[Ip-health] Politico: The ultimate geopolitical game — distributing a coronavirus vaccine

Thiru Balasubramaniam thiru at keionline.org
Wed Jul 29 02:04:17 PDT 2020


The ultimate geopolitical game — distributing a coronavirus vaccine

Decisions on allocating scarce coronavirus vaccines may be made by the
wealthiest countries.

By ASHLEIGH FURLONG 7/27/20, 2:25 PM CET Updated 7/29/20, 7:23 AM CET

Scientists process samples taken from people tested for the novel
coronavirus in Cheshire, northern England | Paul Ellis/AFP via Getty Images

Who will get the coronavirus vaccine first? All the lofty rhetoric aside,
geopolitics and money talks.

It’s not purely about protecting a population’s health. As many experts see
it, a vaccine is also a vital in getting economies back on track.

World leaders know this, and it's causing wealthy countries to snap up
hundreds of millions of doses of pre-ordered potential vaccines, hedging
their bets that one of the front-runners they've chosen will be successful.

Suerie Moon, co-director of the Graduate Institute Geneva’s Global Health
Centre, calls these candidates "strategic assets" on par with "military
weapons.” Having access to a vaccine is a chance to strengthen a country’s
allegiances, political standing and prestige, she noted.

Even before a single vaccine has been produced, deals worth hundreds of
millions or even billions of euros have already been done.

"Industry definitely should not just be making deals with the first
high-income country that has a lot of money" — Doctors Without Borders’
senior vaccines policy adviser

The U.K. has secured up to 30 million doses of a potential vaccine created
by BioNTech and Pfizer, has a separate deal with AstraZeneca for 100
million doses of its vaccine, and another deal with GSK and Sanofi Pasteur
for 60 million doses. AstraZeneca also has a contract with four EU
countries — the Netherlands, Germany, France and Italy — to buy 400 million

Not one to be outdone, the U.S. has three deals agreed, one with BioNTech
and Pfizer (worth nearly $2 billion) for 600 million doses, another with
AstraZeneca for 300 million doses and a third with Novavax for 100 million

But this rich-country scramble is "disastrous at the international level,"
said Moon.

"It means that there will be very, very little vaccine available for the
rest of the world and for countries that either don't have the money or the
production capacity within their own borders to access the vaccine," she

In the first year after a vaccine is found, there just won’t be enough
doses to go around, said Charlie Weller, head of the Wellcome Trust’s
vaccine program.

“Therefore the mechanisms to allocate scarce resources fairly are going to
become absolutely critical,” she said.

The vehicle to organize this effort is the COVID-19 Global Vaccine Access
Facility — known as COVAX — which serves as a purchasing pool. The idea is
to prevent a repeat of the mad dash in 2009 to secure the swine flu
vaccine, which resulted in high-income countries commandeering the lion's
share, leaving poorer countries far down the queue.

Pharma in the middle

Big Pharma is hyper-aware that the world could see this happen again.

Thomas Cueni, director general of IFPMA, warned that industry might be
caught in the middle between governments wanting their country to receive
the vaccine first and global access initiatives attempting to ensure
equitable distribution.

"We do not want to run that risk," he said at a Chatham House event on July
22. "That's why we are fully committed to the COVAX Facility."

"But in terms of getting support for the facility, you need solidarity from
richer countries willing to subsidize the poorer countries," he added.

The Chris Hani Baragwanath Hospital in Soweto, South Africa | Luca Sola/AFP
via Getty Images

However, Doctors Without Borders’ senior vaccines policy adviser, Kate
Elder, thinks that industry shouldn't be automatically released from

"Industry definitely should not just be making deals with the first
high-income country that has a lot of money to come in and negotiate with
them," she said. Elder conceded, however, that Big Pharma seems to have
shifted its stance in the pandemic, with some vaccine-makers promising "not
for profit" vaccines.

For now, promises of so-called solidarity from richer countries have been
forthcoming. German Chancellor Angela Merkel has described a future vaccine
as a “public health good for all humanity,” while European Commission
President Ursula von der Leyen says the vaccine must be deployed at an
affordable price to “every single corner of the world.”

French President Emmanuel Macron has made similar declarations, saying at
the Global Vaccine Summit that when a vaccine is discovered, it must
benefit everyone "because it will be a global public good."

The U.K. has agreed several bilateral deals with drugmakers in which the
precise terms are secret.

Elder said these messages are unprecedented.

“We have never seen so many heads of state, standing up and saying these
are going to be global public goods ... [that] this is going to be the
people's vaccine,” she said.

James Love, director of Knowledge Ecology International, is more skeptical.

The follow-through from these warm words "has been a lack of transparency
and a lot of secret deals," he warned. "[In a] lot of cases this is
considered a national security issue by some countries, and so it's very
hard to get transparency."

The U.K., for example, has agreed several bilateral deals with drugmakers
in which the precise terms are secret.

However, Health Secretary Matt Hancock insisted to the U.K. parliament on
July 20 that the U.K. is "working to ensure that whoever’s vaccine is
approved first, the whole world can have access."

The Stabilitech laboratory in Burgess Hill south east, England | Ben
Stansall/AFP via Getty Images

"We reject narrow nationalism," he said. "We support a global effort,
because this virus respects no borders, and we are all on the same side."

But there is one caveat: The U.K. is covered first.

"Naturally I’m determined to ensure that there is enough vaccine for the
whole U.K. population, first and foremost," Hancock told MPs the next day.
"I am after all the U.K. secretary of state for health and social care."

For Elder, this kind of talk is "almost like trying to have your cake and
eat it too."

At the moment, she noted, it’s unclear whether serving your own population
and participating in a global solution are mutually exclusive.

“But ... in a global context of scarcity of supply of future medical tools
and vaccines that everybody needs, there might be some elements that indeed
are mutually exclusive," she said. "You can't do both things sufficiently."

Export bans

In fact, it may prove surprisingly easy to keep a British-made vaccine in
the country — simply by implementing an export restriction.

Europe’s fondness for banning exports of goods that are considered
necessary for public health was illustrated at the beginning of the
pandemic, when Germany and France scrambled to keep vital personal
protective equipment within their borders, while the EU banned exports
outside the bloc.

For his part, Hancock hasn't yet threatened an export ban. Instead, he has
justified keeping a vaccine in the U.K. by claiming that once a vaccine is
found, it can be manufactured and distributed to anyone.

Scientists at an Uni-pharma lab in Athens | Louisa Gouliamaki/AFP via Getty

"The point of a vaccine is that once you’ve got the blueprint, lots of
people around the world can manufacture it, and we don’t want to stand in
the way of that," he claimed on July 21.

Except Hancock seems to have forgotten about one small issue — intellectual
property, something fiercely guarded by Big Pharma.

It’s the issue that Love has been battling Big Pharma over for more than 25

Love believes that if anyone has a vaccine that could work, "they should
start the technology transfer right now to other companies that have the
capacity to manufacture that vaccine."

The more manufacturers have capacity, the more quickly the vaccines can be
made, which in turn makes it easier to get large quantities cheaply to more
people, explained Love. “But that has not been the path that governments
have really embraced adequately,” he said.

What’s the alternative?

The problem, explained Moon, is that there isn’t a global entity that has
both the power and authority to enforce a workable system to equitably
distribute a vaccine.

The COVAX facility is attempting to do this, but participation is
voluntary. Designed by Gavi, the Vaccines Alliance, CEPI, and the World
Health Organization, the facility aims to ensure quick and equitable access
to 2 billion doses of a future vaccine by agreeing advance purchase deals
with drugmakers. Wealthy countries would pay for any future doses through
their own coffers while donating to the facility to ensure that up to 90
lower-income countries also receive doses.

However, soon after launching, the facility’s draft design was sharply
criticized by civil society groups as it would have seen wealthy countries
covering up to 20 percent of their populations, with no similar arrangement
for donor-funded countries.

Where it gets trickier is whether particular ethnic groups that have died
disproportionately from COVID-19 — such as Black Britons — should be higher
up in the queue.

The feedback appears to have been taken on. According to a Gavi
spokesperson, under the latest iteration, “allocation will initially
prioritize health and social care workers but will then expand to cover 20
percent of the population of participating countries.”

“Further doses will then be made available based on country need,
vulnerability and COVID-19 threat,” the spokesperson said.

Weller believes that limits like these on supply is “the best way we've got
to ensure that there's enough vaccine for those who need it in the rest of
the world.”

Belt and braces

This trade-off isn’t lost on wealthy nations, which are beginning to
express interest in COVAX. However, some countries have continued to agree
bilateral deals, leading to concern that countries could be negotiating
twice for the same vaccines.

How exactly a vaccine would be distributed if a government has both a
bilateral deal with a manufacturer and is part of COVAX is unclear.

“In principle, we are asking manufacturers to supply us as soon as their
vaccine doses become available – ‘equal access,’” said the Gavi
spokesperson when asked about this dilemma. “Some manufacturers may have
obligations to supply their domestic government first. To mitigate that, we
are aiming to sign contracts with manufacturers that don’t have such
obligations as well."

There's broader agreement on who should get the vaccine first: Health care
workers, the elderly and those with co-morbidities are already on the WHO’s
allocation plan.

Where it gets trickier is whether particular ethnic groups that have died
disproportionately from COVID-19 — such as Black Britons — should be higher
up in the queue. There are also questions over which professions should be
prioritized over others.

And then there's the question of whether "governments will give priority
access to well-connected people, to cronies, as political favors,” warned
Moon, adding that there needs to be "a level of vision and leadership" that
sees beyond this.

In the end, equitable distribution is a win-win, according to the Wellcome
Trust's Weller.

“It's the right thing to do. But it's also the fastest way to end the
pandemic,” said Weller. “Until all people in all countries are protected
from COVID, then we're still all at risk.”

This article has been updated to reflect the number of doses the U.K. has
secured from BioNTech and Pfizer. It is 30 million doses.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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