Antibody screening could transform Covid-19 vaccine distribution

The writer is co-director of the Institute of Global Health Innovation at Imperial College London and chair of Pre-emptive Medicine and Health Security Initiative at Flagship Pioneering, the bioplatforms company that founded vaccines maker Moderna

As countries in the global north scale up their Covid-19 vaccination programmes, the world’s poorest countries are being left behind. While most of the world’s population is yet to receive a single dose, some countries are already planning booster shots for later in the year.

A new strategy could release hundreds of millions of doses from advanced economies to less developed countries. Rather than offer booster doses to the whole population, countries could establish Covid-19 protection screening programmes. Antibody levels would be tested and quantified, and booster shots would only be offered to those who needed it.

While antibodies aren’t a perfect measure — the body has an alternative system called T-cell immunity that can provide protection even when antibodies aren’t detected — scientists do know that individuals with Covid-19 antibodies at or near the levels induced by authorised vaccines are protected from severe disease.  

People with sufficient antibodies do not, for now, need an additional dose that could be given to those who are unvaccinated. Indeed, those in wealthy nations could be asked to “donate” their booster dose to those in poorer countries — an act of solidarity at a global scale. 

Recent opinion polling by YouGov for Imperial College’s Institute for Global Health Innovation found broad public support for this approach on both sides of the Atlantic. Nearly four out of five Britons and more than two-thirds of Americans said that they would be happy to donate their booster dose to poor countries if a test showed that they themselves did not need it.

Mass testing programmes that seek to identify active Covid-19 infections could be redeployed for quantitative antibody testing as the initial vaccination programmes near completion. Most advanced countries have invested in the infrastructure already that would enable better prioritisation of the limited doses available globally.

Never before has the world needed 10bn doses of vaccine as quickly as possible. With Covid-19 having spread to every country on earth, the whole world must now be vaccinated, meaning efficient distribution is essential. 

There has been a lot of focus on intellectual property as the greatest barrier to scaling up production and distribution. If only it were that simple. The problems are practical rather than intellectual. Manufacturing vaccines is technically complex, and so it takes time to make new facilities operational. And it is not just about the final stage of manufacture — there are global shortages of the biochemical components that go into vaccines. Focusing on intellectual property is a distraction from other strategies that could make a difference immediately. 

Indeed, AstraZeneca has licensed its Covid-19 vaccine to be produced at cost by the Serum Institute of India and others. Moderna, meanwhile, announced in October 2020 that it would not enforce its patents covering Covid-19 vaccines based on its mRNA technology during the pandemic, so that others could benefit. That announcement was effectively a unilateral patent-enforcement waiver.

Governments and companies are scrambling to scale up the supply of vaccines as fast as possible; there is no disagreement that it is both necessary and desirable. But it will take time, meaning there will be scarcity in the short-run. Introducing antibody screening — so booster doses are distributed globally on the basis of need rather than nationality — is a strategy that could help end this terrible pandemic sooner.