While the World Health Organization, with the support of some European leaders, is advocating for equitable distribution of coronavirus vaccine doses, some countries are investing billions of dollars to buy exclusive rights to promising developments for their citizens.
In the movie “Contagion,” which found new audiences nine years after its release, the vaccine is actually one of the heroes. Scientists are taken hostage for it, doctors inject themselves before the end of trials, and masked robbers break into the homes of officials’ relatives in the hope of obtaining the drug. Officially, the American CDC – Centers for Disease Control and Prevention – organizes a lottery: the vaccine is given according to the date of birth. What happens in reality, and what will happen when (and if) a vaccine against the new coronavirus is invented?
In 2009, Marie-Paule Kieny, who led the World Health Organization’s vaccine research initiative at the time, warned that the most challenging aspect of the process would be creating equitable conditions for distributing the vaccine: “Governments may not be willing to share the vaccine.” She was right. In 2009, several countries developed vaccines against the H1N1 pandemic strain, also known as swine flu. Australia was one of those countries – but the companies producing the vaccine were instructed by the government to meet domestic demand first, before supplying the vaccine overseas. Now almost every country is asking: How do I get in line for the vaccine? How will it be distributed? Who will decide? All of this is currently on the WHO’s plate. The organization says that priority issues are being discussed at regular meetings with representatives of member countries.
Suggestions are being made that health care workers and the most vulnerable populations – the elderly – should be the first to receive the vaccine. Then, as new doses of the vaccine become available, it will be made available to a larger number of people. But that’s just the WHO’s plan.
Experts are concerned that once the vaccine is ready, countries will begin to act on an “every man for himself” basis. “Most likely, the first country to develop a vaccine will initially ban its export until the majority of its population has received the vaccine,” says Amesh Adalja, a specialist in pandemics and infectious diseases at Johns Hopkins University in the US. “Of course, there are various international organizations, such as CEPI (Coalition for Epidemic Preparedness Innovations – BBC), that are working to prevent this from happening. But I am confident that there is a very high probability that the vaccine will first be distributed in the domestic market of the country that develops it. We explain quickly, simply, and clearly what happened, why it matters, and what’s next. The number of offers should remain: episodes. The end of the story: Promotional Podcasts.
Leaders of some countries have already stated that the principle of “every man for himself” cannot apply in times of pandemic. According to French President Emmanuel Macron, access to the vaccine “should be available to the whole planet”. He was supported by Canadian Prime Minister Justin Trudeau, who said that “we have to take care of ourselves and the rest of the world. CEPI funds projects in the field of vaccinology and helps increase the industry’s production capacity (the organization itself is funded by several major funds, including the Bill and Melinda Gates Foundation, as well as a consortium of nations, including the UK, EU countries, Japan, and others). The Coalition is currently supporting the development of nine different vaccines, while establishing a supply chain in collaboration with the WHO, even though none has yet passed clinical trials.
“WHO is working with sponsor companies and CEPI to accelerate vaccine trials and scale up production so that all countries have the opportunity to receive the necessary doses as soon as the vaccine is available. Resources are currently being invested worldwide to support promising vaccines: if a working formula is found by the end of 2020, we expect that by the end of 2021, countries will have a sufficient number of doses for priority populations who want to be vaccinated,” – said BBC in the World Health Organization.
While some countries – mostly European – are talking about collaborating on vaccine development and participating in the WHO-initiated fundraising campaign to fight coronavirus, others are choosing to go their own way. Currently, countries such as the United States and Russia are going it alone. The Russian State Research Center for Virology and Biotechnology “Vector” is working on the creation of its own vaccine against SARS-CoV-2 (officially called the new coronavirus) – this vaccine is based on the vesicular stomatitis virus. The WHO has included this development in the list of promising vaccine candidates. The developers of the Russian vaccine actively participate in the information exchange organized by the WHO and consider it a useful experience. The St. Petersburg company Biocad, an industrial partner of “Vector” in this matter, organizes the entire commercialization process: from preclinical trials to production and distribution of the future vaccine. According to the head of Biocad, Dmitry Morozov, by mid-July, specialists expect to complete preclinical trials of the vaccine against SARS-CoV-2, after which the developers will have to obtain approval for clinical trials, which, according to an optimistic forecast, should begin in late August – early September. By the end of the year, it should be possible to know whether the vaccine is effective.
The majority of vaccine developments do not reach the market, but many countries continue to invest in the development of potentially effective drugs. The current production capacity will allow the Company to supply approximately 5-6 million vaccine doses per month, which will initially be distributed in the Russian market. “The vaccination plan will be announced – we hope the government will fund this vaccination – and based on the plan, we will deliver the vaccine. We already have requests from international partners to supply the vaccine. Of course, as production volumes increase and the Russian market is satisfied, we will be open to supplying doses abroad,” Morozov told BBC. The number of doses should remain the same: 5-6 million per month, which is probably enough to start vaccination in Russia, but clearly not enough to vaccinate the whole world. The projected production volume is calculated only for planned vaccines, not for emergency vaccines (which would be needed during a pandemic).
If the goal is to stop the pandemic, mass vaccination is necessary: if a sufficient number of people develop immunity to the coronavirus, the virus will not be able to spread as quickly, the risk of getting sick will be significantly reduced, and people will be able to return to their normal lives sooner. But today, there is not enough capacity in the world to vaccinate the entire population of the planet. According to The Economist, the world produces about 5 billion doses of all existing vaccines annually, of which 1.5 billion are for seasonal influenza. If all existing capacity were re-profiled for the production of a single coronavirus vaccine (which in itself is impossible, as companies continue to produce vaccines for seasonal flu, measles, rubella, and other diseases), it would take over a year and a half to vaccinate 7.8 billion people on the planet. Experts say that vaccinating 80% of the population is enough to achieve herd immunity. However, there is a possibility that people will need not just one but two doses. In that case, we could be talking about 12-15 billion doses of vaccine. Meanwhile, the WHO and CEPI have already unveiled a plan to procure 2 billion doses to vaccinate the world’s most vulnerable populations. It is expected that by the end of 2021, healthcare workers, people over the age of 65, and people with underlying conditions that contribute to the development of severe covid-19, such as diabetes, will be eligible for vaccination. To implement this ambitious plan, the WHO calculates that about $18.1 billion will be needed. This is not a very large amount of money – just two struggling airlines, Lufthansa and Air France, will receive the same amount from Germany and France, for example. In total, the world’s largest countries have pledged more than $10 trillion to help rebuild the global economy, which faces a shortfall of more than $12 trillion over the next two years as a result of the pandemic.
Russian Biocad acknowledges that additional capacity is needed for mass production of the vaccine – the company is already considering expanding production and possible cooperation with other companies to facilitate and speed up the process. However, the discussion is still only about the domestic market, and other countries are still hoping that their vaccines will be ready sooner. CEPI claims to have found the capacity to produce a staggering four billion doses per year. “Most people don’t believe it’s possible to produce four billion doses a year. But I do,” said coalition representative James Robinson.
The infrastructure of the production facilities depends on the type of vaccine. A viral vaccine (containing an inactivated virus that cannot infect), a vector vaccine (when a segment of the SARS-CoV-2 genome is inserted into the coat of another virus), DNA and RNA-based vaccines, protein-based vaccines, and so on, can be successful. It is impossible to set up production capacity in advance without knowing the “recipe” for a successful vaccine. The world has already faced a similar problem with the production of tests to detect the coronavirus: a shortage of reagents (chemicals needed to perform the test) has prevented many countries from rapidly scaling up testing. In the case of a vaccine, there may also be a shortage of standard components for this process – glass vials, bioreactors (used to grow biological cultures), or adjuvants (added to vaccines to enhance the immune response).
The United States is betting on private pharmaceutical companies, helping them with clinical trials, certification and production. According to American media, five vaccine manufacturers have received lucrative government contracts in the country. These are mostly well-known companies in the pharmaceutical industry: AstraZeneca, Johnson & Johnson, Merck and Sanofi. The fifth is a lesser-known company called Moderna, which works with the National Institute of Allergy and Infectious Diseases. Officials have not explained how they selected promising vaccine developers, but Donald Trump promises to move at “warp speed.”
The media accuse Donald Trump of trying to buy a German company that produces a promising vaccine in order to secure exclusive rights to the drug for Americans. Some countries are already trying to negotiate preliminary agreements to purchase vaccines directly from various manufacturers. Some are even paying for the vaccines in advance. For example, Germany, France, Italy and the Netherlands have joined forces and signed a contract with the British-Swedish conglomerate AstraZeneca for the supply of at least 300 million doses of the vaccine. The United States has reserved the same number of doses. AstraZeneca is working with Oxford University, which is leading the development of the new vaccine. However, the United Kingdom has already claimed its right to the vaccine, stating that the British will be the first to have access to the drug. The problem is that it is currently difficult to predict which developments will be effective and which will fail. Therefore, a country that invests money in an unsuccessful vaccine may end up with nothing at the last moment – in the first days when an effective vaccine appears on the market, the demand for it will be huge, but the number of doses will be limited.
“This is risky. It is also ethically wrong because it may leave the whole world without the necessary doses,” says Sumya Swaminathan, a WHO scientist. Analysts at the consulting firm EY are confident that 97% of coronavirus vaccine developments will not reach the market because they fail in clinical trials. The WHO’s ACT Accelerator initiative aims to make an effective vaccine available worldwide by limiting patent rights. However, the pharmaceutical companies themselves may not agree. The head of Pfizer called the WHO’s objections nonsense, while the head of AstraZeneca said that with patent rights, the main incentive for innovation would disappear. Amesh Adalja, an expert at Johns Hopkins University, is confident that the WHO initiative will not be realized: “Most likely, the successful vaccine formula will not be made public; it will become the intellectual property of the manufacturing company. Theoretically, companies can allow manufacturers from other countries to set up production under license, but the formula will not become public”.
Several countries are claiming the Oxford development, but Boris Johnson promises that the vaccine will reach the British people first. Many countries understand this. In June, for example, the German government invested 300 million euros through its state development bank in the German biotechnology company CureVac, which is working on a promising vaccine. This came shortly after rumors surfaced in the media that the United States was offering to buy the company in order to secure the country’s exclusive rights to the vaccine. Officially, this information was not confirmed, but German journalists provided numerous testimonies to support this version. The U.S. government, still acting alone, appointed Army General Gustav Pernu, previously responsible for operational and strategic logistics at U.S. military bases around the world, to head the “Supersonic Speed” operation. Congress allocated $10 billion for his work to ensure that all Americans receive the coronavirus vaccine as soon as possible.
According to Amesh Adalja of Johns Hopkins University, the optimistic scenario – whoever develops an effective drug first – is that once the vaccine is developed, it will take about two years before everyone without contraindications is vaccinated.
American professor and medical ethics expert Jonathan Moreno has no doubt that wealthy countries will be the first to gain access to the vaccine. In an ideal world, he says, the WHO would be empowered to develop a global vaccination plan, but that will not happen any time soon: “What is happening is a kind of nationalism in the race for the vaccine.”