A dire moment in the pandemic ... was the chance he'd been waiting for

For Sotiris Missailidis, early 2021 was one of the most disheartening moments of the pandemic: The most cutting-edge vaccines against COVID – the ones using mRNA – were still in short supply. The only two companies that make them – Moderna and Pfizer – were effectively only selling them to wealthy countries.

Months earlier, Missailidis and colleagues at Brazil's premier agency for vaccines had approached the companies with what could have been a solution to head off this very scenario: They asked the companies to share their know-how so Brazil could make the vaccines in its own factories. He recalls: "Neither of them accepted."

Yet, ironically, this episode, was also "a brilliant moment," says Missailidis with a wry smile. That's because it enabled Missailidis, who heads reasearch and development at the agency, to finally convince Brazil's government to back a plan with world-changing potential. It's an unprecedented collaboration between scientists from middle-income countries to help each other break the lock that wealthy countries have on not just COVID vaccines but on the invention of new vaccines in general.

"The posture of Moderna and Pfizer pushed for a reaction," says Missailidis. "It was sad. But to a certain extent it was good for us, because it pushed us to have our independence."

If the vision comes to fruition, in future pandemics, it would save hundreds of millions of lives in low- and middle-income countries. It would also amount to a tectonic shift in the way science is done.

The extent of this potential change is on display at the start of a recent gathering in Rio de Janeiro hosted by Missailidis's agency, called the BioManguinhos Fiocruz Foundation.

The auditorium is packed with mRNA experts from Latin America as well as South Africa. But with the exception of a team from PATH – a Seattle-based non-profit that is providing some technical support – none of the scientists present are from the United States or Europe, the wealthy countries of what's often called the Global North. This is a strictly Global South affair.

Always second in line

Missailidis comes to the microphone. "We've always acted in public health emergencies," he says. "This is our mission."

In an interview with NPR, however, Missailidis notes that, until now it's a mission that's faced a major obstacle: It's been virtually impossible for Brazilian scientists to invent their own vaccines from scratch.

Virtually every time the teams that Missailidis oversees have tried, they've been beaten to the punch by pharmaceutical companies in wealthy countries — often called Big Pharma.

"Our time to develop is more delayed than the big Pharmas," says Missailidis. Institutes in middle income countries like his don't have anywhere near the same funding. And governments such as Brazil's understandably want to provide new vaccines to their citizens as quickly as possible.

The upshot, says Missailidis: "If there is an emergency and big Pharma has the vaccine, we're often obliged to interrupt our own development and accept the vaccine that is ready."

They do this through what's called a "technology transfer." Essentially, the maker of a vaccine invented in a wealthy country agrees to share the recipe with a middle income country, so that the middle-income country can start pumping out its own supply.

Brazil has gotten really good at doing these types of transfers. The trouble is that they require the permission of the inventor of the vaccine.

"You'll always have access to what the others want to give you, at the price they want to give you, at the numbers they want to give you," says Missailidis.

In short, you'll always be dependent.

A moment for change

When COVID hit, it seemed the old pattern was set to repeat itself. Some of the scientists whom Missailidis oversees had actually been working on mRNA technology. They proposed adapting it to create an original home-grown mRNA vaccine against COVID. But when Missailidis tried to get the funding, per usual, he was effectively told by higher ups who control the purse strings, 'Just drop it.'

"There were people that were pessimists," says Missailidis. And they said, " 'Well, you'll never go anywhere. And we'll do a technology transfer anyway."

On that last point, the naysayers were proved right. Missailidis and his colleagues did help Brazil reach a technology transfer deal with a different global north company — Europe-based Oxford AstraZeneca. It's vaccine uses older technology – rather than mRNA – but is also highly effective. And in a few months Brazil was making massive quantities of it.

"We managed to vaccinate 90% of the Brazilian population," notes Missailidis.

But this time, Missailidis was also determined that the technology transfer shouldn't prompt Brazil to abandon the homegrown effort — the one to invent Brazil's very own mRNA vaccine. Even if it was going to take them years longer than Moderna and Pfizer to complete it.

"You have to break that barrier of dependence, of always being second in line," says Missailidis. "If you don't bother, you will never change. You will always be at the mercy of big Pharma, at the mercy of richer countries. You need to have a moment where you change – where you come out of that. And this was the moment."

At first, Missailidis had to tell the scientists that the only money available was a few tens of thousands of dollars that he could pull from his existing budget.

"It was like, "Well, take whatever you can and let's keep pushing it. ' " recalls Missailids. "We worked for a long time alone with little support."

But it helped that mRNA vaccines aren't only useful against COVID. This is a totally new technology that could potentially be used to fight all manner of diseases.

In other words, says Missailidis, he could make the case that "not stopping that effort made it possible to guarantee a better future for the next time."

But it was Moderna's and Pfizer's decision not to share their know-how that ultimately proved most pivotal. The result was not simply to shift attitudes in Brazil. It also prompted the World Health Organization and some partners to launch an audacious plan of their own: WHO officials have designated the Brazil team (paired with an Argentine company), along with a separate team in South Africa, to act as "hubs" that will not just figure out how to make mRNA vaccines against COVID but, with WHO's support, teach that knowledge to manufacturers from low- and middle-income countries around the world.

In contrast to Brazil, the South African team isn't exactly inventing a new vaccine. It's effectively trying to replicate Moderna's recipe.

Still, says Missailidis in both cases, "It's a change in paradigm. We stop receiving technology. We produce technology. And we transfer it to others."

Making scientific history

The meeting in Rio de Janeiro is the second time the scientists in the two hubs have gathered in one place.

During a coffee break the head of South Africa's effort, Caryn Fenner of Afrigen Biologics and Vaccines, falls into a conversation about lab equiptment with one of the Argentines, German Sanchez, of Sinergium Biotech.

"Trading of ideas is really important because in terms of the mRNA platform it's still fairly new," says Fenner. "It's not a blanket thing that goes with all vaccines."

But just as valuable as the technical discussions, adds Fenner, is how they are helping build a network of global south scientists. Fenner says they've been trying to do this for years.

"You use a crisis to propel something, right?" she says. "And we've used COVID as a springboard."

What's more says Fenner, by taking the lead on vaccine creation, scientists from the global south can ensure that the focus is placed on diseases that affect their regions, even if they're not priorities for wealthy countries.

The lead scientist on Brazil's team, Patricia Neves, agrees as she surveys the room. Seeing all these scientists from the global south working together, she says, "that's the most exciting thing for me. Because we are not depending on others to do this."

Now, says Neves, we're making history.

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