Vaccine
nationalism won’t defeat the pandemic
by Sharan Burrow on 23rd
February 2021 @SharanBurrow
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International co-operation is vital
to make vaccination, as a public good, available to all.
Sharan Burrow
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.
Limited preparedness
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.
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.
Equitable access
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.
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.
Big Pharma
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.
Funding lagging
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
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