The Role of International Cooperation and Technology Transfers in Advancing Equity in Global Health

“With health, everything is a source of pleasure; without it, nothing else, whatever it may be, is enjoyable…Health is by far the most important element in human happiness”. Arthur Schopenhauer

Open Access Technology Transfer Models

Despite the third new global wave of international technology transfers (ITT) that emerged during the pandemic of international scope due to Sars-CoV-2, there is still a need to discuss and evaluate the current regulatory challenges that exist in accessing medicines and vaccines for neglected diseases. More importantly, we must address the issue of equitable distribution, production, manufacturing capacities and biotechnological developments in low- and middle-income countries in the global south in 2025.

This piece advocates for open-access technology transfer models for emerging medicine and vaccine technologies worldwide, particularly in the Latin America (Latam) region, following recent World Health Organization (WHO) technology transfer initiatives for mRNA technologies. Additionally, it aims to emphasize that the production of medicines and vaccines is concentrated in a few developed countries in the Global North. Many Global South countries need to develop and export new vaccines to save the lives of their residents and to collaborate and export to their regions of influence, such as Latin America, Africa, and Asia, through a process known as South-South Cooperation.

I will elaborate further on the need to build, fund, and expand local pharmaceutical capacity in Latin America, eliminating some regulatory hurdles, intellectual property restrictions, and trade barriers to (ITT). Producing biologicals locally will greatly benefit people, as biotech independence will help achieve equitable access objectives and save millions of lives.

To illustrate this point, I will present the recent yellow fever case as an example of the importance of this issue, as well as the need to explore creative legal solutions to access vaccines and local manufacturing for neglected diseases. Finally, I will discuss some successful cases of (ITT) in Latin America as a key component of cooperative, open science, and technology transfer and dissemination of know-how, which are needed more than ever for global health equity and access.

Intellectual Property and International Technology Transfers

Access to medicines and vaccines is essential for preparing for future biological threats. This is why it is essential to build local manufacturing capacities and expand research and development (R&D) for new mRNA technologies. This means advancing beyond basic fill-and-finish to upstream manufacturing and integrating strategic components of the value chain with technology transfer models that provide open access and (ITT) sublicensing agreements, while reducing IP barriers for new patents, encouraging the licensing, and sharing of trade secrets.

Additionally, we must eliminate trade regulations and supply chain disruptions while developing preclinical trials to reduce long-term import dependency. This includes revising the patent and trade secret landscape, as well as finding new incentives and financial opportunities to produce and export medicines and vaccines.

Now, regarding the central question of who will own the intellectual property (IP) and patents of second-generation innovations in mRNA vaccine and medicine technologies to address priority diseases, it is important to note that they should be publicly and freely available through a global open-access hub for (ITT). New licensing agreements and IP management should align with this goal to promote equity and access in regions of the world most affected by vaccine hoarding, high medicine costs, and emerging health threats.

International TT involves a deep process of collaboration among different stakeholders, including researchers, scientists, corporations, universities, public-private partnerships, governments, and public health institutions. It involves local and international technical cooperation. This should be promoted and expanded in Latam. Countries such as Mexico, Brazil, and Colombia continue to rely heavily on imports. In 2018, for example, Colombia imported USD 106 million of vaccines for human use. This was despite its previous efforts to develop its own pharmaceutical capacity. Since 1939, Colombia has made significant progress in developing its local industry.

During that period, scientists were able to make significant discoveries and became one of the few countries producing and exporting the yellow fever vaccine to the region and beyond. However, this ended in 2002. Now, the country is facing its worst yellow fever outbreak in decades.

Technological Developments for Human Happiness

Over the past 50 years, vaccines have saved millions of human lives. The positive impact one quality of life and reduction of mortality is enormous. This scientific progress is a great achievement for humanity; it exemplifies how technological developments can improve human existence, reduce mortality, and promote happiness. From a historical perspective, vaccines are most needed in vulnerable areas and low- and middle-income countries.

This is an example of human cooperation to advance global health. The current issue is ensuring equity, access, fair distribution, and production in all parts of the world because all human lives have equal value. It is worth mentioning again the need to recognize essential medicines and vaccines as global public goods. This would be a step forward in leveling the playing field for the Least Developed Countries, especially in times of severe cuts in global health funding. Building local capacities is key.

Regarding local manufacturing capacities and bio-industrialization in Latam and successful international technology transfers, more financing is needed to develop local capabilities to face new emerging diseases. Additionally, sharing intellectual property (IP), knowledge, technical expertise and training personnel is essential. There is an urgent need to escalate production of vaccines for neglected tropical diseases in smaller countries in the region. There must be more collaboration with international institutions such as WHO, as well as the private sector, and local governments in countries with smaller budgets and technical capacity. Long-term development priorities include revising vaccination coverage rates in vulnerable regions and improving epidemiological supervision by national health authorities.

Following the onset of the pandemic, other countries such as Panamá, Peru, Chile, and Colombia established new partnerships in the field of vaccine production. However, there are projects in downstream stages of fill and finish. The region has a lot of potential for producing medicines and generics other than vaccines. Cuba, Nicaragua, Mexico, Brazil, and Argentina have more capacities to develop new vaccines from start to finish. For a complete list and table of successful tech transfers after Covid-19 in the region after the pandemic, you can read more here.  Argentina, for instance, developed a successful ITT agreement for an influenza vaccine with a major European firm in 2013, and Sinergium is now working with the WHO mRNA vaccine manufacture platform. Additionally, the Bio-Manguinhos Institute of Technology on immunobiologicals in   Brazil.

The WHO Pandemic Agreement and Global Health Cooperation

After three years of negotiations, the WHO Pandemic Agreement was adopted by member states of the World Health Organization (WHO) in a plenary session of the World Health Assembly in accordance with Article 19 of the WHO Constitution. The agreement represents a solid consensus on global cooperation and equity (defined in Article 3), technology transfers, and the fair and equitable distribution of health products, such as vaccines, therapeutics, and diagnostics, to the world’s most vulnerable areas.

Article 10 elaborates on sustainable, geographically diverse local production, as well as the need to “reduce the potential gap between supply and demand during pandemic emergencies” and provide “training, capacity building, and timely support for the development and production of pandemic-related products, especially in developing countries.” The goal is to achieve geographically diverse production. Although there are no mandatory technology transfers, the agreement is an important step forward for developing countries, as it will help them reduce their dependence and develop their own capacity to produce vaccines, diagnostics, and therapeutics in preparation for future pandemics.

Other recent initiatives, such as the transfer of mRNA vaccine technology, could be expanded in this context. Article 11 calls on members to facilitate or incentivize the transfer of technology for pandemic-related health products as mutually agreed upon, to enhance the availability of licenses and the transfer of relevant knowledge, skills, and technical expertise, and to establish regional or global technology transfer hubs coordinated by the WHO or other mechanisms or networks. More importantly, it calls for support of capacity building and developing country manufacturers, including the pooling of IP, relevant knowledge, and technical expertise. There is no compulsory licensing of pandemic-related patents or mandatory technology transfers; only voluntary measures exist.

Furthermore, Article 17 discusses international cooperation and support for implementation.

“Such cooperation shall include, inter alia, the promotion of the transfer of technology as mutually agreed, including transfer of relevant knowledge, skills, and technical expertise, and the sharing of technical, scientific and legal expertise, as well as financial assistance and support for capacity-strengthening for those Parties that lack the means and resources to implement the provisions of the WHO Pandemic Agreement.”

The key question now is how to implement and enforce it. It is a very important blueprint for global tech cooperation. Ratification by 60 member states or regional economic integration organizations is required. The agreement establishes a network to enhance equity and access, and a future Conference of the Parties (COP) should specify its functions. While there are no binding commitments or enforceable obligations regarding technology transfers to least developed countries (LDCs), liability, or TRIPS waivers, the agreement aims to reduce the gap in pandemic preparedness, response, and access, with a strong emphasis on equity. In this context, it aims to eliminate “unfair, avoidable, or remediable differences among and between individuals, communities, and countries” (See Article 3.4).

In conclusion, much work remains to be done in the near future to close existing technology access gaps in the global south. Governments and corporations must play a role to play when it comes to finding key actors and incentives for innovation and re-industrialization. The WHO´s Health Technology Access Programme (HTAP) is a good concrete example of cooperation in this regard, (HTAP) succeeds the Technology Access Pool (C-TAP), which was created during COVID-19, and it integrates the mRNA technology transfer programme.

In addition, the WHO Pandemic Agreement represents a key answer to the question of global collaboration in addressing existing and emerging health challenges in the global south. Facilitating technology transfer, technical expertise, and locally owned mRNA technologies and manufacturing will help to address global health priorities and prepare for new health threats in the decades to come.