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Jumping the queue : Who will get the vaccine first?

Updated: Jun 25, 2020

In six months, the COVID 19 virus has infected nearly 9 million people and killed almost half a million. Moreover, the world is facing an unprecedented economic crisis with bleak predictions of recession, high unemployment, and enormous debt.

The whole world is awaiting the magic solution in the form of a vaccine. Many world leaders talk about it as a “global public good”, which means universal access for everyone. Researchers all over the world are busy studying and sharing their knowledge. It is very impressive to see the flow of public money to finance research into understanding the virus and creating medicines and vaccines to control it.

The WHO took the lead and joined 34 countries from the north and south to launch the Call for Solidarity Covid19 Technology Access Pool (C-TAP) as a vehicle to ensure fast sharing of knowledge and hence faster development of vaccines and faster manufacturing by as many quality producers as needed. This is the one mechanism that can ensure access to all – a true global public good.

Yet what is really baffling is the fact that neither rich countries nor pharmaceutical companies want to budge one inch from protecting the biomedical system that so far failed to stimulate R&D for many diseases. The US and UK ignored C-TAP while pharmaceutical companies dismissed it. Dr Albert Bourla, chief executive of Pfizer described the pool as “nonsense” and “dangerous”.

Rich countries are making secret deals with pharmaceutical companies to secure high number of doses for their populations e.g. the US paid AstraZeneca $1.2 billion to secure 300 million doses for Americans and the UK secured 100 million doses while Europe secured 400 million doses. . This means-assuming the Oxford Uni vaccine works- that AstraZeneca will give the first patches to these countries while the rest of the world has to wait! It also means that whoever pays the highest price can secure the doses they want! Clearly this is not solidarity. Practically it prioritises citizens who may not be vulnerable to the infection over those who are. This being at the expense of depriving a health worker who treats COVID19 patients in a developing country Malawi from the vaccine which would save lives. Fair distribution of the vaccine should prioritise health workers followed by vulnerable groups e.g. those with chronic conditions, across all countries.

GAVI, the global vaccine alliance which helps poor countries to buy vaccines for children, and Cepi, The Coalition for Epidemic Preparedness Innovations, created COVAX to ensure access to vaccines for developing countries. It was created without meaningful participation from developing countries that are supposed to be the “main” beneficiaries of COVAX. GAVI has no experience of dealing with vaccines beyond Low Income Countries and the initiative lacks transparency on pricing, distribution between and within countries nor decision making process. COVAX ignores dealing with intellectual property and its relation to the C-TAP.

COVAX financing facility depends on Advanced Market Commitment (AMC) to raise funds. The facility was decided upon without attention to how it would deal with the problems of the previous AMC for pneumococcal vaccine e.g. not reaching lowest possible price. It took NGOs (especially MSF) years of campaigning to get the price of that vaccine down by pharma companies.

COVAX’ first deal with AstraZeneca raises concerns given that GAVI hastily announced $750 million to secure 300 million doses-basically only a third less than the US deal despite GAVI priding itself on the low price it offers to LICs. Moreover, the details of the deal are not available for public scrutiny.

Millions of dollars from the public purse have been pledged to advance vaccine development without any clarity on the actual terms of conditions for funding. It does not seem that donors dealt with the true cost of R&D, the situation of IP, setting the price or the distribution of potential vaccines. Public scrutiny is essential. It is not good enough to rely on a company promising “non-profit price” when the public does not know the true cost of R&D and manufacturing.

To ensure that all people who need the vaccine can access it, specific actions must be implemented:

1. Donors to put a conditionality on their funding including full transparency of the cost of R&D and manufacturing, pricing and distribution. All deals should be available for public scrutiny.

2. All donors to ensure that the data and intellectual property related to the products resulting from their funds are contributed to the C-TAP.

3. GAVI to a) ensure that its deals with pharmaceutical companies include contributing data, know-how and intellectual property in C-TAP, b). adopt total transparency on all its deals with pharmaceutical companies including cost of R&D IP and pricing, its operationalizing f fair distribution; c) amends COVAX decision-making to include meaningful participation of developing countries and civil society.

Access to COVID 19 vaccine is not a luxury. It is essential for the world health and global economy. No one will be safe until everyone is safe.

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