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The ultimate geopolitical game — distributing a coronavirus vaccine

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Who will get the coronavirus vaccine first? All the lofty rhetoric aside, geopolitics and money talks.

Its not purely about protecting a populations health. As many experts see it, a vaccine is also a vital in getting economies back on track.

World leaders know this, and its causing wealthy countries to snap up hundreds of millions of doses of pre-ordered potential vaccines, hedging their bets that one of the front-runners theyve chosen will be successful.

Suerie Moon, co-director of the Graduate Institute Genevas Global Health Centre, calls these candidates “strategic assets” on par with “military weapons.” Having access to a vaccine is a chance to strengthen a countrys allegiances, political standing and prestige, she noted.

Even before a single vaccine has been produced, deals worth hundreds of millions or even billions of euros have already been done.

“Industry definitely should not just be making deals with the first high-income country that has a lot of money” — Doctors Without Borders senior vaccines policy adviser

The U.K. has secured up to 30 million doses of a potential vaccine created by BioNTech and Pfizer, has a separate deal with AstraZeneca for 100 million doses of its vaccine, and another deal with GSK and Sanofi Pasteur for 60 million doses. AstraZeneca also has a contract with four EU countries — the Netherlands, Germany, France and Italy — to buy 400 million doses.

Not one to be outdone, the U.S. has three deals agreed, one with BioNTech and Pfizer (worth nearly $2 billion) for 600 million doses, another with AstraZeneca for 300 million doses and a third with Novavax for 100 million doses.

But this rich-country scramble is “disastrous at the international level,” said Moon.

“It means that there will be very, very little vaccine available for the rest of the world and for countries that either dont have the money or the production capacity within their own borders to access the vaccine,” she said.

In the first year after a vaccine is found, there just wont be enough doses to go around, said Charlie Weller, head of the Wellcome Trusts vaccine program.

“Therefore the mechanisms to allocate scarce resources fairly are going to become absolutely critical,” she said.

The vehicle to organize this effort is the COVID-19 Global Vaccine Access Facility — known as COVAX — which serves as a purchasing pool. The idea is to prevent a repeat of the mad dash in 2009 to secure the swine flu vaccine, which resulted in high-income countries commandeering the lions share, leaving poorer countries far down the queue.

Pharma in the middle

Big Pharma is hyper-aware that the world could see this happen again.

Thomas Cueni, director general of IFPMA, warned that industry might be caught in the middle between governments wanting their country to receive the vaccine first and global access initiatives attempting to ensure equitable distribution.

“We do not want to run that risk,” he said at a Chatham House event on July 22. “Thats why we are fully committed to the COVAX Facility.”

“But in terms of getting support for the facility, you need solidarity from richer countries willing to subsidize the poorer countries,” he added.

The Chris Hani Baragwanath Hospital in Soweto, South Africa | Luca Sola/AFP via Getty Images

However, Doctors Without Borders senior vaccines policy adviser, Kate Elder, thinks that industry shouldnt be automatically released from responsibility.

“Industry definitely should not just be making deals with the first high-income country that has a lot of money to come in and negotiate with them,” she said. Elder conceded, however, that Big Pharma seems to have shifted its stance in the pandemic, with some vaccine-makers promising “not for profit” vaccines.

For now, promises of so-called solidarity from richer countries have been forthcoming. German Chancellor Angela Merkel has described a future vaccine as a “public health good for all humanity,” while European Commission President Ursula von der Leyen says the vaccine must be deployed at an affordable price to “every single corner of the world.”

French President Emmanuel Macron has made similar declarations, saying at the Global Vaccine Summit that when a vaccine is discovered, it must benefit everyone “because it will be a global public good.”

The U.K. has agreed several bilateral deals with drugmakers in which the precise terms are secret.

Elder said these messages are unprecedented.

“We have never seen so many heads of state, standing up and saying these are going to be global public goods … [that] this is going to be the peoples vaccine,” she said.

James Love, director of Knowledge Ecology International, is more skeptical.

The follow-through from these warm words “has been a lack of transparency and a lot of secret deals,” he warned. “[In a] lot of cases this is considered a national security issue by some countries, and so its very hard to get transparency.”

The U.K., for example, has agreed several bilateral deals with drugmakers in which the precise terms are secret.

However, Health Secretary Matt Hancock insisted to the U.K. parliament on July 20 that the U.K. is “working to ensure that whoevers vaccine is approved first, the whole world can have access.”

The Stabilitech laboratory in Burgess Hill south east, England | Ben Stansall/AFP via Getty Images

“We reject narrow nationalism,” he said. “We support a global effort, because this virus respects no borders, and we are all on the same side.”

But there is one caveat: The U.K. is covered first.

“Naturally Im determined to ensure that there is enough vaccine for the whole U.K. population, first and foremost,” Hancock told MPs the next day. “I am after all the U.K. secretary of state for health and social care.”

For Elder, this kind of talk is “almost like trying to have your cake and eat it too.”

At the moment, she noted, its unclear whether serving your own population and participating in a global solution are mutually exclusive.

“But … in a global context of scarcity of supply of future medical tools and vaccines that everybody needs, there might be some elements that indeed are mutually exclusive,” she said. “You cant do both things sufficiently.”

Export bans

In fact, it may prove surprisingly easy to keep a British-made vaccine in the country — simply by implementing an export restriction.

Europes fondness for banning exports of goods that are considered necessary for public health was illustrated at the beginning of the pandemic, when Germany and France scrambled to keep vital personal protective equipment within their borders, while the EU banned exports outside the bloc.

For his part, Hancock hasnt yet threatened an export ban. Instead, he has justified keeping a vaccine in the U.K. by claiming that once a vaccine is found, it can be manufactured and distributed to anyone.

Scientists at an Uni-pharma lab in Athens | Louisa Gouliamaki/AFP via Getty Images

“The point of a vaccine is that once youve got the blueprint, lots of people around the world can manufacture it, and we dont want to stand in the way of that,” he claimed on July 21.

Except Hancock seems to have forgotten about one small issue — intellectual property, something fiercely guarded by Big Pharma.

Its the issue that Love has been battling Big Pharma over for more than 25 years.

Love believes that if anyone has a vaccine that could work, “they should start the technology transfer right now to other companies that have the capacity to manufacture that vaccine.”

The more manufacturers have capacity, the more quickly the vaccines can be made, which in turn makes it easier to get large quantities cheaply to more people, explained Love. “But that has not been the path that governments have really embraced adequately,” he said.

Whats the alternative?

The problem, explained Moon, is that there isnt a global entity that has both the power and authority to enforce a workable system to equitably distribute a vaccine.

The COVAX facility is attempting to do this, but participation is voluntary. Designed by Gavi, the Vaccines Alliance, CEPI, and the World Health Organization, the facility aims to ensure quick and equitable access to 2 billion doses of a future vaccine by agreeing advance purchase deals with drugmakers. Wealthy countries would pay for any future doses through their own coffers while donating to the facility to ensure that up to 90 lower-incomeRead More – Source

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