[Ip-health] Achal Prabhala and Kate Elder in The Guardian: How will the world's poorest people get a coronavirus vaccine?

Thiru Balasubramaniam thiru at keionline.org
Wed Jun 24 14:17:33 PDT 2020


How will the world's poorest people get a coronavirus vaccine?

Achal Prabhala and Kate Elder

Rich countries’ governments are putting all their trust in a marriage of
markets and philanthropy called Gavi

Published on Wed 24 Jun 2020 15.26 BST

Vaccines for Covid-19 are coming. Billions of dollars are flowing in, over
100 efforts are under way, and at least 13 leading candidates are already
being tested on humans. But how will these vaccines reach the poorest
people on the planet? This question haunts the fate of more than half the
world’s population. It is the central question of our time. The failure to
address this question in the past has resulted in millions of unnecessary
deaths – and yet, some believe there is a simple answer. Ask pharmaceutical
corporations about how they will ensure access to Covid-19 vaccines, and
they say “Gavi”. Ask the wealthiest governments in the world what they are
doing to ensure global equity, and they too say “Gavi”.

Gavi, the Vaccines Alliance, is a 20-year old public-private partnership
that believes the marriage of markets and philanthropy will bring vaccines
to everyone in the world. The numbers are impressive: every year, Gavi
sends out 500 million vaccine doses against 17 different diseases. The sums
of money pumped into Gavi are equally impressive. At the Global Vaccine
Summit held earlier this month, Gavi raised a record-breaking $8.8bn. With
£330m committed annually for the next five years, the British government is
their single largest donor, alongside other wealthy countries and the Gates
Foundation. At the summit, Gavi launched its newest initiative, a fund for
future Covid-19 vaccines – the Covax Facility – which invites countries to
invest in a wide portfolio of potential vaccines, pool their risk, and gain
dedicated access to eventual products.

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Gavi heavily publicised a unit of the Covax Facility called the Covax
Advance Market Commitment (or AMC, and yes, it’s confusing) that deals with
the access side of things. The first deal – a US$750m agreement with
AstraZeneca for 300 million doses of the potential Oxford University
vaccine – was heralded as a commitment by industry to meet the needs of the
world’s poorest countries. But it came at a high price, representing only a
minor discount over the full price paid by the US government. The problem
is, we know very little about this deal because the agreement isn’t public,
despite all the public money involved. We don’t know if, for example,
AstraZeneca gets to keep the money if its vaccine fails. We don’t even know
for a fact that all the vaccines bought are intended for use in poor
countries. We asked AstraZeneca about this but did not receive a response
in time for publication.

At the summit, Gavi devoted considerably less attention to decisions made
within the Covax Facility to make the fund attractive to rich countries.
For instance, there is consensus that the most vulnerable people in the
world be given the vaccines first and in a fair and equitable way, and the
World Health Organization’s forthcoming Global Allocation Framework will
specify how that can be done. And yet, a report prepared for the Gavi board
meeting that starts this week, and circulated ahead by Gavi to
stakeholders, including civil society organisations, proposes that rich
countries can ignore the WHO framework, with only poor countries having to
abide by it. According to the document, it seems Gavi will allocate rich
countries enough vaccines for a fixed percentage of their population, which
their “national advisory bodies” will decide. Poor countries, meanwhile,
will only get vaccines for their highest priority people, after
demonstrating proof.

Rich countries are “encouraged (but not required)” to donate vaccines if
they have more than they need, but we do not know when poor countries will
get these donated vaccines: will it be at the same time as the rich
countries, or only after they have used up all the vaccines they need? We
put the questions raised by this document to Gavi, but it was unable to
provide answers before this week’s board meeting.

The prospect of a two-tiered system puts into question the fundamental
issue that Gavi was founded to address: equitable access to vaccines. In
many ways, Gavi has helped create the problem it is now trying to solve.
Three decades of getting medicines and vaccines to poor people have
revealed the problem and the solution: monopolies over vaccines in the
pharmaceutical industry, enforced through patents which, when suspended,
result in prices going down and supply going up. The rich countries and
organisations who fund Gavi are equally culpable: the US, UK and EU have
committed billions towards vaccine research, almost all of which has gone
to private pharmaceutical companies – without any conditions to prevent
them from monopolising their vaccines.

All these countries have further stockpiled future vaccines by making
direct deals with manufacturers, again without any access conditions
whatsoever. In failing to challenge the most perverse feature of the
pharmaceutical industry – monopolies that block access to their products –
Gavi is in step with the governments who fund it. At best, Gavi has failed
at negotiating control over the vaccines it funds. At worst, it believes
that pharmaceutical monopolies, which have thwarted equitable access, are
somehow essential to achieving it.

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And unaffordable prices are only one part of the monopoly problem; in this
pandemic, expanding supply is a major challenge. We have a shot at making
enough vaccines for everyone, everywhere, if we put the planet’s full
manufacturing capacity to use. But that can only happen if the vaccines are
set free. Gavi’s inability to consider this problem, or use its leverage to
force a solution, is baffling.

Pharmaceutical companies say they will make no money off the pandemic, that
they will supply vaccines at a cost. Yet, they have already seen
multibillion dollar increases in their market capitalisation, and are
unwilling to relinquish the monopolies that drive their outsize profits.
Leaders of rich countries (apart from the US) have said all the right
things about equitable access to vaccines. Yet they are entering into
multiple advance deals to stock up on possibly far more vaccines than they
will ever need. They cannot have it both ways, and neither can Gavi. Seth
Berkley, the Gavi CEO, cannot claim to want “the world to come together”
with “no barriers” while failing to tackle both rich country nationalism
and pharmaceutical industry greed.

Gavi can change the rules of the game and turn the Covid-19 vaccine into a
global public good. It can ask far more of the pharmaceutical companies it
is funding, and it can force the entire vaccine ecosystem to join a
cooperative, collaborative and monopoly-free mechanism like the WHO’s
Covid-19 Technology Access Pool. This would be the right move to make, and
in doing so, Gavi could finally deliver on the promise it made to the world
20 years ago.

Achal Prabhala is the coordinator of the AccessIBSA project, which
campaigns for access to medicines in India, Brazil and South Africa. Kate
Elder is the senior vaccines policy adviser at the Médecins Sans Frontières
Access Campaign

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

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