# Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view

Lan Yao, Hiam Chemaitelly, Emanuel Goldman, Esayas Kebede Gudina, Asma Khalil, Rahaman Ahmed, Ayorinde Babatunde James, Anna Roca, Mosoka Papa Fallah, Andrew Macnab, et al.

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## To cite this version:

Lan Yao, Hiam Chemaitelly, Emanuel Goldman, Esayas Kebede Gudina, Asma Khalil, et al. Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view. *EClinicalMedicine*, 2023, 64, 10.1016/j.eclinm.2023.102222. hal-05139226

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# Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view

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Lan Yao,ᵃ,ᵇ Hiam Chemaitelly,ᶜ,>d,>e Emanuel Goldman,ᵇ Esayar Kebede Gudina,⁹ Asma Khalil,ᵇ,au Rahaman Ahmed,ij Ayorinde Babatunde James,⁴
Anna Roca,¹ Mosoka Papa Fallah,¹m,av,aw Andrew Macnab,ⁿ William C. Cho,º John Eikelboom,¹p,ax Farah Naz Qamar,q Peter Kremsner,r,ay
Miquel Oliu-Barton,⁵,† Ivan Sisa,⁷ Birkneh Tilahun Tadesse,⁹ Florian Marks,⁹ Lishi Wang,⁹ Jerome H. Kim,⁵,⁹ Xia Meng,⁹ Yongjun Wang,⁹ Alyce D. Fly,ᵃ
Cong-Yi Wang,aa Sara W. Day,ab Scott C. Howard,ab J. Carolyn Graff,ab Marcello Maida,ac Kunal Ray,ad Carlos Franco-Paredes,ac,az
Tapfumanei Mashe,af,ag Ngashi Ngongo,ah Jean Kaseya,ah Nicaise Ndembi,ah Yu Hu,ai,aj Maria Elena Bottazzi,ak,al,am Peter J. Hotez,ak,al,am
Ken J. Ishii,an,ao,ap Gang Wang,qq Dianjun Sun,ar,** Lotfi Aleya,as,*** and Weikuan Gub,b,at,*

ᵃDepartment of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA

ᵇDepartment of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA

ᶜInfectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar

World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar

Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA

Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA

Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia

Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK

Cell Biology and Genetics Department, University of Lagos, Lagos 101017, Nigeria

Centre for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Lagos 100001, Nigeria

Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria

Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia

Refuge Place International, Monrovia, Liberia

The Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, South Africa

Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China

Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada

Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Karachi, Sindh 74800, Pakistan

Institut für Tropenmedizin, Universität Tübingen, Germany

Université Paris Dauphine - PSL, Pl. du Maréchal de Lattre de Tassigny, Paris 75016, France

Bruegel, Rue de la Charité 33, Brussels 1210, Belgium

College of Health Sciences, Universidad San Francisco de Quito, Quito 170901, Ecuador

International Vaccine Institute, Seoul, Republic of Korea

Department of Basic Medicine, Inner Mongolia Medical University, Jinshan Development Zone, Huhhot, China

International Vaccine Institute, Seoul, Republic of Korea

Seoul National University, College of Natural Sciences, Seoul, Republic of Korea

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China

NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, The Centre for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

<footnote>*Corresponding author. 956 Court Avenue, Memphis, TN 38163, USA.</footnote>

<footnote>**Corresponding author. 157 Baojian Road, Harbin, Heilongjiang 150081, China.</footnote>

<footnote>***Corresponding author. Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex F-25030, France.</footnote>

<footnote>E-mail addresses: wgu@uthsc.edu (W. Gu), hrbmusdj@163.com, weiwei@hrbmu.edu.cn, weiwei@hrbmu.com (D. Sun), lotfi.aleya@univ-fcomte.fr (L. Aleya), lanyao@bsu.edu (L. Yao), Hsc2001@qatar-med.cornell.edu (H. Chemaitelly), egoldman@njms.rutgers.edu (E. Goldman), esayar.gudina@ju.edu.et (E.K. Gudina), akhalil@sgul.ac.uk (A. Khalil), ahmedrahman158@gmail.com (R. Ahmed), ayorindejames@gmail.com (A.B. James), aroca@mrc.gm (A. Roca), fallahm@africa-union.org (M.P. Fallah), ajmacnab@gmail.com (A. Macnab), williamcscho@gmail.com, chocs@ha.org.hk (W.C. Cho), eikelbj@mcmaster.ca (J. Eikelboom), farah.qamar@aku.edu (F.N. Qamar), peter.kremsner@uni-tuebingen.de (P. Kremsner), oliubart@gmail.com (M. Oliu-Barton), isisa@usfq.edu.ec (I. Sisa), Birkneh.Tadesse@ivi.int (B.T. Tadesse), fmarks@ivi.int (F. Marks), Lwang37@126.com (L. Wang), jerome.kim@ivi.int (J.H. Kim), Mengxia45@163.com (X. Meng), yongjunwang@ncrcnd.org.cn (Y. Wang), adfly@bsu.edu (A.D. Fly), wangcy@tjh.tjmu.edu.cn (C.-Y. Wang), sday5@uthsc.edu (S.W. Day), scott.howard@ResonanceHealth.org (S.C. Howard), jgraff@uthsc.edu (J.C. Graff), Marcello.maida@hotmail.it (M. Maida), kunalray@gmail.com (K. Ray), carlos.franco.paredes@gmail.com (C. Franco-Paredes), mashet2006@yahoo.co.uk (T. Mashe), ngongon@africa-union.org (N. Ngongo), kaseyaj@africa-union.org (J. Kaseya), NicaiseN@africa-union.org (N. Ndembi), dr.huyu@126.com (Y. Hu), bottazzi@bcm.edu (M.E. Bottazzi), hotez@bcm.edu (P.J. Hotez), kenishii@ims.u-tokyo.ac.jp (K.J. Ishii), wgilu79@163.com (G. Wang).</footnote>
abCollege of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA

acGastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy

adSchool of Biological Science, Ramkrishna Mission Vivekananda Education & Research Institute, Narendrapur 700103, West Bengal, India

aeHospital Infantil de Mexico, Federico Gomez, Mexico

afOne Health Office, Ministry of Health and Child Care, Harare, Zimbabwe

agWorld Health Organization, Harare, Zimbabwe

ahInstitute of Human Virology, Abuja, Nigeria

aiInstitute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China

alHubei Clinical and Research Centre of Thrombosis and Hemostasis, Wuhan, China

akDepartment of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA

alNational School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA

amMolecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA

anDivision of Vaccine Science, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

aoInternational Vaccine Design Centre, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

apCentre for Vaccine Adjuvant Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan

aqDepartment of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China

arCentre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health 23618104, 157 Baojian Road, Harbin, Heilongjiang 150081, China

asChrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex F-25030, France

atResearch Service, Memphis VA Medical Centre, 1030 Jefferson Avenue, Memphis, TN 38104, USA

avVascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK

avCentre for Emerging Infectious Diseases Policy and Research, Boston University, Boston, MA, USA

awAfrica Centre for Disease Control, Addis Ababa, Ethiopia

axDepartment of Medicine, McMaster University, Hamilton, ON, Canada

ayCentre de Recherches Medicales de Lambarene, Gabon

azDepartment of Microbiology, Immunology, and Pathology, Colorado State University, USA

## Summary

In counteracting highly infectious and disruptive respiratory diseases such as COVID-19, vaccination remains the primary and safest way to prevent disease, reduce the severity of illness, and save lives. Unfortunately, vaccination is often not the first intervention deployed for a new pandemic, as it takes time to develop and test vaccines, and confirmation of safety requires a period of observation after vaccination to detect potential late-onset vaccine-associated adverse events. In the meantime, nonpharmacologic public health interventions such as mask-wearing and social distancing can provide some degree of protection. As climate change, with its environmental impacts on pathogen evolution and international mobility continue to rise, highly infectious respiratory diseases will likely emerge more frequently and their impact is expected to be substantial. How quickly a safe and efficacious vaccine can be deployed against rising infectious respiratory diseases may be the most important challenge that humanity will face in the near future. While some organizations are engaged in addressing the World Health Organization's "blueprint for priority diseases", the lack of worldwide preparedness, and the uncertainty around universal vaccine availability, remain major concerns. We therefore propose the establishment of an international candidate vaccine pool repository for potential respiratory diseases, supported by multiple stakeholders and countries that contribute facilities, technologies, and other medical and financial resources. The types and categories of candidate vaccines can be determined based on information from previous pandemics and epidemics. Each participant country or region can focus on developing one or a few vaccine types or categories, together covering most if not all possible potential infectious diseases. The safety of these vaccines can be tested using animal models. Information for effective candidates that can be potentially applied to humans will then be shared across all participants. When a new pandemic arises, these pre-selected and tested vaccines can be quickly tested in RCTs for human populations.

Copyright Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

**Keywords:** COVID-19; Disease; Infection; International collaboration; Vaccine
## Introduction

Mitigating the impact of an infectious disease pandemic entails the availability of effective vaccines that can reduce disease severity and prevent deaths. By the end of 2022, coronavirus disease 2019 (COVID-19) claimed almost 7 million lives around the world, with the death rate being substantially higher during the first disease wave substantially higher during the first disease wave, prior to vaccine availability¹⁻³ (https://www.worldometers.info/coronavirus/). In particular, the death rate declined from 5.7% during the first wave to approximately 1.7% during the second and third waves second and third waves in developed countries, when vaccines became available when vaccines became available and the later variants, Omicron and Delta, caused significantly less morbidity and mortality.⁴ Evidence suggests a 60%–90% decline in severity following vaccination,⁵⁻⁷ and that vaccination remains the safest and best tool for protecting against COVID-19-related hospitalization and death, irrespective of previous infection status.⁸ Once vaccines were available, they averted an estimated 20 million deaths from COVID-19.⁹ Widespread vaccination is also expected to reduce the economic burden of the disease and its impact on social liberties,¹⁰,¹¹ and the likelihood of the emergence of immune escape virus variants.¹²⁻¹⁴ Among all pandemic diseases, air transmissible respiratory diseases are the most contagious and difficult to contain. The critical question is thus how to make vaccines available as early as possible during future similar or even more severe pandemics.

## Risk of emerging respiratory infectious disease pandemics

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is thus far the most contagious and disruptive infectious disease of the 21st century, causing a humanitarian crisis and high mortality. This pandemic is unlikely to be the last. Evidence suggests that the occurrence of such pandemics may become more frequent in the near future.¹⁵,¹⁶ Thus, according to the WHO and the US CDC there are several pathogens that could cause future pandemics including Crimean-Cong haemorrhagic fever, Ebola virus disease and Marburg virus disease, Lassa fever, Middle East respiratory syndrome (MERS), Nipah and henipaviral disease, Rift Valley fever, Zika virus, Disease X, Cholera, Polio, Enterovirus-71, high drug-resistant Tuberculosis and avian influenza H5N1.¹⁷,¹⁸ For example, as this manuscript is written the avian influenza H5N1 is subject of close surveillance by the WHO and the Institute of Public Health of Chile where last March 2023 was reported a human infection of avian influenza H5N1.¹⁹

Infectious diseases transmission are driven by several factors. Human interaction is one of the main

factors at environmental level. For instance, global warming increases the chance of survival of microorganisms and their global spread.¹⁵,²⁰ The urbanization phenomenon through new road construction has been associated with higher R₀ (reproductive number) for viral, bacterial and protozoan pathogens transmission in nonremote villages compared to remote communities.²¹ In addition, urbanization has caused deforestation and contamination of major watersheds and local climate, both of which can affect the transmission of enteric pathogens.¹⁸,²²

Modernization and development of human society increases domestic and international travels, contributing to the transmission of infectious diseases in human populations.²³ Population growth and density also increase exposure to bacteria, viruses and animals, and therefore further infection transmission.¹⁶ The impact of human and societal development on the spread of infectious disease is hard to mitigate, making infectious diseases an inevitable health challenge that humanity must face.²⁴

## The urgent need for an international vaccine candidate repository pool for potential respiratory infectious diseases

Before endorsing a framework that discusses the organization of an international collaboration on vaccine candidates pool, it is imperative to acknowledge that future infectious respiratory diseases threaten all human societies and cannot be contained unless globally controlled. For example, SARS-CoV-2 showed growing resilience and sustainable circulation with emerging variants.⁸ In the future, a new dreadful pandemic that spreads rapidly may emerge. The emergence of new variants of concern within the existing COVID-19 pandemic remains possible as well. Confronting such threats requires the support of not only scientific societies but also governments and public and private organizations around the world. In addition to existing organizations and pharmaceutical companies for vaccine development (Supplementary Table S1), if there were a new pandemic, a centralized data and resource exchange would also be helpful. Providing data on vaccine safety and effectiveness of the potential vaccines would enormously help modeling and forecast, especially in the mid- and long-term.

## Proposed mission of the international vaccine pool (InterVax™)

The mission of international vaccine pool InterVax™ is to build a foundation to accelerate the development of vaccines against potential future respiratory infectious disease pandemic threats so vaccines can be accessible to any people in need.

The scope of the international pool includes vaccines against known viruses, that may potentially lead to high
contiguous and catastrophic pandemics, if mutated or transmitted to humans.

The international pool will focus on the collection and analysis of information on known viruses; design and production of potential vaccines; and testing the safety of potential vaccines in vitro and in vivo on animal models.

The InterVax™ is an open platform that provides information all over the world for utilization; users are expected to follow the same principles of the mission of the international pool. InterVax" will be registered as a non-profit independent entity trademark. Members of the entity have access to the pool and own this trademark equally in terms of health equity.

## Suggested function of the international vaccine pool (InterVax™)

### Funding

International vaccine pool accepts all funds from government, public and private, organizations and individuals. No funds should have any additional condition except equal global distribution of the products of InterVax™.

### Independence

International vaccine pool will work closely with WHO and other major vaccine organizations as an independent entity, leveraging its existing infrastructure and contacts in different countries, to achieve its mission (Supplementary Table S1). Accordingly, the initiative will be available to all countries with no discrimination.

### Interactions

International vaccine pool should collaborate with other international and national organizations, so that information for effective candidates that can be potentially applied to humans will then be shared across all participants to ensure the vaccine reaches where it is needed in case new infectious disease emerge. While the international vaccine pool stands as an independent organization, its interaction with existing organizations for vaccine research and production (listed in Supplementary Table S1 as examples) will benefit from potential resources (WHO, CDCs from variety countries), financial support (CDCs, WHO, CEPI, SRC), disease monitoring (ISID, IVI), network information (IFIC, SCARDA, IVI) and technology renovations (BARDA, VAANZ, GIZ, SRC, etc).

## Possibility for the establishment of the international vaccine pool (InterVax™)

Currently, the three major types of vaccines are mRNA vaccines, protein subunit vaccines, and viral vector vaccines.²⁵ These are either directly synthesized in the laboratory, as pieces (e.g., spike proteins) of the virus, or

a modified virus. The rapid development of biotechnologies and our understanding of genomic components of various organisms enables us to design and produce a variety of molecules including mRNA and proteins through diverse approaches. First, through genomic sequencing, we can extract genome sequences for an array of viruses, other infectious pathogens, and their hosts. Such information enables estimation, to a high degree of reliability, of the potential pathogenic effect of infectious agents on human hosts, as well as projecting and ranking their potential transmission based on information on clustering from previous pandemics. Second, current technologies allow us to design and produce genomic sequences that can be utilized in the production of mRNA or protein sequences that can be used as vaccines.

The span of diversity in knowledge, technological advancement, resources, and methodologies across different countries and regions suggests that a well-organized international collaboration will lead to the production of a large volume of material that can be solicited for potential vaccine development.

Such an initiative would be of global interest, including to economic giants as exemplified by the COVID-19 pandemic that caused significant losses to all economies. During the pandemic, countries globally were racing to produce or procure effective vaccines against SARS-CoV-2 infection to restore normalcy. The short-term urgency also necessitated an unprecedented pouring of resources to make any vaccine available, even with partial efficacy. Additionally, despite significant investment in research and development, no single country has had the capacity to meet the unprecedented global demand for vaccines. The proposed vaccine pool will allow rapid vaccine production at a much lower cost and will equip countries, including economic giants with better preparedness against the economic and health consequences of future pandemics. The vaccine pool is also likely to encourage innovation in vaccine development providing economic giants with an incentive to produce more effective vaccines that can compete in international markets.

One might ask whether it is even possible to launch such an effort, given the enormous stakes for existing economic giants. While it is certainly a concern that some elements of society will seek to use an emerging pandemic as an economic opportunity, we believe that because the stakes are so high, everyone will join forces to combat a common enemy. To this end, proper public dissemination and communication through the press and social media will be instrumental to align everyone in this battle, including the economic giants.

## Expected benefit of the vaccine candidate pool

An international vaccine pool could reduce harmful competition among countries or vaccine production
companies that emphasize outcome rather than value and expense (Fig. 1A). Outcome-centered competition may lead to all sorts of poor decisions. In addition, the vaccine pool will enhance the detection of repetitive products and therefore alert stakeholders to potential duplication of effort and waste of resources in the event when the same vaccines are studying with the same way in multiple places.

An international vaccine pool may facilitate the pro-
duction of candidates for all types of vaccines that are
ready to be tested and utilized against a new pathogen,
notably in case of a new pandemic, whereas an indi-
vidual country may have limited technologies and re-
sources to develop vaccine candidates for every type of
potential infectious virus. Cooperation across countries
and regions will thus bring economies of scale.

This system has the potential to protect geographic
areas not yet affected by an emerging pandemic. Private
sector will likely have a role in a global response, prob-
ably in partnership with governments. This was
certainly the case with COVID-19 and vaccine develop-
ment by both Pfizer-BioNTech and Moderna, with the
support of the United States and other governments.
Again, we are all in this together, and as business and
government entities recognize the common threat, the
imperative of a common response will take precedence.

An international vaccine pool can be used to ensure
timely control of infection spread in areas with
emerging variants. It could be used to quickly identify
geographical areas where a new disease is emerging and
provide available measures to restrict its spread.
Without an international collaboration pool, the vaccine
may not be available in places where the disease occurs
first, or in a large pandemic area. Such places may be in
a low-income country where the capability of vaccine
production is either weak or even non-existent. An

example is monkeypox which is endemic in some Af-
rican countries but became significant (multicentre
drug and vaccine trials) when it affected high-income
countries.²⁶ Even in areas where new mutants or dis-
ease outbreaks have not yet occurred, the vaccine pool
could still be beneficial by enabling more rapid and
efficient vaccine development and distribution in case of
an arising public health emergency. With such an in-
ternational organization, a vaccine may be available for
these places that are in need, notably the regions that are
closely connected to where the outbreak was detected,
and low-income countries where the spread can lead to
more hazard.²⁷,²⁸ Thus, the vaccine pool could address
health equity issues by prioritizing the most vulnerable
regions. Governments have a vital role to play in sup-
porting the private sector in vaccine development,
providing the necessary funding, regulatory support,
and incentives to encourage innovation. However, it is
crucial to ensure that these efforts align with the broader
mission of the vaccine pool of improving global health
outcomes and increasing vaccines' availability and
accessibility. Governments must prioritize public health
and ensure that any private sector involvement is subject
to appropriate oversight, transparency, and ethical
considerations.

An international vaccine pool can allow pre-testing of the safety and immunogenicity of molecules in animal models. In this case, it saves the time to get into clinical trials of human populations in case infectious disease occurs. In the case of a disease with high infectivity and mortality, saving time means saving hundreds of thousands of lives.

An established platform of an international pool can
be utilized to test and document human safety in
various populations in different categories to ensure
their safe usage. For example, testing the safety and

<figure><img src="image_5.png" /><figcaption>**Fig. 1:** Function and organization of international vaccine candidate pool. (A) Function Position and Interaction. It shows how the InterVax works with WHO, Public/Private organizations, Research Institutes, Vaccine producer, Profit organizations and Governments/individuals. (B) Vaccine Pool Organization. The flowchart demonstrates the supports InterVax obtained from various organizations and data shared with industrial sections.</figcaption></figure>
dosages in pregnant women or ensuring efforts to
demonstrate safety in pregnancy, one of the lessons
learned from the COVID-19 pandemic.²⁹,³⁰

The vaccine pool may also facilitate testing the po-
tential utility of vaccines developed against one infection
in protecting the population against other infections. An
example to this end is a meningococcal vaccine recently
found to be effective against acquiring gonorrhea
infection.

An international vaccine pool will effectively works
with existing organizations for vaccine production effi-
ciency and reduce the duplication of novel vaccine given
an unknown viral outbreak. For example, the vaccine
pool complements the 100 days vaccine mission of CEPI
in a more effective way, avoiding unnecessary duplica-
tion and waste of research & development resources and
time, without any negative effect on the new vaccine
safety. While CEPI develops its 100 capacity, the Inter-
Vax™ will be capable for the information collection and
prediction of future threatening viruses. While the 100
days vaccine mission of CEPI is mainly supported by G7
countries, the international vaccine pool will ensure the
developing countries to have an equal opportunity for
the pandemic preparations.

Proposed organization and operation of the
global vaccine coordination committee

To achieve such an international vaccine candidate pool (Fig. 1B), we call for international action to immediately 1) start the discussion on how to form an organized committee to plan the pool, 2) invite more WHO members to join our mission and to potentially assume WHO a leading role in the organization and coordination of committee activities, 3) invite more scientists from developing countries, from low or middle-income countries, underserved population and under-resourced groups, to join the InterVax™, and 4) establish dialogues among the scientific community, the WHO, world leaders in other health organizations, and relevant governmental and private organizations.

While the vicissitudes of political and cultural dif-
ferences do pose a challenge, it is worth noting that even
in cases of extreme opposition, countries have
continued to cooperate on certain activities. We believe
the imperative of mutual survival will take precedence
over political divisions. In the ideal, Science is an in-
ternational enterprise that has no national boundaries.
The World Health Organization, with headquarters in
Switzerland, would be an appropriate organization to
oversee this initiative.

Future directions

When a consensus is formed, work may begin to 1)
form an executive committee for activity coordination, 2)
form subcommittees and designate coordinators in

countries and regions, 3) develop a vaccine synthesis
plan to rank potential risks of various known pathogens,
4) collaborate with industry for potential assistance in
the accomplishment of certain goals, and 5) start care-
fully to coordinate the global task for the division of
candidate synthesis.

This also entails:

* Creating a live repository of available technologies and molecules used in existing vaccines, available manufacturing and storage facilities, and infrastructure, as well as available financial schemes that can facilitate vaccine development.

* Mapping of research institutions that can facilitate the conduct of safety test and clinical trials such as the Adjuvant Development Program at the National Institute of Allergy and Infectious Diseases in the USA.

* Creation of an aligned incentive structure that rewards government, private, and academic institutions that participate.

* Determine the locations and establish headquarters and offices in different regions and countries.

* Nominate coordinator/s and representatives from major organizations and/or countries.

* Intellectual property management system. Within the InterVax™ to establish a “patent-free platform pool” so that certain vectors such as Adeno, VSV, MVA, etc., could be made available without IP issues.

In conclusion, we urge the international community,
especially the WHO, to start a worldwide coordinated
synthesis of vaccines and provide locations, resource
supplements, and personnel training. Doing so will help
achieve effective infection control and regain functional
global and local economies in the event of a future
pandemic.

Contributors

Conceived and designed the experiments: LY, JHK, WG, DS, LA. Per-
formed data searching and collection: LY, WG. Analysed the data: All
Authors. Contributed analysis tools: WG, DS, LA. Wrote first draft of
manuscript: LY, WG, edited by EG, CG. Revise and approve manuscript:
All authors.

Data sharing statement

All the data are available at the public databases as provided in the
manuscript.

Declaration of interests

Peter Hotez is a co-inventor of a COVID-19 recombinant protein vaccine technology owned by Baylor College of Medicine (BCM) that was recently licensed by BCM non-exclusively and with no patent restrictions to several companies committed to advance vaccines for low- and middle-income countries. The co-inventors have no involvement in license negotiations conducted by BCM. Similar to other research universities, a long-standing BCM policy provides its faculty and staff, who make discoveries that result in a commercial license, a share of any royalty income, according to BCM policy. Jerome H. Kim services as the consultant for SK bioscience and Moderna. Other authors declare no competing financial interests.
## Acknowledgements

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Africa Centers for Disease Control and Prevention and/or other organization. This work was partially supported by funding from merit grant 101 BX000671 to WG from the Department of Veterans Affairs and the Veterans Administration Medical Center in Memphis, TN, USA. HC is grateful for institutional salary support from the Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, both at Weill Cornell Medicine-Qatar.

## Appendix A. Supplementary data

Supplementary data related to this article can be found at https://doi.org/10.1016/j.eclinm.2023.102222.

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