Recent announcements of demonstrated efficacy in
COVID-19
vaccine trials have brought hope that a return to normality is in
sight. The preliminary data for Pfizer/BioNTech and Moderna’s novel mRNA
vaccines are highly encouraging, suggesting that their approval for
emergency use is forthcoming.
And more recent news of effectiveness (albeit at a slightly lower rate)
in a vaccine from AstraZeneca and the University of Oxford has fueled
optimism that even more breakthroughs are on their way.
In theory, the arrival of a safe and effective vaccine would represent the beginning of the end of the
COVID-19
pandemic. In reality, we are not even at the end of the beginning of
delivering what is needed: a “people’s vaccine” that is equitably
distributed and made freely available to all who need it.
To be sure, the work to create vaccines in a matter of months deserves
praise. Humanity has made a monumental technological leap forward. But
the springboard was decades of massive public investment in research and
development.
Most of the leading vaccine candidates prime the immune system’s
defenses against the viral “spike protein,” an approach made possible
through years of research at the US National Institutes of Health. More
immediately, BioNTech has received $445 million from the German
government, and Moderna has received $1 million from the Coalition for
Epidemic Preparedness Innovations and more than $1 billion from the US
Biomedical Advanced Research and Development Authority and the US
Defense Advanced Research Projects Agency. The AstraZeneca-Oxford
vaccine has received more than £1 billion ($1.3 billion) of public
funding.
But for technological advances to translate into Health for All,
innovations that are created collectively should be governed in the
public interest, not for private profit. This is especially true when it
comes to developing, manufacturing, and distributing a vaccine in the
context of a pandemic.
No country acting alone can resolve this crisis. That is why we need
vaccines that are universally and freely available. And yet, the current
innovation system prioritizes the interests of high-income countries
over those of everyone else, and profits over public health.
The first step toward a people’s vaccine is to ensure full transparency
of the clinical-trial results, which would enable independent and timely
assessments of safety and efficacy. The publication of scanty,
preliminary data through corporate press releases is meant for financial
markets, not the public-health community. This practice sets a bad
precedent. While pharmaceutical share prices surge, health professionals
and the public are left second-guessing the reported results. As more
details about the flaws in clinical trial design and implementation for
the AstraZeneca-Oxford vaccine emerge, so do the calls for open science
and immediate sharing of protocols and results.
In addition, critical questions about the leading vaccine candidates
remain unanswered. Responding to political and economic pressure in
high-income countries, pharmaceutical companies are rushing their
vaccine candidates across the finish line. Accordingly, they have
designed their phase-three clinical trials to deliver the quickest
possible positive read-out, rather than addressing more relevant
questions such as whether the vaccine prevents infection or just
protects against the disease. It also is unclear how long the protection
will last; whether a given vaccine works equally well in young and old
people, or in people with co-morbidities; and how the top candidates
compare to one another (critical for designing effective vaccination
strategies).
Moreover, national interests – especially those of developed countries –
remain the dominant factor in vaccine rollout. While the international
purchase and distribution platform COVAX represents a momentous step
forward, its impact is being offset by massive bilateral
advance-purchase agreements by rich countries that can afford to bet on
multiple vaccines. For example, high-income countries have already
bought close to 80% of the Pfizer/BioNTech and Moderna vaccine doses
that will be available within the first year.
All told, rich countries have laid claim to 3.8 billion doses from
different vaccine makers, compared to 3.2 billion (which includes around
700 million doses for COVAX) for the rest of the world combined. In
other words, high-income countries have pre-ordered enough doses to
cover their populations several times over, leaving the rest of the
world with potentially too few to cover even their most at-risk
communities.
At the same time, because the vaccine race is focused primarily on
Western markets, some candidates are scarcely viable outside of a
developed-country context. The Pfizer/BioNTech vaccine must be kept at
-70ºC, which is colder than an Antarctic winter. Distributing this
vaccine will create costly and complex logistical challenges, especially
for low- and middle-income countries. Although other candidates – such
as the AstraZeneca-Oxford vaccine – are stable at higher temperatures,
it is notable that such glaring features of market discrimination are
built into the first product to reach the approval stage.
Beyond national interest lurks the problem of even narrower private
interests, which stem from an over-financialized biopharmaceutical
innovation model. The business model for future vaccine development is
already being sized up now that the pandemic has revealed the potential
windfall for investors. But while they benefit from sky-rocketing stock
prices, soaring capital gains, and dumping a company’s shares the same
day it announces promising preliminary results in a clinical trial,
delivering a people’s vaccine has become an afterthought.
The
COVID-19
crisis is a perfect test of whether a more public-health-oriented
approach to innovation and production will prevail in the years ahead.
While Pfizer is sticking with the model of maximizing shareholder value,
AstraZeneca has at least pledged not to profit from its vaccine “during
the pandemic.” Yet, despite all the public investment that underwrote
these innovations, the process will remain opaque, leaving one to wonder
if AstraZeneca is actually ready to prioritize public health over
profit and offer its vaccine at cost.
While the recent vaccine news has brought hope, it also has exposed the
pharmaceutical industry’s broken business model, casting doubt on the
prospects of delivering a people’s vaccine and achieving Health for All.
Business as usual may allow us to scrape by in this crisis. But there
is a better way to do things. Before the next pandemic arrives, we must
recognize vaccines as global health commons, and start to reorient the
innovation system toward symbiotic public-private partnerships governed
in the public interest.
