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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2021. Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines. Washington, DC: The National Academies Press. doi: 10.17226/26285.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Ravi Anupindi, Prashant Yadav, Kenisha M.P. Jefferson, and Elizabeth Ashby, Editors Committee on Addressing Issues of Vaccine Distribution and Supply Chains to Advance Pandemic and Seasonal Influenza Preparedness and Response Board on Global Health Health and Medicine Division A Consensus Study Report of and NATIONAL ACADEMY OF MEDICINE PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and XXXXXX. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13:  978-0-309-XXXXX-X International Standard Book Number-10:  0-309-XXXXX-X Digital Object Identifier:  https://doi.org/10.17226/26285 Library of Congress Catalog Number: XXXXXXXXXX Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2021 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Globally resilient supply chains for seasonal and pandemic influenza vaccines. Washington, DC: The National Academies Press. https://doi.org/10.17226/26285. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin- ions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

COMMITTEE ON ADDRESSING ISSUES OF VACCINE DISTRIBUTION AND SUPPLY CHAINS TO ADVANCE PANDEMIC AND SEASONAL INFLUENZA PREPAREDNESS AND RESPONSE RAVI ANUPINDI (Chair), Colonel William G. and Ann C. Svetlich Professor of Operations Research and Management, University of Michigan PRASHANT YADAV (Vice Chair), Senior Fellow, Center for Global Development; Affiliate Professor, INSEAD, France; Lecturer, Harvard Medical School MAHSHID ABIR, Senior Policy Researcher, RAND Corporation; Associate Professor, University of Michigan Medical School RICK A. BRIGHT, Senior Vice President, Pandemic Prevention and Response, Rockefeller Foundation WILLIAM G. BUREL, President and Chief Executive Officer, Hamilton Grace, LLC MATTHEW DOWNHAM, Sustainable Manufacturing Lead, Coalition for Epidemic Preparedness Innovations NAGWA HASANIN, Senior Health Advisor, UNICEF NOREEN A. HYNES, Associate Professor, Johns Hopkins University Schools of Medicine and Public Health DAVID C. KASLOW, Chief Scientific Officer, PATH PINAR KESKINOCAK, William W. George Chair and Professor and Director, Center for Health and Humanitarian Systems, Georgia Institute of Technology SAAD OMER, Director, Yale Institute for Global Health JENNIFER PANCORBO, Director of Industry Programs and Research, Biomanufacturing Training and Education Center, North Carolina State University Study Staff KENISHA M.P. JEFFERSON, Study Director ELIZABETH ASHBY, Research Associate EMILIE RYAN-CASTILLO, Senior Program Assistant CLAIRE BIFFL, Senior Program Assistant PATRICIA CUFF, Senior Program Officer JULIE PAVLIN, Director, Board on Global Health v PREPUBLICATION COPY—Uncorrected Proofs

Consultants JOSEPH ALPER, Science Writer (until July 2021) KEVIN FAHEY, Science Writer (from August 2021) EUGENIA GROHMAN, Editor (from July 2021) MELISSA MAITIN-SHEPARD, Science Writer (from July 2021) JANAMARIE PERROUD, Technical Writer vi PREPUBLICATION COPY—Uncorrected Proofs

Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine (National Academies) in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectiv- ity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Adeiza Ben Adinoyi, International Federation of Red Cross and Red Crescent Societies Paula Barbosa, International Federation of Pharmaceutical Manufac- turers & Associations Thomas J. Bollyky, Council on Foreign Relations Hans Christiansen, UNICEF Rajinder Kumar Suri, Developing Countries Vaccine Manufacturers Network Julie L. Swann, North Carolina State University Mary E. Wilson, University of California, San Francisco Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its vii PREPUBLICATION COPY—Uncorrected Proofs

viii REVIEWERS release. The review of this report was overseen by Andy Stergachis (Uni- versity of Washington) and Bobbie Berkowitz (Columbia University). They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Re- sponsibility for the final content rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY—Uncorrected Proofs

National Academy of Medicine Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Series This study, Globally Resilient Supply Chains for Seasonal and Pan- demic Influenza Vaccines, provides recommendations on how to bolster vaccine distribution and enhance global vaccine development and manu- facturing infrastructure for pandemic and seasonal influenza events, using lessons learned from COVID-19. It is one of four studies conducted under the Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Initiative, which explores how the scientific and technological breakthroughs throughout the COVID-19 pandemic could inform and advance future pandemic and seasonal influenza vaccine preparedness and response efforts. The three companion studies to this study examine how the lessons learned from COVID-19 around vaccine research and development, public health interventions and countermeasures, and global coordination, part- nerships, and financing could be best utilized to improve the development and distribution of pandemic and seasonal influenza vaccines. Together, the four consensus studies present a path better preparedness in addressing pandemic and seasonal influenza. Launched by the National Academy of Medicine with support from the Office of Global Affairs, U.S. Department of Health and Human Services, the Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Initiative acknowledges that influenza is here to stay. The unprec- edented scope of this initiative allowed for international experts to look at this issue from multiple angles and provide recommendations that set out a pathway to more effective influenza vaccines worldwide. Driven by international cooperation, this independent initiative provides a platform to highlight why we need to act as a global community to better prepare for pandemic and seasonal influenza. ix PREPUBLICATION COPY—Uncorrected Proofs

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Acknowledgments This report is a product of the cooperation and contributions of many people, all of whom helped address a very broad statement of task in an extremely short timeframe. The committee is especially grateful to all the external experts who provided invaluable input at committee meetings. Their names and affiliations can be found in the committee meeting agen- das in Appendix C. This report would not be possible without the spon- sorship of the U.S. Department of Health and Human Service’s Office of Global Affairs and the support from the National Academy of Medicine’s International Committee, which was integral in conceptualizing the study’s statement of task. The committee also thanks Leslie Sim and Taryn Young for their flex- ibility and coordination during the review process as well as Lauren Shern for providing guidance throughout the course of the project. A special thank you to Victor Stewart and Ron Brown for quickly processing con- tracts and agreements throughout the life cycle of the study. Our acknowledgments also extend to the directors of the partner in- fluenza studies, Janelle Winters, Hoda Soltani, and Ellen Schenk, for their unwavering support and advice during the study process. xi PREPUBLICATION COPY—Uncorrected Proofs

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Preface The global COVID-19 pandemic has exposed serious weaknesses in the supply chain for vaccines and medical products. Many of these challenges have been managed with reactive responses by U.S. government agencies and global actors. However, these responses cannot hide the shortcomings in the current structures for managing vaccine supply chains before and during a pandemic. The supply chain challenges, which have unfolded throughout the COVID-19 pandemic, have exposed major weaknesses in the mechanisms of global coordination. While the world is still struggling to manage the challenges in the global COVID-19 vaccine supply chain, everyone needs to prepare for a more robust vaccine supply chain to deal with future pandemics. Global health experts have long warned of the risks of influenza variants with potential to cause a pandemic. This committee was tasked with examining the sup- ply chain and distribution challenges related to vaccines and vaccinations during the COVID-19 response (as well as past responses to SARS, H1N1, and Ebola), identify deficiencies in the global supply chain for pandemic and seasonal influenza, and develop recommendations for action by U.S. government agencies and global actors. Vaccine manufacturing and distribution is a complex task. It requires hundreds of components, globally distributed high-quality biologic manu- facturing capacity, a competent supply chain workforce, data and infor- mation tools, and financial resources for fast distribution and equitable deployment of vaccines. At a country level, getting vaccines into the arms of people also requires country preparedness and robust planning and the capability to adopt, distribute, deliver, and administer vaccines to appropri- xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv PREFACE ate cohorts of people at scale. Vaccine characteristics and country access to a portfolio of vaccines also influence vaccine uptake and impact the ef- ficiency of vaccine distribution and delivery. In a global end-to-end supply chain, actions for different parts of this supply chain are made by different agencies and actors—from private firms to national governments, regional structures, global and U.N. agencies and nongovernmental organizations. COVID-19 has also illustrated the devas- tating impact of a pandemic on the global economy and livelihoods, which necessitates considering roles for a broader set of actors. Health care and non–health care domains can engage in the vaccine supply chain to ensure a safer world through a whole-of-society approach. The committee’s report takes stock of past actions and reports on seasonal and pandemic influenza vaccine manufacturing and distribution, looks at experiences and structures that have evolved for COVID-19 vac- cines, and identifies deficiencies in the global supply chains for seasonal and pandemic influenza vaccines and also covers country preparedness and planning capabilities that need to be urgently addressed. The report points out technical areas and structural weaknesses that need to be strengthened and lays out mechanisms to strengthen coordination and information ex- change systems in the global supply chain to ensure rapid and agile decision making to meet global vaccination needs equitably. We hope that this report will provide clear guidance on the actions required by different stakeholders, both U.S. agencies and global actors, to build a robust and resilient global end-to-end supply chain for seasonal and pandemic influenza vaccines. Pursuing the recommendations in this report will not always be easy: the split of mandate, resourcing, and decision- making processes between national, regional, and global levels creates the need for embedding collaborative and coordinate efforts in existing agencies and structures. Everyone recognizes that for vaccine supply chains to work well during a pandemic, there is need for strong collaboration and coordi- nation between a range of national, regional, and global actors in the sup- ply chain, both public and private actors. If there is one key message that every reader should take away from this report, it is that this committee firmly believes that for the global vaccine supply chain to work well during a pandemic, many of the activities and coordination structures in the sup- ply chain should be designed, created, and resourced during non-pandemic periods and not during a pandemic. We thank first the members of committee, who committed their time and scientific expertise during an extremely busy period with their multiple roles. Ours was a very interdisciplinary committee, with experts of varied backgrounds in many different aspects of vaccine development, manufac- turing, distribution, and policy. The committee members exhibited immense PREPUBLICATION COPY—Uncorrected Proofs

PREFACE xv patience and respect when discussing items, which for some were relatively straightforward and simple, and for others were new and complex. Thanks also to National Academies of Sciences, Engineering, and Med- icine (the National Academies) staff, who helped us stay organized and focused, and helped put our thoughts into writing. They worked tirelessly through our sessions, took notes, and iterated with many draft versions of this report. We also thank Janamarie Perroud for providing an overview of previous work on this subject, which was an important foundation for framing this study (see Appendix A). We are also grateful to the many ex- perts who committed their time to present to the committee during public sessions. Ravi Anupindi, Chair Prashant Yadav, Vice Chair PREPUBLICATION COPY—Uncorrected Proofs

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Contents ACRONYMS AND ABBREVIATIONS  xxiii SUMMARY  1 1 INTRODUCTIONS  17 Understanding Influenza Viruses, 18 Committee Task and Approach, 19 Structure of the Report, 22 References, 23 2 INFLUENZA VIRUS AND INFLUENZA VACCINES: A PRIMER  25 Seasonal and Pandemic Influenza Viruses, 27 Surveillance, 29 Vaccine Development, 31 Vaccine Production, 33 Vaccine Production Platforms, 36 Production Challenges, 41 References, 50 3 CRITICAL COMPONENTS FOR VACCINE MANUFACTURING  59 The Critical Components, 61 Manufacturing Preparedness and Response, 62 Forecasting Demand, 69 xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii CONTENTS Production, 71 Stockpiling, 72 Management and Allocation, 73 Training and Readiness of Critical Workforce Personnel. 78 Distributed Manufacturing Networks, 84 References, 88 4 VACCINE DISTRIBUTION AND DELIVERY  95 Design for Distribution, 96 Vaccine Portfolios, 102 Demand Forecasting and Generation, 104 Global Distribution and Transportation, 108 In-Country Storage and Distribution, 112 Matching Supply and Demand, 118 References, 123 5 FRAMEWORKS, TOOLS, AND INNOVATIONS FOR DISTRIBUTION READINESS  131 Initiatives, 132 Tools and Frameworks for Global Vaccination, 138 Tools for Country Pandemic Preparedness, 140 Innovations, 148 References, 150 6 BARRIERS, INCENTIVES, AND INNOVATIONS FOR SUSTAINABLE MANUFACTURING  155 Tradeoffs in Vaccine Development and Manufacturing, 155 Barriers to Vaccine Manufacturing and Innovation, 163 Facilitating Manufacturing Innovation, 172 References, 182 7 A WAY FORWARD 189 Vaccine Technologies and Innovations, 190 An Integrated Approach Across the Vaccine Landscape, 190 Final Thoughts, 191 References, 192 APPENDIXES A Review of Previous Recommendations for Pandemic Vaccine Manufacturing  193 B Biographical Sketches of Committee Members and Staff  223 C Agendas: Open Committee Meetings  231 PREPUBLICATION COPY—Uncorrected Proofs

Boxes, Figures, and Tables BOXES 1-1 Statement of Task, 21 2-1 Adjuvants for Influenza Vaccines, 37 3-1 The Defense Production Act, 63 3-2 COVAX Marketplace for Critical Supplies, 69 3-3 Regulatory Harmonization and Convergence for Improved Public Health, 78 FIGURES 2-1 WHO Global Influenza Surveillance and Response System, 30 2-2 Egg-based influenza vaccine manufacturing and timeline, 32 2-3 Influenza vaccine response capability, 42 2-4 Vaccine manufacturing network, 44 3-1 Supply chain challenges along the value chain, 64 3-2 Calculations of fixed costs for vaccine facilities in developing countries, based on four hypothetical scenarios, 87 4-1 Nations with the largest share of exports for key vaccine components and supplies in 2018, 111 xix PREPUBLICATION COPY—Uncorrected Proofs

xx BOXES, FIGURES, AND TABLES TABLES 2-1 Key Characteristics of Influenza Subtypes, 26 2-2 Stages of and Data for Seasonal Influenza Vaccine Development and Manufacturing, 31 2-3 Comparative Characteristics of Selected Seasonal Influenza Vaccines, 34 2-4 Influenza Vaccine Manufacturing Facilities by WHO Region, 35 2-5 Novel Technology Platforms for Producing Influenza Vaccines, 40 3-1 Summary of Recommendations on Critical Components for Vaccine Manufacturing, 60 3-2 Examples of Vaccine Manufacturing Educational Structures, 82 4-1 Summary of Recommendations on Vaccine Distribution and Delivery, 96 5-1 Summary of Recommendations and Relevant Actors on Frameworks, Tools, and Innovations for Distribution Readiness, 132 5-2 Innovations for Vaccine Development during COVID-19, 149 6-1 Summary of Recommendations on Barriers, Incentives, and Innovations for Sustainable Manufacturing, 156 6-2 Advantages and Disadvantages of Technology Platforms Used to Develop Vaccines, 158 6-3 Non-U.S. Funding Options for No-Fault Compensation Mechanisms, 170 6-4 Pros and Cons of Options for Housing a Vaccine Injury Compensation System, 171 A-1 Pandemic Vaccine Manufacturing Recommendations in Chronological Order, 202 A-2 Trends in Unimplemented Pandemic Vaccine Manufacturing Recommendations, 214 PREPUBLICATION COPY—Uncorrected Proofs

Acronyms and Abbreviations ABS access and benefit sharing ACT-A Access to COVID-19 Tools Accelerator ALAN American Logistics Aid Network AMC advance market commitment ASPR Assistant Secretary for Preparedness and Response BARDA Biomedical Advanced Research and Development Authority BRFSS Behavioral Risk Factor Surveillance System CBER Center for Biological Evaluation and Research CDC Centers for Disease Control and Prevention CEPI Coalition for Epidemic Preparedness Innovations COVAX COVID-19 Vaccines Global Access CVIC COVID-19 Vaccine Introduction and deployment Costing tool CVV candidate vaccine viruses DCVMN Developing Countries Vaccine Manufacturers Network DPA Defense Production Act EMA European Medicines Agency EPI Expanded Program on Immunization xxi PREPUBLICATION COPY—Uncorrected Proofs

xxii ACRONYMS AND ABBREVIATIONS EUA emergency use authorization FDA Food and Drug Administration FEMA Federal Emergency Management Agency GAO U.S. Government Accounting Office GAP Global Action Plan for Influenza Vaccines GAVI Global Alliance for Vaccines and Immunization GISRS Global Influenza Surveillance and Response System GPMB Global Preparedness Monitoring Board   GVAP Global Vaccine Action Plan H1N1 Influenza A virus subtype H1N1, aka swine flu H5N1 Influenza A virus subtype H5N1, aka avian flu HHS U.S. Department of Health and Human Services IA2030 Immunization Agenda 2030 ICMRA International Coalition of Medicines Regulatory Authorities IFC International Finance Corporation IFPMA International Federation of Pharmaceutical Manufacturers & Associations IIS immunization information systems IIV inactivated influenza virus IMF International Monetary Fund IPAC WHO’s Immunization Practices Advisory Committee IPPPR Independent Panel for Pandemic Preparedness and Response LAIV live attenuated influenza virus LMICs low- and middle-income countries LMIS logistic management information system LSHTM London School of Hygiene & Tropical Medicine MDCK Madin-Darby Canine Kidney MERS Middle East Respiratory Syndrome mRNA messenger RNA NIH National Institutes of Health NIS-Flu National Immunization Survey-Flu PREPUBLICATION COPY—Uncorrected Proofs

ACRONYMS AND ABBREVIATIONS xxiii NITAG National Immunization Technical Advisory Group NIVSM National Influenza Vaccine Modernization Strategy NRAs national regulatory authorities NVAC National Vaccine Advisory Committee OECD Organization for Economic Co-operation and Development OGA Office of Global Affairs OSTP Office of Science and Technology Policy OWS Operation Warp Speed PAHO Pan-American Health Organization PDVAC Product Development for Vaccines Advisory Committee PEPFAR U.S. President’s Emergency Plan for AIDS Relief PIP Pandemic Influenza Preparedness Framework PIVI Partnership for Influenza Vaccine Introduction TPP Target Product Profiles TRIPS Trade-Related Aspects of Intellectual Property Rights USAID U.S. Agency for International Development USDFC U.S. International Development Finance Corporation USTR U.S. Trade Representative VIPS Vaccine Innovation Prioritization Strategy VLP virus-like particle WEF World Economic Forum WHO World Health Organization WTO World Trade Organization PREPUBLICATION COPY—Uncorrected Proofs

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Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines Get This Book
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Influenza viruses, both seasonal and pandemic, have the potential to disrupt the health and well-being of populations around the world. The global response to the COVID-19 pandemic and prior public health emergencies of international concern illustrate the importance of global preparedness and coordination among governments, academia, scientists, policy makers, nongovernmental organizations, the private sector, and the public to address the threat of pandemic influenza. These health emergencies have revealed opportunities to enhance global vaccine infrastructure, manufacturing, distribution, and administration.

Globally Resilient Supply Chains for Seasonal and Pandemic Influenza Vaccines outlines key findings and recommendations to bolster vaccine distribution, manufacturing, and supply chains for future seasonal and pandemic influenza events. This report addresses the challenges of manufacturing and distributing vaccines for both seasonal and pandemic influenza, highlighting the critical components of vaccine manufacturing and distribution and offering recommendations that would address gaps in the current global vaccine infrastructure.

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