Behind the principle of “global public good” lie two distinct issues: intellectual property rights and distribution of the first doses of a vaccine. The former might be easier to resolve than the latter.
South African President Cyril Ramaphosa has said that Africa wants any vaccine against the coronavirus to be patent-free.
But that is unlikely because laboratories working to develop a vaccine will want to recoup the billions of dollars that they invest. And they can rely on support from the US, which opposes any challenge to international intellectual property rights and repeated that position this week to the WHO.
So the vaccine will probably not be free, although several companies have committed to providing it at cost.
But that kind of at-cost promise is relative. It was made in the past for drugs to treat HIV, said Matthew Kavanagh, a professor of global health at Georgetown University. But generic drug manufacturers later found their actual costs were a tenth as much or even less, showing there is leeway in how at-cost prices are set.
Mark Feinberg, former chief science officer at Merck Vaccines and now the CEO of the International AIDS Vaccine Initiative, said pharmaceutical labs have learned their lesson about making profits during a tragedy and do not want to become pariahs. That would hurt their reputation and their profits.
Feinberg said he thinks the patent to a coronavirus vaccine will be shared because once a vaccine is developed, no single drug manufacturer can produce enough of it to meet world demand and will have to partner with other manufacturers.
So the tough question becomes, who among the 7.6 billion of us on Earth gets vaccinated first?
– America First –
The WHO, European leaders and NGOs involved in the fight against COVID-19 aim to establish a new mechanism of equitable sharing of any vaccine. First in line to get a shot would be health care workers in any country hit by the virus, followed by essential workers such as police, firefighters and bus drivers, before everybody else.
But Trump, eager to get the US economy and the country back on track as he seeks re-election in November, cares little for international solidarity.
His administration has a goal — merely hypothetical at this point because clinical trials of possible vaccines are only just starting — of having 300 million doses on hand by January. The unstated idea is that they would be enough to vaccinate everybody in America.
“His mentality is highly insular. And his mentality is highly xenophobic, which is the opposite of what it takes to control a pandemic,” said Sten Vermund, dean of the Yale School of Public Health.
But this is a globalized world and the US relies heavily on other countries for goods and food. “We won’t be normal if the rest of the world is riven by the coronavirus,” Vermund said.
The Trump administration has already invested hundreds of millions of dollars in several experimental vaccines being developed by four companies — Johnson & Johnson, Moderna, Sanofi and AstraZenec — in the hope that one or more of the drugs come to fruition and are produced in the US.
Executives with Moderna and Sanofi have effectively told Europe to start placing orders.
The real backstop against vaccines becoming nationalized will be to build factories to make them in several continents.
But this crisis is not like that of the H1N1 flu pandemic in 2009, said Pascal Barollier, who works with Gavi, an organization that buys vaccines for developing countries.
“We are starting from scratch. We have no vaccine, no factories,” he said.
A public-private coalition called Cepi, created in 2017 after the world failed to develop a vaccine against Ebola, has invested half a billion dollars in nine companies working to develop vaccines against COVID-19.
In exchange for that funding, the coalition asks that any vaccine technology that turns out to be successful be shared so that a vaccine can be produced quickly and at scale.
With that kind of public funding, labs are building extra vaccine production lines without even waiting for the results of clinical trials.
Some companies are teaming up: Moderna will be able to churn out doses in the US for the US market and in Switzerland for the European market. Sanofi has formed an alliance with a rival, GSK; they each have several factories on both sides of the Atlantic.
In order to vaccinate the entire planet against COVID-19, it would help if several vaccines emerge, rather than just one.