By Jeffrey Dorfman/Frank Kirstein The issue of vaccine production has become a topic of hot debate following the approval of treatments for COVID-19. In South Africa angry exchanges have been spurred by the country’s lagging access to COVID-19 vaccines. Generally, vaccines are produced by private companies who sell them under contract. In some cases, producers will make provisions for access on particular markets. This is sometimes as a condition for receiving early development funding or for allowing parts of production to occur in a particular country. Some middle-income countries, particularly India, Argentina and Mexico, have sufficient production capacity to be partly indispensable. These countries have strategic leverage to get vaccines because of their own vaccine manufacturing capacity. India illustrates this well. The Serum Institute of India, a privately owned pharmaceutical company, is manufacturing large quantities of the University of Oxford/AstraZeneca and Novavax COVID-19 vaccines. The company is scheduled to reach 100 million doses produced a month by March 2021. In return, India will keep a portion of the vaccines it manufactures — reportedly 100 million doses in the first instance. What about South Africa’s own capacity to produce vaccines? What can the country do? South Africa does not have large-scale vaccine manufacturing capability. The Biovac Institute — a public-private partnership between the South African government and a consortium of South African healthcare companies — is beginning to get into vaccine manufacture with an eye on more secure and accessible childhood vaccine supplies for southern Africa. But this capability is still in its infancy. It’s small compared to the COVID-19 vaccine market. Get your news from people who know what they are talking about. In addition, a publicly traded South African-owned global pharmaceutical company, Aspen Pharmaceuticals operates four pharmaceutical manufacturing and packaging plants in the country. The company is also moving into the vaccine packaging market. We see a clear disconnect between what would be needed to make the Biovac Institute a strategic vaccine asset going forward and what is planned for Biovac. If South Africa is serious about supplying anti-pandemic vaccines in the future, it needs to rethink the scale of financial, technical and strategic investment into vaccine production. This investment must be made not only in the private sector, but also, critically, in publicly accountable institutions such as the Biovac Institute. Only if investment is increased, sustained, and backed by political commitment, will the country have sufficient vaccine production capacity to use as a lever to get national and regional access to future anti-pandemic vaccines. Vaccine production capacity The Biovac Institute’s primary remit is to make childhood vaccines available for the southern African market, mostly for the public sector. For its part, Aspen’s existing pharmaceutical manufacturing capacity is about 10 billion tablets a year. It produces ge