A deadly virus causes a global pandemic. A wealthy country signs a more than $100 million contract for vaccine with a manufacturer in a small nation. But when the vaccine becomesavailable, the small nation’s government balks, demanding enough for its entire population first before any can be exported.
That’s what happened in 2009, when Australia demanded biotech manufacturer CSL fulfill domestic needs for H1N1 vaccine before any could be sent to the United States.
And it’s exactly the scenario public health experts fear as the world enters into a scientifically turbo-charged but chaotic race to create and then produce coronavirus vaccines. Rather than widespread collaboration, coordination and sharing, “me first” vaccine nationalism pits nation against nation to get and keep enough doses for their citizens.
Countries are focusing on their own vaccine development programs rather than collaborating to pool resources. Agreements are scarce to share vaccines when they’re available so front line health workers and those in COVID-19 hots spots internationally can have first access.
Further, as what happened in Australia shows, no matter what contracts may be in place, the country where a vaccine is manufactured could slap export restrictions on it to ensure its own population gets first dibs.
When it comes to creating vaccine, the United States has largely chosen to go it alone. It has declined to join international development efforts and instead cut advance deals worth billions of dollars with pharmaceutical and manufacturing companies for control of hundreds of millions of doses.
It’s a risky bet say experts.
“Many people naively assume it’s the United States that’s going to have (a vaccine) first, because we have several candidates. But that may not be how it goes,” said Amesh Adalja a senior scholar at the Johns Hopkins Center for Health Security.
Through the White House coronavirus effort, dubbed Operation Warp Speed the United States plans to invest in about seven candidate vaccines. That’s out of 21 vaccine candidates currently in clinical trials globally and another 139 in preclinical evaluation, according to the World Health Organization.
Any sharing efforts will only come after America’s needs are fulfilled, according to Operation Warp Speed officials.
“The vaccine and therapeutic candidates Operation Warp Speed has invested in are the candidates OWS believes to be the most promising. OWS will cooperate with all nations deemed friendly to our national security in order to develop safe and effective COVID-19 countermeasures,” a senior administration official said.
During the 2009 global H1N1 influenza pandemic, the United States pledged to share up to 10% of its vaccine supply with low and middle income countries on a rolling basis as supplies became available. It was one of nine nations that did so.
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The presidential election looming in November, however, could bring policy changes should the White House change hands. Presumed Democratic presidential nominee Joe Biden told a health care activist Wednesday he “absolutely positively” would commit to sharing technology and access to a coronavirus vaccine if the United States is the first across the finish line.
In any case, there is no certainty one of the U.S. candidate vaccines will make it there. By some estimates, vaccines that reach human clinical trials have a 17% chance of success said Kate Elder, senior vaccines policy advisor with the humanitarian group Doctors without Borders, which advocates for making vaccines affordable and accessible to all.
“That’s a huge failure rate,” she said.
Other nations are at least contemplating more collaborative approaches. The European Union is creating a European vaccines strategy in which members pool funding, research and manufacturing resources. Any resulting vaccines would be allocated to all members.
France, Germany, Italy and the Netherlands have created an “inclusive vaccine alliance” to pool vaccine development resources and secure vaccine supplies for Europe while also allowing fair access to the vaccine for all countries.
Another effort is the COVID-19 Global Vaccine Access Facility (Covax) launched by an international non-profit, GAVI The Vaccine Alliance. Focused on low- and middle-income countries, it allows nations to pool resources for research, production and advanced purchase agreements, with each getting a share of vaccines.
Still a work in progress, it launched in June and is meant to counteract vaccine nationalism and give poorer nations a seat at the vaccine table.
Gavi acknowledges it is normal for governments to want to protect their people but told USA TODAY “the fact is that we are not safe unless everybody is safe which is why it is so important that we tackle the issue of a vaccine against COVID-19 at a global level.”
“The benefits of a global approach is that, even those countries fortunate enough to have secured their own supply, are able to mitigate the risk to their populations by gaining access to the COVAX Facility, the world’s largest portfolio of vaccine candidates,” a GAVI spokesperson said.
Taking part in these types of global vaccine partnerships – which the United States has declined to do – would be a kind of insurance, said David Fidler, a senior fellow on global health a the Council on Foreign Relations.
“(It’s) buying into multiple candidate vaccines so you’d at least get part of the production if one or more of them works out,” he said.
Global health means vaccine sharing
Another issue is sharing.
To public health experts, nations in an ideal world would collaborate to create vaccines. As soon as one proved safe and effective the formula would be licensed to every facility with the capability of manufacturing it. The resulting doses would go first to front-line health care workers in virus hot spots around the world, then to health workers globally, then to the rest of the world’s population.
That is the best way to protect everyone, said Robbie Silverman, a senior advisor to Oxfam, an international anti-poverty organization based in the United Kingdom.
“This is a global pandemic. If the disease is located anywhere in the world, it will come back to the United States,” said Silverman, who works on health and inequity issues.
Public health experts acknowledge we do not live in an ideal world.
“It’s hard to see a politician saying, ‘Yup, let’s give 30% of our vaccine to countries in sub-Saharan Africa,’” said Fidler.
So far few countries outside of vaccine consortia have committed to sharing with less fortunate nations. It’s a tough sell, concedes Jason Schwartz, a professor of health policy at the Yale University School of Public Health.
“But that’s what global health is. It’s not just the right thing to do to help countries without resources. It also helps us,” he said.
The United States is not embracing that approach. In June, a senior U.S. official said the nation’s top priority is to get coronavirus vaccine to everyone in America who wants it.
“Let’s take care of Americans first. To the extent there is a surplus” excess vaccine could be used to make sure the rest of the world is vaccinated, the official said.
The same impetus caused the United States to buy up more than 90% of the world’s supply of remdesivir for the next three months. It’s one of the few proven treatment for COVID-19 and the purchase, announced July 1, left little for the rest of the world.
The U.S. isn’t the only country putting itself first. In the past six months more than 46 nations put export restrictions on medical supplies including masks, gloves, disinfectants and ventilators, according to Professor Simon Evenett, a professor of international trade at the University of St. Gallen in Switzerland and creator of the Global Trade Alert initiative, which tracks trade protectionism.
Such behavior, however, isn’t a good recipe for stopping COVID-19 public health experts say. As the World Health Organization puts it, “No one is safe until everyone is safe.”
The geopolitics of securing a vaccine
A final concern is that once a vaccine or vaccines become available, possession will become nine-tenths of the law. Countries where vaccine is manufactured may not let it out, no matter what contracts the manufacturers have with other nations.
Under international law, any nation has the sovereign right to seize private property for the public good. In the middle of a health emergency, seizing vaccine can be seen as exactly that, said Fidler.
“That’s not something any country can or would sign away in connection with vaccine development,” he said.
So even if a country had signed a contract to get a certain amount of vaccine being produced in another country, that country could seize it, in legal terms “expropriate” it.
“It’s not just a fear. It will happen,” said Sam Halabi, a law professor at the University of Missouri and expert on global health law. Not even the best-written contract can “blunt the geopolitics of the vaccine.”
The hope is that eventually those contracts will be honored, said Thomas Bollyky, director of the global health program at the Council on Foreign Relations.
For now, countries are jockeying for position, trying to best position themselves to get as much vaccine as possible as quickly as possible when one or more become available.
Any attempts to make vaccine distribution more equitable – and likely to stop the pandemic globally – need to happen now, he said.
“We’re running out of time,” he said. “Anything that focuses on allocating according to public health needs instead of the public purse will require some time to put together, and we’re running out of it.“
Contact Weise at [email protected]