Biovac says it is short on biobags thanks to delays from its US supplier.

nasdaq.com/articles/insig…
⛓️May 10th: Although the US has sent supplies to help the AZ line the...

💉@Novavax line in India has not been fixed and remains running at a fraction of its capacity. 🇮🇳

💉Another line in the UK has also been hit by shortages 🇬🇧

⛓️May 12th: Brazil 🇧🇷

Two more lines hit by shortages:

@astrazeneca line in Brazil @fiocruz_en
@Sinovac line in Brazil @butantanoficial

Problems with one line also include delays in receiving items from China due to export controls there.

bloomberg.com/news/articles/…
⛓️ There are also problems further up the supply chain at @merckgroup 🇩🇪

usnews.com/news/world/art…
⛓️These problems are serious, appear to be getting worse, and are not going to vanish.

We need multilateral efforts between the US, EU, etc and firms in the sector.
⛓️They also raise the question of whether vaccine makers that have come later, like @CureVacRNA, @Novavax are facing these restrictions at a critical time when they should be scaling up production?

And if all their 2021 output now needs to be adjusted downwards? 🤯
⛓️They also make me wonder how the international scale-up of the J&J vaccine @JNJGlobalHealth is faring...

... and how a firm like @sanofi is going to obtain what it needs to scale up when it arrives.
⛓️In short, are those 11bn doses even still realistic?

And I'm also wondering whether the vaccine makers themselves even know the answers right now?

Because I've been told that nobody really has good oversight of all the supply chains.
⛓️The industry is clear about what needs to happen.

All the trade and regulatory barriers need to be identified and governments need to work with @wto to ensure there are policies that expedite cross-border supply of key items.

For more see: ifpma.org/resource-centr…
⛓️Sort that lot out then let us talk about how an IP waiver is going to increase the vaccine supply........... 💉💉💉💉💉💉💉💉💉
⛓️P.S. DM me with supply chain issues (customs, tariffs, or export controls) and production delays related to these. 💉🌏✌️
April 30th: Mexico 🇲🇽

This story reports that a Mexico 🇲🇽packing plant was unable to finish @AstraZeneca vaccine for Argentina 🇦🇷because of delays to the export of supplies from US. 🇺🇸 #supplychains

france24.com/es/minuto-a-mi…

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More from @natashaloder

10 May
So finally I have an answer to what has happened to Novavax production in India, thanks to the difficulty getting raw materials out of the US. The news was worse than I expected.

There is says, Stan Erck of that firm, a "global raw material supply difficulty".
Novavax lines in India and the UK have been affected by shortages of items needed from the US.

Start with the UK which has been manufacturing this vaccine for a while (not yet approved).

Novavax is struggling with 3 key things: biobags, media, and filters. @halhod
Novavax is doing its best to operate its lines at "full cadence". But when they have missing items the lines have to shut down.

For the UK they are "weeks" behind where they would have been had they had all the raw materials needed.

(FYI @RoryStewartUK)
Read 16 tweets
28 Apr
Deputy chief medical officer Van Tam says UK covid cases are as low as they are going to get. Here is a visual reminder of where Israel and UK are at currently with cases (ours are just over 2,000 a day).
The briefing can be seen here:
26.50 Van Tam says: solid data on the way vaccine can cut household transmission.
Read 18 tweets
25 Jan
January 23rd edition. We have so many vaccine and covid stories & visuals this week, I've assembled a reading list of them all.

How fast can vaccination against covid-19 make a difference? Israel has some answers. economist.com/science-and-te… Image
A successful vaccination drive will be a shot in the arm for Boris Johnson's government
economist.com/britain/2021/0… Image
Nationalism and geopolitics are slowing innoculations in Asia.
economist.com/asia/2021/01/2… Image
Read 11 tweets
31 Dec 20
For anyone following the dosing debate @peterbachmd @matthewherper this has just been published.

Unfortunately, I have to go and make supper for my family. I look forward to reading your thoughts.
Image
Image
Read 7 tweets
7 Feb 20
Breaking: Singapore proposing social distancing measures in the wake of evidence of some community spread. Warns more stringent measures might be necessary. #2019n_CoV
Minister says: First, we will advise all event organisers to cancel or defer non-essential large-scale events. For those who wish to proceed, we will want them to take all necessary precautions....#2019n_CoV
Second, all employers and individuals should implement regular temperature-taking. They should be done at least twice daily. #2019n_CoV
Read 7 tweets
22 Oct 19
@JohnTuckerPhD @John_LaMattina Peer reviewed paper in Addiction. sciencedaily.com/releases/2019/…
@JohnTuckerPhD @John_LaMattina “Put simply, drug-related payments to physicians seem to increase drug prescriptions, and higher payments seem to increase them more."
@JohnTuckerPhD @John_LaMattina “From 2014 to 2016, the doctors who received payments prescribed, on average, over 13,070 daily doses of opioids per year more than their unpaid colleagues”
Read 4 tweets

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