Ever since the first COVID-19 vaccines debuted in 2020, the world has been divided between rich countries that can afford to develop or purchase vaccines and poor countries that have generally been forced to accept whatever the rich don’t need (or what big pharmaceutical companies are willing to donate). That started to change in 2021, thanks in large part to Dr. Peter Hotez and Dr. Maria Elena Bottazzi, the codirectors of the Center for Vaccine Development at Texas Children’s Hospital, in Houston. With funding from private donors—including $1 million from the philanthropic arm of Austin-based Tito’s vodka—Hotez and Bottazzi developed a low-cost, open-source vaccine targeted at low- and middle-income countries.
By the end of 2022, an estimated 100 million people in India and Indonesia had received Hotez and Bottazzi’s vaccine, which is not patented and can be manufactured by any pharmaceutical company. Indonesia’s version is halal-
certified; it contains no animal-based ingredients and is acceptable to observant Muslims. Unlike the Pfizer and Moderna vaccines, which are made with mRNA (messenger ribonucleic acid) technology, Hotez and Bottazzi’s version is based on the recombinant protein technology that low-income nations already use to make the hepatitis B vaccine. By partnering with local pharmaceutical manufacturers in those countries, Hotez and Bottazzi have reduced the cost of vaccinating the world’s population while boosting the Global South’s readiness for another pandemic. In 2022 Houston congresswoman Lizzie Fletcher nominated Hotez and Bottazzi for the Nobel Peace Prize, calling their vaccine “a contribution that is of the greatest benefit to humankind.”
Texas Monthly: Can you explain in layman’s terms how your vaccine differs from the mRNA vaccines we’re more familiar with?
Bottazzi: An mRNA vaccine is a piece of RNA that, when it gets into your cells, has to be translated into a protein, which is what triggers the immune response. When you use a recombinant protein vaccine, you are directly giving the body the protein. You don’t need the human machinery to do it. The recombinant protein vaccine is very rapidly processed. You can activate a pretty robust and very durable immune response. The RNA technology requires your body to do a lot of processing. Maybe that is why the pharmaceutical companies are still trying to figure out how to ensure durability against COVID variants.
Hotez: We wanted to work with vaccine producers in low- and middle-income countries. Recombinant protein technology is widely used in Bangladesh, India, Vietnam, Indonesia, Brazil, and many other places. They use it to make the hepatitis B vaccine. So we can use that technology to plug right into their system. You don’t have to rely exclusively on multinational pharma companies for vaccine equity. It’s not that the pharma companies are bad guys—they provide a lot of vaccines—but the system is too dependent on the big companies. We’ve shown that there’s another pathway to advance vaccine equity.
Bottazzi: When a multinational company collaborates with one of these developing-country manufacturers, they do it with a little bit of a colonialist mentality. For instance, the AstraZeneca group worked with India, but the brand of the vaccine is an AstraZeneca brand. It doesn’t empower the local pharmaceutical manufacturers.
Hotez: We’re doing true codevelopment with low- and middle-income countries. We call it vaccine diplomacy.
Bottazzi: It allows an Indian manufacturer like Biological E. Limited to brand their own indigenous vaccine as Corbevax, and then an Indonesian company can brand their vaccine IndoVac. They are similar but not necessarily related. They can do their independent development. They make it from scratch, with our technology and our contribution. But at the end of the day they can say it’s an indigenously made vaccine. No multinational company told them how to do it.
TM: How did that collaboration work? Did you travel to India and Indonesia, or was it all virtual?
Hotez: It was virtual except for physically sending the production cell bay to India. That was the one physical transfer of materials. Then it was a bunch of five a.m. Zoom calls.
TM: I understand that getting the funding to develop the vaccine was a challenge. You didn’t get any money from Operation Warp Speed, the vaccine-development partnership launched by the U.S. government. So how did you raise the money?
Hotez: In 2012 we got a grant from the National Institutes of Health to make SARS [severe acute respiratory syndrome] and MERS [Middle East respiratory syndrome] vaccines. That allowed us to work out a lot of the processes. For the actual COVID vaccine we had some transition money from NIH, which was modest. The funding mostly came from private philanthropies here in Texas. If we hadn’t moved to Texas [in 2011], we would not have raised those funds. I came to Texas to work at Texas Children’s Hospital and the Baylor College of Medicine, which are part of Houston’s amazing Texas Medical Center. That’s a side of Texas that most of America doesn’t really know about.
TM: How did your collaboration work? Did you divide up responsibilities or work on everything together?
Hotez: I can’t imagine doing this alone. It’s too scary to go out and make vaccines for the world from a modest-sized research institute in Texas. Being able to bounce ideas off Maria Elena has been so critical for my own career development. Having that back-and-forth prevents you from going too far down the rabbit hole. What many people don’t understand about science is that more things don’t work than do work. It can be a very emotionally draining experience.
Bottazzi: It’s not a single individual. We have a whole team, and everyone has their own role. If it was just me and Peter, we would not have done anything. You need a workforce behind you. These are young, diverse, passionate people, many of whom have been with us for a long time. And it was very hard for them, especially the people in the labs. Especially when COVID was at its peak, it was a big risk for them to take.
TM: How did you make the Indonesian vaccine compliant with halal, or Muslim dietary restrictions?
Hotez: We use yeast. It’s a vegan technology.
Bottazzi: The technology doesn’t require any reagents that have an animal or human source. But for it to be halal, that all has to be documented. For us, it was a decision we took years ago—even before COVID. If we’re going to make vaccines that can be used around the world, they have to be amenable to different cultures. So we kept all the records. If somebody wants to confirm that it’s all synthetic or vegan, we have the documentation. There’s a special ministry in Indonesia that provides halal certification, and they checked our records.
TM: Why did you choose not to patent your vaccine?
Bottazzi: Open science is very important to us. We want to enable countries in the Global South to develop their own vaccine manufacturing capacity instead of simply accepting something that was created by multinational pharma companies. We wanted this to be a collaboration, instead of “Here are some leftover vaccines.”
This article originally appeared in the January 2023 issue of Texas Monthly with the headline “The Texans Vaccinating the World.” Subscribe today.