CEPI CEO: Scarcity, 'vaccine nationalism' biggest barriers for COVID-19 vaccine access

Global politics and vaccine scarcity are the biggest challenges to ensuring that a future COVID-19 vaccine will be available in the world’s poorest countries, according to Richard Hatchett, CEO at the Coalition for Epidemic Preparedness Innovations.

“Managing the scarcity of a vaccine in a context that is highly politically charged is the biggest challenge. The biggest challenge to global access and equity and equitable access for developing countries is a phenomenon that I’ve sometimes referred to as ‘vaccine nationalism,’” he told Devex President and Editor-in-chief Raj Kumar during a virtual event Thursday.

When a vaccine is developed, it is not likely that the productive capacity will not meet the global need. While some vaccines may reach a billion doses in a year, far more will be needed for the coronavirus response, Hatchett said.

It will likely be necessary to have a number of different vaccines in order to meet global demand and the needs of different populations, including the elderly, pregnant women, and those living in low- and middle-income countries where cold chains can be hard to maintain, he said.

Wealthy countries will come under significant pressure to either purchase large quantities or prohibit exports of a locally developed vaccine in order to meet domestic needs, which could mean that poorer countries are left without access. This “vaccine nationalism” is a great challenge, and one seen in 2009 when 15-20 of the world’s wealthy countries bought up all the influenza vaccines in response to the H1N1 pandemic, Hatchett said.

Those countries were able to purchase the entire global supply. Eventually, an effort in which Hatchett was involved established an international vaccine donation program. Fewer than half the doses promised were delivered, and not until after the “wave of the pandemic had come and gone, so it didn’t achieve much in terms of equity,” he said.

“That’s the scenario we desperately want to prevent,” he said, noting that now the stakes are certainly higher than they were in 2009.

To help, CEPI has diversified the vaccine candidates it has invested in — by geography and by type of vaccine. It has also joined with a number of other organizations, including Gavi, the Vaccine Alliance, in the Access to COVID-19 Tools, or ACT Accelerator.

Now the two vaccine-focused organizations are looking at how to bridge the gap between CEPI’s research and development focus, and Gavi’s work funding procurement and working on vaccine delivery.

To that end, CEPI is moving into an area where it hasn’t traditionally worked — building manufacturing capacity, including in some cases, amassing an inventory of raw materials that will be needed to produce vaccines, even as the candidates proceed through trials. By doing this work before a vaccine is licensed, CEPI can help scale production more rapidly once it gets the necessary approvals.

Gavi launched the Gavi Advance Market Commitment for COVID-19 Vaccines, a financing instrument that aims to incentivize manufacturers to produce sufficient quantities and guarantee access for LMICs. By committing to purchase a future vaccine — assuming it meets specified standards — and potentially committing some money upfront, Gavi is creating a “mechanism that is ready to catch and buy doses and distribute them to developing countries,” Hatchett said.

Over 200 vaccines are in development, and while it’s possible a vaccine might be available this year, perhaps in an emergency capacity for health care workers, a vaccine is likely to be more broadly available sometime in the first half of 2021, he said.

More interviews with humanitarian leaders on COVID-19. Watch:
• Rockefeller Foundation’s pandemic chief calls for ‘herd awareness’
• UNAIDS director warns of 'colliding epidemics'
• Peter Sands' 'nightmare' coronavirus scenario