The journey towards mRNA vaccine technology transfer: From knowledge to implementation

Coronavirus disease 2019 (COVID-19) vaccines were less accessible in low- and middle-income countries (LMICs) than in high-income countries during the pandemic. As a result, vaccine distribution initiatives such as COVID-19 Vaccines Global Access and the African Union's African Vaccine Acquisition Trust were established to guarantee equitable access to COVID-19 vaccines in LMICs. Yet these initiatives alone did not suffice to reverse the inequity. As a response, the World Health Organization and the Medicines Patent Pool launched the messenger RNA (mRNA) Technology Transfer Programme in June 2021 to support sustainable mRNA vaccine production in LMICs. Afrigen Biologics and Vaccines (Afrigen) in Cape Town, South Africa became the heart of a global collaborative network embarking on a challenging yet innovative journey to develop its first mRNA vaccine, AfriVac 2121, amidst a global pandemic. The World Health Organization also selected 15 manufacturing partners from LMICs in Africa, Europe, South America, and Asia to join the program and receive the mRNA vaccine manufacturing platform. In this article, we outline the establishment of the programme, its technology transfer strategy, and the progress made in equipping partners with the capacity to implement mRNA technology. We describe the development of the manufacturing platform and pre-clinical validation, and we reflect on the key successes and challenges encountered along the way. Despite the obstacles, the program has laid the groundwork for a globally distributed, locally driven mRNA vaccine manufacturing ecosystem, and fully equipped the main hub at Afrigen for mRNA vaccine development and manufacturing. Our work underscores the imperative need for sustained investment in technology access, global collaboration, local expertise and infrastructure to ensure equitable access to life-saving vaccines.