Developing countries are increasingly turning to homegrown Covid vaccinations as the UN-backed Covax programme falls behind. While western countries roll out booster jabs to their own populations, Covax, which was set up by UN agencies, governments and donors to ensure fair access to Covid-19 vaccines for low- and middle-income countries, has said it will miss its target to distribute 2bn doses globally by the end of this year. According to the latest supply forecast, on 8 September, the programme is now expecting to provide 1.4bn vaccine doses over 2021 – a shortfall of nearly a third. The shortage is largely a result of export and manufacturing constraints and increasing demand from vaccine-producing countries. India – a key producer – only delivered 28m of a promised 40m doses in March when infections surged as the Delta variant spread around the country. Developing countries have responded by producing new local vaccines. Among them is Egypt, which has launched human trials for its homemade vaccine Covi Vax, after successful laboratory tests. “The Egyptian Medicines Authority gave its approval to manufacture the first batch of vaccine doses under the name Covi Vax for use in clinical trials,” said Mohamed Ahmed Ali, professor of virology at the National Research Centre and head of the research team for production of the vaccine. Earlier this year, researchers in Saudi Arabia announced the start of early-stage human trials of a vaccine developed by researchers at Imam Abdulrahman bin Faisal University. Cuba is seeking WHO approval for its own vaccines as it seeks to reach full immunisation, including children as young as two, by the end of 2021. Several Brazilian research institutes are also betting on the development of homegrown vaccines against Covid-19. The Butantan Institute, a public research centre in São Paulo, is carrying out early-stage human trials of ButanVac. The viral vector vaccine, developed by the Icahn School of Medicine in New York and an international consortium, can be produced entirely in Brazil in future. Cristiano Gonçalves, innovation manager at Butantan, said: “The consortium and supporters behind ButanVac are concerned about low- and middle-income countries that are being underserved right now. The idea is for ButanVac to serve the domestic market, and for Butantan to reserve part of its production for export.” The Indian government also plans to launch ZyCoV-D, the world’s first DNA vaccine, which is being produced by Zydus Cadila, a private company, in partnership with the Indian Ministry of Science and Technology’s biotechnology department. This will allow expansion of the existing vaccination programme to include young children and adolescents. In Singapore, three mRNA vaccines developed by the US company Arcturus Therapeutics are undergoing mid-stage human trials to check their efficacy. The production of homegrown vaccines follows a number of agreements in which developing countries have begun to take on the manufacturing of vaccines developed in Europe, the US or China. In Brazil, about two-thirds of the population have received at least one vaccine dose, many of which were a result of technology-transfer agreements between Brazilian laboratories and international pharmaceutical companies. In July 2020, the Butantan Institute backed large-scale human trials of CoronaVac, the vaccine made by the Chinese company Sinovac Biotech. In exchange, Sinovac committed to transferring technology to the Brazilian institute. Butantan is importing the raw materials from China and packaging the vaccine in Brazil. For the next phase of the technology-transfer agreement, a factory is being prepared to start producing doses. The Oswaldo Cruz Foundation, a research centre in Rio de Janeiro linked to the health ministry, began negotiations with AstraZeneca in the first half of last year. As a result, the Anglo-Swedish drugmaker’s Covishield vaccine also underwent large-scale human trials in Brazil, and is now being produced in the country with raw materials imported from abroad. In future, the vaccine will be fully produced in Brazil. Similar agreements have helped to plug the vaccination gap in many other low- and middle-income countries, such as Egypt, which has already started local production of Sinovac’s vaccine. Last month, the Egyptian health minister, Hala Zayed, announced an ambitious plan to produce more than 1bn doses a year of the jab, which would make it “the largest producer of vaccines in Africa and the Middle East”, she said. Morocco has also launched a project to produce China’s Sinopharm vaccine locally. The state-owned Moroccan Press Agency announced in July that the government plans to produce 5m doses a month. Indonesia is also in talks with the World Health Organization as well as six drug companies to become a global hub for manufacturing vaccines, according to its health minister, Budi Gunadi Sadikin. However, Amjad al-Khouli, an epidemiologist at the WHO’s regional office for the eastern Mediterranean, pointed out that technology-transfer deals depended on existing capacity and could be overshadowed by intellectual property concerns. “This still requires agreements to transfer vaccine-manufacturing technology, solve the issue of intellectual property, and a strong drug-manufacturing structure, which is not available in most developing countries,” Khouli said. Yet richer countries are stepping in to help build up critical vaccine-manufacturing capacity. Senegal is awaiting its first doses of a locally manufactured Covid vaccine in the first quarter of next year, after the president, Macky Sall, signed a deal to create a large-scale vaccine manufacturing facility with the European Commission, the European Investment Bank and the US in July. The European Commission president, Ursula von der Leyen, said the agreement was part of a “much broader Team Europe initiative to support the production of medicines and vaccines across Africa”.