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In December 2006, the Indonesian authorities refused to provide samples of the avian influenza virus without guarantees that it would benefit from any vaccine produced by them. Amid the swine flu outbreak in 2009, the Australian government ordered a vaccine manufacturer to meet its demand before fulfilling orders abroad. That November, after several wealthy nations obtained vaccines, World Health Organization officials expressed concern that the disaster may be ahead.
“Things would be much worse if the pandemic had been more severe, and it would be more difficult to create some justice in the distribution of the vaccine,” said Marie-Paule Kieny, then director of the WHO initiative for vaccine research. “Governments may be less inclined to share the vaccine they have.”
With vaccines seen as one of the few real avenues to emerge from the coronavirus crisis, fears of “vaccine nationalism” are already mounting. Each step of creating, testing, and mass producing a vaccine is an epic challenge, but the political and ethical decisions surrounding its subsequent distribution pose another. Governments, including in the UK, are being questioned about how they will get to the front of the line. How will an eventual vaccine be distributed? Who decides? Will the supplies go to the highest bidder? Are wealthy nations already buying potential vaccines? And what will prevent governments from simply confiscating vaccines made in your country?
According to experts and the industry, it will take at least a year to vaccinate the world from the time vaccines become available. That’s a 12-month row, if things go well, after finding a vaccine. “The reality is that there is no established process for this,” says Steven Jones, a Canadian member of a team that created a successful Ebola vaccine.
Possible problems have been detected. On Friday, a parade of world leaders, charity chiefs and industry bosses, including French President Emmanuel Macron, German Chancellor Angela Merkel and philanthropist Melinda Gates, joined in supporting a WHO initiative to ensure that all Treatments and vaccines are shared equitably worldwide. Dominic Raab also supported it. However, just as notable were the nations that did not attend: the United States, China, Russia, and India.
A delicate system of international cooperation must be sought in the midst of a crisis. “We are talking about billions of doses available to everyone,” says Charlie Weller, chief vaccine officer for the Wellcome Trust. “We don’t have a roadmap on how to do it. Many of these discussions are being resolved now.”
There are organizations designed to help the equitable distribution of a vaccine, notably Gavi, which aims to increase access to poor countries, and the Coalition for Innovation in Epidemic Preparedness, which the UK helps to fund. However, some are forceful about hopes for centrally managed global cooperation. “Can you imagine the WHO telling Donald Trump that he can only have a tenth of the vaccine he wants,” says David Salisbury, former director of immunization at the Health Department. “Surely, he will look to see who can make a vaccine in the necessary amounts in the United States, and he will not let the vaccine out.” That will happen. ”
Jones is also pessimistic. “WHO may try to take a leadership role, but they are in a difficult situation. They can try to apply moral and ethical guidelines. “
UK ministers have also been under pressure to ensure that Britain benefits first from the vaccines discovered here. Matt Hancock has said that “he makes sure that the UK contributes to and benefits from the efforts around the world.”
It is inevitable that some nations will try to use “advance purchase agreements” to secure supplies, paying potential vaccine producers if their product works. These agreements provide funds for research, but there is no system to control their impact on fair distribution.
Unfortunately, a row of vaccinations is inevitable. Making billions of doses, rather than millions, adds another order of difficulty. Therefore, Weller said in a briefing last week: “For at least a year after the Covid-19 vaccine is available, there is likely to be insufficient supply to meet global demand for billions of doses. “
Thomas Breuer, medical director of GSK Vaccines, paints an even bleaker picture. His company is working with pharmaceutical giant Sanofi to develop a production process that can deliver large quantities. “Let’s say the GSK-Sanofi approach is successful, which alone will not be enough to supply 20% of the world’s population in one year,” he says. “Several of the large-scale solutions have to come into play if we want to serve the world’s population in a period of one or two years. A single company is not enough “.
There is also industry concern about being pushed to the center of an impossible political tug-of-war. “They will have a large number of customers, many of whom will wave dollar, euro and pound bills,” says Salisbury. Therefore, many are praying for an international agreement. “Now is the time to have a conversation with the government about those allocation principles,” says Richard Torbett, executive director of the Association of the British Pharmaceutical Industry. “Let’s not wait until we have something to fight for.” He adds that manufacturers simply won’t be left to decide who gets what. “They will start from the point of saying that we want to maximize global access.”
The threat of vaccine export bans is clearly a concern. “It would really be a mistake for world leaders to be tempted by such behavior,” says Torbett. He hopes that, in the end, the need for multiple vaccines from many different global sources can encourage international cooperation: “All countries will want to be fairly allocated.”
While some leaders may be tempted to go it alone, Weller says such actions could come back to haunt them: “As long as Covid is out of control somewhere, it threatens everyone, everywhere. That’s what it all comes down to. “
