While political and global health leaders have repeatedly said that any future COVID-19 vaccines are “global public goods” that must be widely accessible and affordable across the world, they may be about to repeat the same mistakes they’ve made before.
Opinion: To deliver a COVID-19 vaccine equitably, we must start planning now
We will need political commitment and wisdom to ensure that a coronavirus vaccine is delivered globally and equitably, writes PATH's Deborah Atherly. This op-ed outlines a number of factors that will be critical to such a vaccine's success.
The good news is that as the world desperately waits for a coronavirus vaccine and closely watches over 100 candidates under development — including eight now in human trials — we’re hopeful that we will have a vaccine.
The bad news is that barring any significant change in governments’ actions, companies that hold any vaccine’s patents and intellectual property rights will get to solely decide the scale at which they produce COVID-19 vaccines, how they price them, and who gets first dibs.
As the U.S. and other major public health donors come together for Gavi’s funding replenishment conference, they must refrain from agreeing on a plan that still needs a lot of work. Gavi is a Swiss foundation that was launched by Bill Gates 20 years ago with the laudable mandate to shorten the time frame between the availability of vaccines in rich countries and then in poor countries.
During this conference, Gavi — with the support of academics, economists, and other global health entities — is expected to unveil an “advance market commitment” initiative for COVID-19 vaccines. It hopes this fund will attract pharmaceutical companies to prepare to make as many doses as possible before knowing if they have a successful vaccine and to secure doses for developing countries.
Those in favor point to Gavi’s experience of a past $1.5 billion advance market commitment that was used to introduce the pneumonia vaccine in developing countries and a $5 million “advance purchase commitment” — a similar initiative — for Ebola vaccines.
The problem? While there were successes and failures with both of these examples, today’s global dynamic is significantly different from the challenges faced when these funds were developed.
Most notably, the entire planet will need this vaccine, and we don’t yet have any agreed-upon framework for deciding who receives the expectedly scarce supply first. The world’s ugly scramble for personal protective equipment, ventilators, and oxygen supply that has left many resource-crunched countries empty-handed is a clear indication of the fierce competition over vaccines to come.
As fear mounts of a worldwide fight in which manufacturers prioritize selling to the highest bidders, important questions need to be answered before any fund is launched.
First, how will a new fund ensure equitable distribution of vaccines for all when the rules of the game haven’t changed? Pharmaceutical corporations are still allowed to hold monopolies through intellectual property rights on any vaccines they produce.
This means they will be able to decide on their own how much vaccines will cost and who will get them, since other manufactures won’t be legally allowed to create similar, more affordable versions any time soon. Mandating that companies agree to transfer their technology to other producers so that all chances of maximizing vaccine production are utilized must be core to this new fund.
Second, how do you design a fund to incentivize participation from the pharmaceutical sector when there is so little transparency on the full costs to develop these vaccines and to produce them?
If Gavi isn’t able to start its negotiations from a fair playing field because pharma holds all the costing information, it risks paying a higher price than necessary or just failing altogether because it’s too hard to compete with the expectations of industry in reaping first-to-market advantage. Transparency from industry on the total costs for developing these vaccines and producing them must be the starting point that Gavi requires in negotiations.
Lastly, how do you get governments to buy in — both literally and figuratively — to a fund when they haven’t been part of the design process from the start?
Gavi will be looking to raise a lot of money for the fund it intends to launch — likely tens of billions of dollars — but the role of governments that it expects to finance this new mechanism, as well as developing country governments that should benefit from it, has been absent. Governments must demand a seat at the planning table, as they will ultimately be the beneficiaries of this fund and its success will hinge on their cooperation.
As a treatment provider working in countries facing humanitarian crises, Médecins Sans Frontières has teams racing to respond to the coronavirus pandemic in over 70 countries. We understand and feel the urgency to secure future COVID-19 vaccines for the world’s most vulnerable. But after almost 50 years of seeing the consequences of the current global health system, we know that we can’t keep doing what we’ve done before and expect different results.
The pandemic demands something new. People living in the places where MSF traditionally works are just starting to experience the extremity of this virus. They deserve something new.
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