Equitable access to coronavirus vaccine threatened by ‘vaccine nationalism’

30 Jul 2020

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Instead of a global response to the pandemic, we’re seeing an outbreak of vaccine nationalism, writes Prof Duncan Matthews of the Queen Mary University of London.

Click to read 'How countries aim to get the coronavirus vaccine first by cutting opaque supply deals' on The Conversation

A version of this article was originally published by The Conversation (CC BY-ND 4.0)

The University of Oxford recently published promising news about the results from the phase one and two trials of the coronavirus vaccine it is developing for Covid-19. The clinical trials, involving 1,077 volunteers in the UK aged 18 to 55, showed that the AZD1222 vaccine appeared to be safe and generated the all-important dual antibody and T-cell immune response.

Yet as encouraging as this is, the public-private partnership that underpins the project is a concern. Much of the funding came from the UK government, which announced a £65.5m grant to the University of Oxford earlier this year. Other funding had already come from outside the UK, including from the German Centre for Infection Research and the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI), so this was not solely a UK initiative.

In March, Oxford also reached a licensing agreement with AstraZeneca to commercialise and manufacture the vaccine. But despite this work being largely paid for by the public purse, very little is known about the details of this commercial partnership. There is a lot we don’t know about who will own the intellectual property, how it will be shared and at what price it will be sold. The same is equally true of numerous other public-private partnerships to develop a Covid-19 vaccine.

And while this global pandemic surely demands a globally coordinated response, governments have instead been clamouring to secure their own supplies of the vaccine.

The spread of vaccine nationalism

If the Oxford-AstraZeneca vaccine proves successful, the company has undertaken to manufacture up to 30m doses that will be available for people in the UK by September. This is part of an agreement to deliver 100m doses in total, which would be made available to other countries but the UK will get access first.

In the same vein, the UK has placed advance purchase orders for two other coronavirus vaccine prospects: 30m doses of the one being developed by Pfizer and BioNTech, and 60m from Valneva of France. Again, these agreements lack transparency. We don’t know, for example, whether the UK taxpayer will still pay if the drugs don’t work.

‘These opaque agreements raise concerns about precisely how publicly funded research conducted by publicly owned universities is being privatised’

We are seeing the same kind of approach elsewhere. In May, the US reached its own supply agreement with AstraZeneca for the AZD1222 coronavirus vaccine. The Americans are investing $1.2bn in return for a 30,000-person vaccine trial in the US, and the manufacturing capacity to produce at least 300m doses, with the first doses to be delivered as early as October. Similarly, the US has a supply deal with the Pfizer-BioNTech project.

Elsewhere, AstraZeneca has agreed to supply 400m doses of AZD1222 to Europe, starting from the end of the year, through the Inclusive Vaccines Alliance (IVA) set up by Germany, France, Italy and the Netherlands.

When Ursula von der Leyen, the European Commission president, unveiled the EU vaccine strategy days later – reportedly to ensure that the union was not left behind in the vaccine race by big spenders like the US – she hailed the IVA as an important step towards joint action between the member states. Tellingly, there was no mention of access to AZD1222 for countries outside the EU.

For other countries, AstraZeneca announced a $750m agreement in June with CEPI and Gavi, the global public-private vaccine alliance backed by the Bill and Melinda Gates Foundation, to make, procure and distribute 300m doses of AZD1222 with delivery starting at the end of the year. AstraZeneca also signed an agreement with the Serum Institute of India to sub-license AZD1222 to supply 1bn doses to low and middle-income countries, with a commitment to provide 400m by year end. In all cases, little is known about the terms of the agreements.

One important aspect of this lack of transparency concerns pricing. For example, the deals with the IVA, CEPI and Gavi say AstraZeneca will supply the vaccine at no profit during the pandemic. This leaves open the prospect that “no profit” will cease to apply if the World Health Organization declares that this is no longer a pandemic. Because the terms of these agreements have not been fully disclosed, we just don’t know.

The social enterprise alternative

Without doubting the commitment of AstraZeneca to its stated objective of broad and equitable access to this coronavirus vaccine, these opaque agreements raise concerns about precisely how publicly funded research conducted by publicly owned universities is being privatised.

Other approaches are possible. Along with the funding package for the University of Oxford, the UK government also allocated £18.5m to Imperial College London for a different coronavirus vaccine project.

Having completed clinical trials, Imperial announced on 17 July that it was proceeding to the next trial phase involving 105 participants aged 18 to 75. In order to rapidly develop this vaccine and distribute it as widely as possible in the UK and overseas – including to low and middle-income countries – Imperial formed a new social enterprise, VacEquity Global Health. This is in partnership with Morningside Ventures, a fund based in Hong Kong that invests in companies for the public good.

Rather than partnering with one company, the Imperial model envisages links with multiple manufacturers, waiving royalties and charging a modest amount for its vaccine. Agreements to purchase, manufacture and distribute the vaccine are still being negotiated.

It remains to be seen whether this social enterprise approach proves more successful in achieving equitable access to Covid-19 vaccines in the longer term, but it seems more in line with how we should be tackling this crisis.

Public money invested in publicly funded institutions should be treated as a public good, not as private intellectual property rights to be licensed and traded by private companies without full and proper public scrutiny. The vaccine nationalism that we have seen in the past couple of months only encourages this. At the very least, these agreements need to be fully transparent to address these concerns.

The Conversation

By Prof Duncan Matthews

Duncan Matthews is professor of intellectual property law at Queen Mary University of London. He has worked as a researcher at policy think-tank the National Institute for Economic and Social Research in London, and as an EU lobbyist.