Protecting the world: global access to COVID-19 vaccines
The threat of vaccine nationalism and the forces working against it
Biopharmaceutical companies and academic scientists around the world have set aside commercial and professional rivalries to collaborate on the development of vaccines to protect against COVID-19.
Technologies that have been slowly advancing for a decade or more have been propelled into clinical trials in what is by far the fastest vaccine R&D progress ever achieved.
Governments and philanthropic organizations are investing billions of dollars in the largest at-risk manufacturing project since the Manhattan Project, with the goal of having large quantities of vaccines on hand the moment regulators give the go-ahead for emergency use.
While the pandemic is global, the largest attempts to tame it are being undertaken by national or regional governments that have a primary responsibility to protect their own populations.
This raises the specter of vaccine nationalism.
A coalition has come together to try to head off a scenario in which billions of people in poor countries are kept waiting.
The U.S. organized faster and at a far larger scale than the rest of the world to create at-risk COVID-19 manufacturing capacity. It has launched an organization, Operation Warp Speed, that combines the expertise and resources of the world’s largest pandemic countermeasures funding agency, BARDA, with the largest biomedical research funder, NIH, with the logistics and planning capabilities of the U.S. military (see “Operation Warp Speed Takes First Step”).
Operation Warp Speed’s work is supported by an NIH-led public-private partnership, Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV), that is conducting preclinical research on vaccine candidates and creating harmonized clinical trial protocols (see “ACTIV Coming into Focus”).
While Operation Warp Speed and ACTIV are aiming to create vaccines that could be used globally, the U.S. government has made it clear that they are first and foremost intended to protect the U.S. population. Senior Trump administration officials have said that only after every U.S. resident who wants protection has access to a vaccine will the fruits of Operation Warp Speed be exported to the rest of the world (see “Path to 300M Doses by January”).
The EU has mobilized more slowly but is putting place initiatives that are designed to achieve results similar to those of Operation Warp Speed. This week the EU announced that it will make advance purchase commitments of COVID-19 vaccines. Just as the U.S. will only fund vaccine development programs with U.S.-based manufacturing, the EU is restricting advanced purchases to vaccines manufactured in the EU (see “EU Lays Out Strategy”).
Individual European countries are investing in domestic COVID-19 R&D and manufacturing, including a €300 million ($337.3 million) investment by the German government in CureVac AG, and groups of EU countries are banding together to purchase vaccines for their populations (see “Germany Takes €300 Stake in CureVac”; “Four EU Countries Secure Access to Oxford Vaccine”).
While EU governments have made commitments to global equitable distribution of vaccines, in many cases these commitments are vague and do not come close to assuring that people living in Africa, South America, or much of Asia will be able to gain access on a timely basis.
China, which has a robust COVID-19 vaccine development program, has not publicly disclosed its plans for prioritizing access to vaccines if and when safety and efficacy have been demonstrated (see “China Emerging as a Leader in COVID-19 Vaccines”; “World Leaders -- Except U.S. and China -- Commit to Collaborate”).
An informal coalition of global health funders, foundations and international organizations has come together to try to head off a scenario in which billions of people in poor countries are kept waiting and at risk of infection until people living in countries that have procured COVID-19 vaccines are protected.
On the R&D side of the equation, the Coalition for Epidemic Preparedness Innovations (CEPI), which makes commitment to global equitable access a condition for funding, is providing support to nine COVID-19 vaccine development programs, and it is considering investing in a tenth (see “CEPI’s Biggest Ever Award”; “Three CEPI-funded vaccines”).
Some of the early CEPI investments have been picked up by the U.S. government, including vaccines from Moderna Inc. (NASDAQ:MRNA), Novavax Inc. (NASDAQ:NVAX) and AstraZeneca plc (LSE:AZN; NYSE:AZN).
CEPI is part of a global initiative, COVID-19 Vaccine Global Access (COVAX) Facility, that is creating two funding mechanisms that have the goal of purchasing over 15 billion doses of COVID-19 vaccines over six years and ensuring that priority populations around the world have access to the vaccines (see “COVAX Created to Try to Avoid Global Bidding Frenzy”).
The World Economic Forum is leading the establishment of a consortium, the Manufacturers Alliance for Global Equitable Access to Coronavirus Vaccines (Manage-Cov), that is intended to complement COVAX by bringing the capabilities of contract manufacturers in developing countries into the fight against COVID-19 (see “World Economic Forum Creating Consortium to Expand Manufacturing”).