Feared shortages of vaccines protecting against pneumonia and HPV could endanger millions

Millions of lives could be endangered in the coming years as a result of feared supply shortages to two vaccines that protect children against pneumonia and a cancer-causing virus.

Following an analysis of the impact of the Covid pandemic on the vaccine manufacturing industry, the World Health Organisation (WHO) has determined that global supplies of the human papillomavirus (HPV) and pneumococcal conjugate vaccine (PCV) could be reduced by up to 10 per cent within the next three years. This figure could rise to 20 per cent by 2027.

The estimates, which come from a “moderate scenario” modelled by the WHO, take into account the impact of Covid-19 on universal resources needed to make vaccines, existing manufacturing processes and capacities and clinical developments in the pipeline.

Some 60 million doses of the HPV vaccine are administered to teenagers every year to protect against cervical, oral and other cancers linked to sex, while around 160 million shots of PCV were rolled out in 2019 to prevent pneumonia deaths in infants caused by the bacterium Streptococcus pneumoniae. Together, the two vaccines help to prevent millions of infections and deaths across the globe.

But the immense strain placed on the vaccine manufacturing industry by the Covid-19 jabs is now threatening to limit the number of HPV and PCV doses that are produced annually.

Tania Cernuschi, team lead for the WHO’s global access, immunisation, vaccines and biologicals department, said the organisation had worked with manufacturers, industry leaders, independent experts and immunisation partners since winter to ascertain the impact of Covid-19 upon the sector.

The research found that many of the same chemical ingredients, laboratories and experienced staff used to produce the Covid vaccines are also required for the manufacturing of PCV.

“There is an overlap in the production process,” said Ms Cernuschi. “We are aware of plants that are being shifted to Covid-19. So that’s where there is a risk in this case.”

As for the HPV vaccine, which was already short in supply prior to Covid, the WHO’s research has concluded that manufacturers who were looking to develop new jabs against human papillomavirus are delaying and pushing back this work.

“There’s been a big hope that new manufacturers will come online and that they would play a key role to reduce the current global shortage of HPV vaccine that we’ve been facing for the past few years,” said Ms Cernuschi. “But we fear the development programmes are now delayed.

“We were hoping for the shortages to be resolved by 2024, but we know think that may take a little longer.”

Only two HPV vaccines, manufactured by MSD and GSK, have been approved for use by the WHO. Several other companies are developing their own jabs against human papillomavirus, including the Serum Institute of India and Walvax.

MSD said it has “nearly doubled global distribution of our HPV vaccines” since 2017 and expects to increase supply once new facilities come online in 2023. The US-based pharmaceutical said it had met its HPV vaccine production targets despite the impact of Covid on manufacturing processes.

GSK, which also produces a PCV vaccine alongside its HPV jab, also said it is not currently experiencing any supply or manufacturing issues as a result of Covid-19. Nor has Pfizer yet to report any constraints in delivering its PCV vaccine to the global market.

The WHO estimates that more than 200 million PCV doses will be needed annually by 2030, while some 170 million HPV jabs will be required by 2028 to meet global demand.

In the face of shortages, lower-income countries “always suffer worse consequences as scarce supply gets allocated to richer countries,” said Ms Cernuschi.

Save the Children said that PCV vaccines have played a vital role in reducing pneumonia deaths among infants, despite only reaching roughly half of children worldwide. It highlighted how severe pneumonia in young Kenyan children dropped by 92 per cent after PCV was introduced to the country.

However, the charity warned “there is a long way to go”, with an estimated 800,000 under-5s dying every year as a result of pneumonia.

“Far too many parents still see their children lose their lives in the cruellest way, gasping for breath as their lungs fill with pus and fluid,” said Jessica Winn, head of Save the Children’s Pneumonia Hub. “The wider introduction of PCV is set to avert millions more of these preventable child deaths.

“Any slowdown of the rollout owing to reduced supply, particularly in poorer countries that already have high rates of pneumonia and other infections caused by the same bacteria, such as sepsis and meningitis, could leave millions of children at risk of serious illness and death.”

Meanwhile, there were a total of 311,000 cervical cancer deaths in 2018, the vast majority of which are attributable to HPV infection, according to the WHO. Hundreds of thousands of more are diagnosed with the cancer every year.

Yet research has shown that an estimated 92 per cent of cancers caused by human papillomavirus could be prevented by the HPV vaccines, therefore saving hundreds of thousands of lives.

Jo’s Cervical Cancer Trust said the HPV vaccine is “an incredibly important tool in getting us closer to a future without cervical cancer”.

The charity’s chief executive, Samantha Dixon, said: “At a time when we should be focusing on reducing the barriers to delivering the HPV vaccine it’s worrying that any shortages in supply could present another.”

As the vital manufacturing of the Covid vaccines ramps up, the WHO is concerned that the availability of shots against other various childhood diseases, such as measles, diphtheria and polio, could also be impacted.

“What we have is confirmation that the risks are real to the production of other vaccines,” Ms Cernuschi said. “But there’s a lot of uncertainty around what type of disruption we can expect in the near future.”