International co-operation is vital to make vaccination, as a public good, available to all.
To the virus, we are all one herd. To beat it, we must act as one community
Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization
Scientists are performing magnificently in developing vaccines against the SARS-CoV-2 virus with unprecedented speed, but Big Pharma is calling the shots and governments are being left to squabble over what are, to begin with, inadequate supplies. Vaccine nationalism is rearing its ugly head, with devastating consequences for poorer countries and eventually for the whole world.
The moral and humanitarian case for fair access to vaccination is obvious and so is the public-health case: where vaccines are scarce, there will be more cases, each one an opportunity for the virus to continue to mutate, as all RNA viruses do. This means new variants could emerge which are different enough from the original virus that existing vaccines won’t work against it them. If those circulate widely, people who have been vaccinated will once again be susceptible to severe illness and death.
In normal times, vaccines are not major money-spinners for pharmaceutical companies, which can make much larger profits from medicines that people take daily for long periods rather than one- or two-shot immunisations. Vaccines for germs that are not now circulating, and may never emerge, make no money at all—and with virtually all late-stage vaccine development now done by private pharmaceutical firms, when the pandemic emerged vaccine preparedness was limited.
Other coronaviruses, such as SARS and MERS, had already warned of the danger from this family of viruses, and the WHO put them on a priority list for developing vaccines. But with no severe coronavirus circulating except occasional, limited outbreaks of MERS, it was far from clear there would ever be a market for such a vaccine. So apart from a little public-private funded work on MERS, and some government-funded university research on the viruses, market forces prevented the development of vaccines—and anti-viral drugs—for coronaviruses.
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Huge injections of government money into companies after Covid-19 emerged changed that and, along with the vaccines already approved, dozens more are under development and assessment, many capitalising on university work. So pharmaceutical companies benefit from publicly-funded university research, government subsidies and of course profits on sales—although some companies are pledging to provide vaccines at cost as long as the pandemic lasts.
That’s difficult to quantify, however, since the companies insist on secrecy in contracts with governments. In one case, South Africa is paying twice the price per shot that the European Union pays, apparently because South Africa did not subsidise development of the vaccine. Others, including companies making the new mRNA jab, will profit from sales.
The Covax facility exists to provide equitable access to vaccines. Some 190 countries are paying into it, so that it can buy and fairly distribute two billion doses by the end of this year. Richer countries are entitled to receive doses via Covax but many are not claiming their allocations, to free up supplies for poorer nations.
Canada has caused outrage by claiming 1.9 million doses in the first round of distribution and now has enough vaccines on order to cover its population nearly ten times. That is the case in many rich countries: because orders were placed before we knew which vaccines would work, several countries over-ordered in case only one was effective.
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Yet many vaccines were, so they now have more than they need and are expected to turn over surplus purchase contracts to countries with shortfalls—once their population is vaccinated. But it isn’t clear if that means their whole population or just people at most risk of dying. If it’s everyone, rich countries might be vaccinating people at low risk while unvaccinated people at high risk are still dying of Covid-19 in poor ones.
Moreover, rich countries can pass up their Covax allocations, because they buy their own vaccines separately. But many have been able to outbid Covax to get their supplies from the companies first, so the limited initial pool of vaccines is initially mostly going to the rich.
Unless production speeds up considerably, people in poorer countries may not receive protection until 2024. An urgent global effort is needed to ramp up production and distribution, including of new vaccines and vaccine combinations that may be needed to tackle new Covid-19 variants—those which are already emerging and probably many more to come.
Fortunately, even where existing vaccines are underperforming in stopping mild to moderate symptoms from some new variants, there is hope that they will perform well in stopping hospitalisation and death. There is also some evidence emerging that certain vaccines may not only protect the individual but also reduce transmission, helping to stem the spread of the virus—although none so far clearly stops all transmission.
The production and distribution of the vaccines is complex and major supply-chain problems are appearing in every region. This is complicated by the secrecy around contracts, including prices, and production and distribution setbacks. And then there is perhaps the biggest secret of all—the recipes for the vaccines themselves, jealously guarded by the pharmaceutical companies which control the intellectual property.
The world reacted angrily when China suppressed information in the early days of the outbreak and initially refused to release the genetic sequence of the virus—even claiming for three crucial weeks that it did not spread from person to person. Things might have been very different today if the Chinese regime had been open at the start. We have however yet to see the same anger directed at the secrecy enjoyed by Big Pharma.
If a company does not plan to make a profit from the pandemic, why not make the recipe open-source, so that production capacity can be unleashed, including in developing countries? Where companies are profiting from the pandemic through price-gouging, governments need to take strong stands, given all the public money that has gone into the research that made the vaccines possible. Intellectual property derived from the public purse is being used for private profit.
The pandemic will never be brought under control by market forces—the reverse is probably true. Questions are also being raised about the possible influence of the private pathology industry in hindering the rollout of rapid antigen tests, which are vital for public health screening to stop virus transmission. These tests are a fraction of the cost of the also vital polymerase-chain-reaction (PCR) diagnostic tests, which are providing a profit bonanza for private companies that supply the complex lab-based testing, with millions of them being processed worldwide each day.
Reliance on PCR tests alone is not enough. The right mix of testing strategies is needed but prominent voices in PCR testing are being raised against rapid antigen tests. Private profit should have no part in that or indeed any decision on how to control the pandemic.
While the world’s attention has turned to vaccines, funding for research into treatments for Covid-19 is lagging, with investment of billions more dollars needed. Investment in antiviral drugs is being delayed by the same market forces that have delayed investment in other vitally-needed antimicrobials, such as the necessary new antibiotics.
Of course, science alone can’t bring the pandemic under control. Social distancing, masks, occupational health and safety with fundamental workers’ rights, social protection including sick and isolation pay, hygiene and investment in health, care and other areas are also crucial.
Governments must stand up to the powerful corporations that are warping the global response to the pandemic and the pandemic profiteers—not only tech monopolies such as Amazon but also companies in the health sector which put healthy profits ahead of global health. Millions of lives and livelihoods are at stake, and governments need to meet the challenge head on.
This article first appeared on Equal Times