In April 2024, a hybrid meeting organized by the WHO, PAHO, and MPP during the World Bank Spring Meetings focused on financing mRNA-based technologies in Low- and Middle-Income Countries (LMICs). This meeting sought to engage multilateral development banks (MDBs) and stakeholders in financing the expansion of vaccine production and enhancing pandemic preparedness. The COVID-19 pandemic underscored the disparities in vaccine production and distribution, highlighting the need for localized production to improve global health equity. The WHO’s mRNA Technology Transfer Programme, initiated in 2021, aims to build local capacity for mRNA vaccine development and manufacturing. Key sessions covered during the meeting include innovative investment models, with MDBs discussing funding instruments and the necessity of an integrated ecosystem for sustainable vaccine manufacturing. Challenges such as technological risks and the need for higher risk appetite were addressed, along with innovative financing mechanisms like blended financing. An analysis of capital and operational expenditures for mRNA vaccine facilities was presented, projecting significant production capacity in LMICs within a decade. Panelists emphasized the need for sustainable R&D investment and shared experiences in securing funding for mRNA technology. The meeting underscored the importance of collaboration, innovative financing, ecosystem development, and public–private partnerships, marking a pivotal step towards advancing mRNA technology in LMICs to tackle global health challenges.

Over the past quarter century, product development partnerships (PDPs) have importantly brought health technologies, particularly for neglected diseases, to market for low- and middle-income countries (LMICs). With public sector financing, PDPs de-risk the gulf between where the global burden of disease falls and where paying markets exist. From fighting COVID-19 to developing novel antibiotics, the work of PDPs now extends beyond these traditional bounds. As PDPs have shepherded more health technologies to market, they are also confronting new access challenges. This article lays out 5 areas to strategically leverage the PDP model for better access to new health technologies. Making the case for enhanced support of the PDP approach will require greater transparency, as well as recognition of the contributions made by both public and private sector partners. The governance and funding of PDPs must be accountable to meeting the needs and building capacity of target beneficiaries in LMICs. To take an end-to-end approach, PDPs must work in tandem with other public sector institutions as well as local manufacturers as part of a larger innovation ecosystem. PDPs will need to keep pace with both the dynamics of diseases and markets in delivering the next generation of much needed health technologies.

In an effort to improve pandemic preparedness and health security, many low- and middle-income countries (LMICs) have launched initiatives to expand regional vaccine manufacturing. A number of elements relating to vaccine markets, production, value chains, and ecosystems significantly impact the ability to generate economically viable and sustainable vaccine manufacturing in LMICs. This paper provides an overview of vaccine manufacturing characteristics and global vaccine markets dynamics. Establishing vaccine manufacturing is a complex undertaking due to a variety of factors including intense competition, associated uncertainty regarding the ability to capture market share and substantial capital investment requirements. Substantive government commitment and investment are essential to ensure new local entrants compete successfully. In the medium to long run, the role of government should shift from supporting individual firms to strengthening local science ecosystems as this bolsters economic sustainability in three ways. First, investment in science promotes technological advances which can reduce production costs, e.g., through process innovations for vaccine manufacturing. Second, strong science ecosystems help to address the skills gap faced by manufacturers. And third, strong science ecosystems enable research and development of new vaccines that address local unmet needs and open new markets. Furthermore, developing a regional approach to vaccine manufacturing and procurement, with associated regulatory harmonization, is crucial to achieving economically viable and distributed vaccine manufacturing. Importantly, investment in research and development and fostering of regional collaborations drives innovation, feeding into new product discovery and consequently a strong pipeline of new vaccine products, driving economically sustainable regional vaccine manufacturing. This offers the potential to prevent endemic infectious diseases with significant socioeconomic and health burden or to develop therapeutic vaccines, generating regular interpandemic demand for regional vaccine manufacturers, consequently sustaining capacity retention and associated pandemic preparedness.