Who Will Have Access to the Coronavirus Vaccine?

Gavi-logo_1bThe Guardian asks How will the world’s poorest people get a coronavirus vaccine? What are they suggesting?

Vaccines for Covid-19 are coming. Billions of dollars are flowing in, over 100 efforts are under way, and at least 13 leading candidates are already being tested on humans. But how will these vaccines reach the poorest people on the planet? This question haunts the fate of more than half the world’s population. It is the central question of our time.

What? No it’s not.

The failure to address this question in the past has resulted in millions of unnecessary deaths.

The implication is that vaccine’s are free. They aren’t. Developing vaccine’s costs money. Producing doses costs money. If the pharmaceutical industry could make any money providing these millions of doses of vaccine, they would. Industries are not charities. They expect to make profit in return for their products.

And yet, some believe there is a simple answer. Ask pharmaceutical corporations about how they will ensure access to Covid-19 vaccines, and they say “Gavi”. Ask the wealthiest governments in the world what they are doing to ensure global equity, and they too say “Gavi”.

Why should either corporations or national government’s need to ensure global equity? Corporations are responsible to their shareholders. National governments are responsible to the citizen’s of their nations.

Gavi, the Vaccines Alliance, is a 20-year old public-private partnership that believes the marriage of markets and philanthropy will bring vaccines to everyone in the world. The numbers are impressive: every year, Gavi sends out 500 million vaccine doses against 17 different diseases. The sums of money pumped into Gavi are equally impressive. At the Global Vaccine Summit held earlier this month, Gavi raised a record-breaking $8.8bn. With £330m committed annually for the next five years, the British government is their single largest donor, alongside other wealthy countries and the Gates Foundation.

Sounds reasonable. If poor nations can’t pay for vaccines, and you want them to get them, setting up a charity makes sense. I would rather my donations be voluntary, rather than my government forcing me to donate at gun point, but I can think of worse things that my government spends my money on.

At the summit, Gavi launched its newest initiative, a fund for future Covid-19 vaccines – the Covax Facility – which invites countries to invest in a wide portfolio of potential vaccines, pool their risk, and gain dedicated access to eventual products. Gavi heavily publicised a unit of the Covax Facility called the Covax Advance Market Commitment (or AMC, and yes, it’s confusing) that deals with the access side of things.

This is sensible. It’s likely many of the vaccine candidates will fail. Having a way to share the risks with others so that, when an effective vaccine is found, your people have access to it, seems like a sound plan.

The first deal – a US$750m agreement with AstraZeneca for 300 million doses of the potential Oxford University vaccine – was heralded as a commitment by industry to meet the needs of the world’s poorest countries. But it came at a high price, representing only a minor discount over the full price paid by the US government.

Vaccine development and manufacture is expensive. Why should Gavi pay any less than the Americans?

The problem is, we know very little about this deal because the agreement isn’t public, despite all the public money involved. We don’t know if, for example, AstraZeneca gets to keep the money if its vaccine fails. We don’t even know for a fact that all the vaccines bought are intended for use in poor countries. We asked AstraZeneca about this but did not receive a response in time for publication.

This is the problem with governments investing public money in private charities. There is no accountability.

At the summit, Gavi devoted considerably less attention to decisions made within the Covax Facility to make the fund attractive to rich countries. For instance, there is consensus that the most vulnerable people in the world be given the vaccines first and in a fair and equitable way, and the World Health Organization’s forthcoming Global Allocation Framework will specify how that can be done. And yet, a report prepared for the Gavi board meeting that starts this week, and circulated ahead by Gavi to stakeholders, including civil society organisations, proposes that rich countries can ignore the WHO framework, with only poor countries having to abide by it. According to the document, it seems Gavi will allocate rich countries enough vaccines for a fixed percentage of their population, which their “national advisory bodies” will decide. Poor countries, meanwhile, will only get vaccines for their highest priority people, after demonstrating proof.

Presumably the vaccine doses for the highest priority people are being charitably funded, and “rich” countries using tax money to do this want something in return for their own citizens: access to additional doses for them. This seems fair.

Rich countries are “encouraged (but not required)” to donate vaccines if they have more than they need, but we do not know when poor countries will get these donated vaccines: will it be at the same time as the rich countries, or only after they have used up all the vaccines they need? We put the questions raised by this document to Gavi, but it was unable to provide answers before this week’s board meeting.

How can you know if you have more than you need until after you’ve used up all the doses you need?

The prospect of a two-tiered system puts into question the fundamental issue that Gavi was founded to address: equitable access to vaccines.

Assuming Gavi’s goal is genuine, presumably they felt that establishing such a system would win them the maximum funds to be used toward equitable charitable distribution. Then again, perhaps Gavi is corrupt.

In many ways, Gavi has helped create the problem it is now trying to solve. Three decades of getting medicines and vaccines to poor people have revealed the problem and the solution: monopolies over vaccines in the pharmaceutical industry, enforced through patents which, when suspended, result in prices going down and supply going up.

How is the patent system any fault of Gavi’s?

The rich countries and organisations who fund Gavi are equally culpable: the US, UK and EU have committed billions towards vaccine research, almost all of which has gone to private pharmaceutical companies – without any conditions to prevent them from monopolising their vaccines.

I agree that governments using our taxes to fund private research that will primarily benefit corporations is a tough pill to swallow. Then again, those trying to find a vaccine for the SARS2 coronavirus will need funding to pay for the research.

All these countries have further stockpiled future vaccines by making direct deals with manufacturers, again without any access conditions whatsoever.

Why would a country that wants to ensure its citizen’s have access to a vaccine agree to access for others that might hurt its own?

In failing to challenge the most perverse feature of the pharmaceutical industry – monopolies that block access to their products – Gavi is in step with the governments who fund it. At best, Gavi has failed at negotiating control over the vaccines it funds. At worst, it believes that pharmaceutical monopolies, which have thwarted equitable access, are somehow essential to achieving it.

Since Gavi itself doesn’t have the expertise to develop vaccines, it is in no position to negotiate control over them. The pharmaceutical companies–who are not monopolies–are able to afford to hire the best epidemiologists because they are for profit businesses. This makes them essential to quickly achieving the goal of finding a vaccine. And without a vaccine, there is nothing to negotiate access to.

And unaffordable prices are only one part of the monopoly problem; in this pandemic, expanding supply is a major challenge. We have a shot at making enough vaccines for everyone, everywhere, if we put the planet’s full manufacturing capacity to use. But that can only happen if the vaccines are set free. Gavi’s inability to consider this problem, or use its leverage to force a solution, is baffling.

Since Gavi is not a manufacturer, again it has no leverage. Countries, using legislation like the war measures act in the US, may be able to force manufacturers to produce a vaccine once one is developed. Whoever develops the vaccine deserves to be rewarded, but presumably they won’t have carte blanch to set the price, and no one company will have the capacity to meet the demand. They will have to share their formula with other manufacturers.

Pharmaceutical companies say they will make no money off the pandemic, that they will supply vaccines at a cost.

This seems unlikely, though it has happened in the past, when Merck gave away its (unprofitable) cure for river blindness, and manufactured and distributed it pro bono.

Yet, they have already seen multibillion dollar increases in their market capitalisation, and are unwilling to relinquish the monopolies that drive their outsize profits.

The limited monopoly that a drug company gets via patents is intended to pay for the cost of developing new drugs. Despite the problems I have with the patent system, the pharmaceutical industry is probably the best case for it.

Leaders of rich countries (apart from the US) have said all the right things about equitable access to vaccines. Yet they are entering into multiple advance deals to stock up on possibly far more vaccines than they will ever need.

At least the leaders of the US are being honest.

They cannot have it both ways, and neither can Gavi. Seth Berkley, the Gavi CEO, cannot claim to want “the world to come together” with “no barriers” while failing to tackle both rich country nationalism and pharmaceutical industry greed.

I don’t believe that world leaders really care about equitable access to vaccines. Actions speak louder than words. How is Gavi supposed to tackle nationalism and corporate greed?

Gavi can change the rules of the game and turn the Covid-19 vaccine into a global public good. It can ask far more of the pharmaceutical companies it is funding, and it can force the entire vaccine ecosystem to join a cooperative, collaborative and monopoly-free mechanism like the WHO’s Covid-19 Technology Access Pool. This would be the right move to make, and in doing so, Gavi could finally deliver on the promise it made to the world 20 years ago.

I don’t think it can. If you tell Merck that they aren’t allowed to make a profit on the drugs they invest in developing, they will take their wares elsewhere. Compared to the world governments, Gavi is not nearly the biggest fish in the pond. If the organization wants to get any access to the vaccine, it has to play the game sensibly.

About jimbelton

I'm a software developer, and a writer of both fiction and non-fiction, and I blog about movies, books, and philosophy. My interest in religious philosophy and the search for the truth inspires much of my writing.
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