Designing Vaccines for People, Not Profits
Dec 1, 2020 MARIANA MAZZUCATO, HENRY LISHI LI, ELS TORREELE
For all the hope spurred by announcements of demonstrated efficacy in
multiple COVID-19 vaccine candidates, there is still a long way to go to
deliver on the promise of a universal, freely available "people's
vaccine." As matters stand, national and private interests are trumping
the principle of health justice.
LONDON – Recent announcements of demonstrated efficacy in COVID-19 vaccine
trials have brought hope that a return to normality is in sight. The
preliminary data for Pfizer/BioNTech and Moderna’s novel mRNA vaccines
are highly encouraging,
suggesting that their approval for emergency use is forthcoming. And more
recent news of effectiveness (albeit at a slightly lower rate) in a vaccine
from AstraZeneca and the University of Oxford has fueled optimism that even
more breakthroughs are on their way.
In theory, the arrival of a safe and effective vaccine would represent the
beginning of the end of the COVID-19 pandemic. In reality, we are not even at
the end of the beginning of delivering what is needed: a “people’s vaccine” that
is equitably distributed and made freely available to all who need it.
To be sure, the work to create vaccines in a matter of months deserves
praise. Humanity has made a monumental technological leap forward. But the
springboard was decades of massive public investment in research and
development.
Most of the leading vaccine candidates prime the immune system’s defenses
against the viral “spike protein,” an approach made possible through years of research at
the US National Institutes of Health. More immediately, BioNTech has
received $445 million from
the German government, and Moderna has received $1 million from the
Coalition for Epidemic Preparedness Innovations and more than $1 billion from the
US Biomedical Advanced Research and Development Authority and the US Defense
Advanced Research Projects Agency. The AstraZeneca-Oxford vaccine has
received more than £1 billion ($1.3
billion) of public funding.
But for technological advances to translate into Health for All,
innovations that are created collectively should be governed in the public
interest, not for private profit. This is especially true when it comes to
developing, manufacturing, and distributing a vaccine in the context of a
pandemic.
No country acting alone can resolve this crisis. That is why we need
vaccines that are universally and freely available. And yet, the current innovation
system prioritizes the interests of high-income countries over those of
everyone else, and profits over public health.
The first step toward a people’s vaccine is to ensure full transparency of
the clinical-trial results, which would enable independent and timely
assessments of safety and efficacy. The publication of scanty, preliminary data
through corporate press releases is meant for financial markets, not the
public-health community. This practice sets a bad precedent. While
pharmaceutical share prices surge, health professionals and the public are left
second-guessing the reported results. As more details about the flaws in clinical
trial design and implementation for the AstraZeneca-Oxford vaccine emerge, so
do the calls for open science and immediate sharing of protocols and results.
In addition, critical questions about the leading vaccine candidates remain unanswered. Responding to political and
economic pressure in high-income countries, pharmaceutical companies are
rushing their vaccine candidates across the finish line. Accordingly, they
have designed their phase-three clinical
trials to deliver the quickest possible positive read-out, rather than
addressing more relevant questions such
as whether the vaccine prevents infection or just protects against the disease.
It also is unclear how long the protection will last; whether a given vaccine
works equally well in young and old people, or in people with co-morbidities;
and how the top candidates compare to one another (critical for designing
effective vaccination strategies).
Moreover, national interests – especially those of developed countries –
remain the dominant factor in vaccine rollout. While the international purchase
and distribution platform COVAX represents a momentous step
forward, its impact is being offset by massive bilateral advance-purchase
agreements by rich countries that can afford to bet on multiple vaccines. For
example, high-income countries have already bought close to 80% of the Pfizer/BioNTech and Moderna vaccine
doses that will be available within the first year.
All told, rich countries have laid claim to 3.8 billion doses from
different vaccine makers, compared to 3.2 billion (which includes around 700
million doses for COVAX) for the rest of the world combined. In other words,
high-income countries have pre-ordered enough doses to cover their populations
several times over, leaving the rest of the world with potentially too few to
cover even their most at-risk communities.
At the same time, because the vaccine race is focused primarily on Western
markets, some candidates are scarcely viable outside of a developed-country
context. The Pfizer/BioNTech vaccine must be kept at -70ºC, which is colder than an Antarctic winter.
Distributing this vaccine will create costly and complex logistical challenges,
especially for low- and middle-income countries. Although other candidates –
such as the AstraZeneca-Oxford vaccine – are stable at higher temperatures, it
is notable that such glaring features of market discrimination are built into
the first product to reach the approval stage.
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Beyond national interest lurks the problem of even narrower private
interests, which stem from an over-financialized biopharmaceutical innovation
model. The business model for future vaccine development is already being sized
up now that the pandemic has revealed the potential windfall for investors. But
while they benefit from sky-rocketing stock prices, soaring capital gains,
and dumping a company’s shares the same day it announces promising preliminary
results in a clinical trial, delivering a people’s vaccine has become an
afterthought.
The COVID-19 crisis is a perfect test of whether a more
public-health-oriented approach to innovation and production will prevail in
the years ahead. While Pfizer is sticking
with the model of maximizing shareholder value, AstraZeneca has at least pledged
not to profit from its vaccine “during the pandemic.” Yet, despite all the
public investment that underwrote these innovations, the process will remain opaque, leaving
one to wonder if AstraZeneca is actually ready to prioritize public health over
profit and offer its vaccine at cost.
While the recent vaccine news has brought hope, it also has exposed the
pharmaceutical industry’s broken business model, casting
doubt on the prospects of delivering a people’s vaccine and achieving Health
for All. Business as usual may allow us to scrape by in this crisis. But there
is a better way to do things. Before the next pandemic arrives, we must
recognize vaccines as global health commons, and start to reorient the
innovation system toward symbiotic public-private partnerships governed in the
public interest.
Writing for PS since 2015
20 Commentaries
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Mariana
Mazzucato, Professor of the Economics of Innovation and Public Value at
University College London and Founding Director of the UCL Institute for Innovation and Public Purpose,
is Chair of the World Health Organization's Council on the Economics of Health
for All and the author of The Value of Everything: Making and
Taking in the Global Economy and The Entrepreneurial
State: Debunking Public vs. Private Sector Myths.
Writing for PS since 2020
1 Commentary
Henry Lishi
Li is a research fellow in health innovation at the UCL Institute for
Innovation and Public Purpose.
Writing for PS since 2020
2 Commentaries
Els Torreele
is a visiting policy fellow at the UCL Institute for Innovation and Public
Purpose.
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