PHM-Exch> Covid Vaccine: Theshort spring of solidarity

Tue Aug 18 00:15:51 PDT 2020

While official speeches emphasize international solidarity in containing
the corona pandemic, many countries are focusing on national solutions for
vaccine research.

>From Andreas Wulf (Medico Intl and PHM)

The Russian government is playing at full risk. The first nationally
approved vaccine Sputnik 5 against the Corona virus has immediately
attracted strong international criticism, as no transparent data have been
made public and the relevant phase 3 studies have only just begun[1]
<#_ftn1>. Nobody knows whether this "Sputnik moment" for Putin will not
turn into a "Challenger Disaster" if the vaccine turns out to be less
effective or has even dangerous side effects. But at the same time
countries are already queuing up to test and use this vaccine, the
Philippine President Duterte wants to be the first to test it and if it
works for him, it will be good for the whole country[2] <#_ftn2>.

This development of a vaccine nationalism can be seen as a counterpoint to
the brief 'spring of solidarity' when, on 4 May, the WHO and the European
Commission called with great fanfare for joint global fundraising for the
fight against the coronavirus. An impressive 15.9 billion euros were raised
until today, almost half of which was contributed by "Team Europe" - the
European Commission, the EU member states and the European Investment Bank
[3] <#_ftn3>. The event was also memorable because Emmanuel Macron and
Angela Merkel designated a coronavirus vaccine as a "global public good".
And EU Commission President Ursula von der Leyen stressed that "governments
and global health organisations are pulling together in the fight against
the coronavirus".

*International solidarity?*

It sounded as if solidarity was written in capital letters. Already in
April, the WHO presented its "Access to COVID-19 Tools (ACT) Accelerator"[4]
<#_ftn4>, an ambitious structure with the most important global health
partnerships, in which the development of vaccines, drugs and diagnostics
as well as their procurement and distribution were to be accelerated and
coordinated. This should also help prevent a deja-vu of the experience with
the H1N1 influenza pandemic in 2009: There should not be a repeat of the
race for access to the vaccine, with the rich countries winning out while
the poorer countries are supplied with "humanitarian crumbles" by the WHO.

The U.S. government left this seemingly global alliance early on by
publicly launching a national ambitious vaccine program for local
pharmaceutical companies. Operation Warp Speed, which is worth ten billion
US dollars, is to develop and produce hundreds of millions of vaccine doses
by January 2021 at the latest, primarily for its own use, but also for the
rest of the world. But the USA is not the only country that is distancing
itself from the ACT Accelerator. Neither the Russian government with its
Sputnik 5 nor the Chinese government, which also promise an early success
of their own vaccine developments[5] <#_ftn5>, have joined the WHO's
Accelerator Initiative so far. India is also holding back, which is all the
more momentous because Indian vaccine production is currently the most
important in the Global South.

*Who is closest to himself*

So the full-bodied invocation of global solidarity lasted only briefly. And
with every further announcement of a promising vaccine candidate, the
façade continues to crumble. For it is becoming increasingly clear that
global production capacities are also limited and may not be able to be
increased as quickly. This is exactly what the WHO initiative wants to
prevent. Not only the US government, also the "Inclusive Vaccine Alliance
of Germany, France, Italy and the Netherlands", for example, has made its
own deals with pharmaceutical companies for purchase guarantees and
delivery quantities for successful vaccine candidates. The EU Commission
has taken over the current negotiations with Sanofi-GSK[6] <#_ftn6>.
Politicians like von der Leyen like to use phrases like "nobody is safe
until everyone is safe". But when it comes to getting out of the social and
economic crisis as quickly as possible, their own citizens are still a
little closer than the world community.

And so the COVAX Facility, the vaccine pillar within the ACT Accelerator,
which is organized by the WHO together with the Global Alliance for
Vaccines and Immunisation (GAVI) and the Coalition for Epidemic
Preparedness Innovations (CEPI), is making little progress towards a global
"buying and distribution pooling mechanism" for effective Covid19 vaccines.
COVAX is currently focusing on a portfolio of nine vaccine candidates from
different vaccine classes (DNA/mRNA; viral vectors, proteins). Through
agreements with research institutions and companies that will produce the
vaccines in the USA, Europe, China and Australia, the risk of having backed
the wrong horse in the end is to be minimized. In addition, this
multinational cooperation is intended to ensure that a promising product is
ultimately cheaper than if individual countries negotiate with
manufacturers alone. The experience of the Global Fund in the pooled
procurement of AIDS / TB /Malaria drugs is the inspiration here.

As a sign of global solidarity in the Covid19 crisis, the COVAX Facility
aims to support the financially weakest countries with funds from global
and national development budgets in the procurement of the vaccine. So far,
however, no financial commitments have been made. And among the 75
countries that have at least signalled a possible participation in the
budgets, most of the financially strong countries with their own vaccine
production capacities are missing - in Europe, for example, the
heavyweights France, Italy, Great Britain and Germany[7] <#_ftn7> .

*Priority supply*

But even in the COVAX Facility, not all countries would be equal. The plan
for the global distribution of a vaccine envisages, as a first step, the
simultaneous supply for 3% of the population in every country, which should
mainly include "indispensable key persons", i.e. health, nursing and other
professionals, in a first step... Subsequently, in further tranches, 20
percent of the respective populations are to be provided with the vaccine,
with particular attention being paid to risk groups such as the elderly and
the chronically ill. However, "self-paying countries" are already granted
priority supply in this second procurement round, while countries dependent
on aid funds must wait until corresponding quantities can be produced and
paid for. On the way to a population-wide supply, the differences in
availability are widening more and more.

It is also unclear whether GAVI actually has the authority to negotiate
successfully with the pharmaceutical companies. There has been and still is
great criticism of the fact that the manufacturers are also represented
with a seat and vote on the GAVI board. Experience from the price and
supply negotiations for the pneumococcal vaccines - GAVI's flagship project
- raises doubts: even after years, there is no real price competition
between the few manufacturers; the profits are enormous[8] <#_ftn8>.

*Selfishness also harms the rich countries*

Sothe  COVAX Facility is anyway only a model of "Solidarity light". But
even for this one, six months after the beginning of the pandemic, there is
no sufficient global support. Instead, competition and mutual accusations
are intensifying. US and British governments are accusing Russia and China
of stealing vaccine data. It may be convenient for the European states to
point the finger at the US president and his "America first" policy.
However, they do not want to be reminded that they are not honouring their
own commitments. It is to be expected that the selfish impulses in the
fight against the pandemic will hinder the longer-term strategy also for
the technologically advanced states. This is because the production and
supply chains have long since been globalized, even in vaccine production -
even states such as the USA are dependent on secure trade and supply
contracts. And even if a country could protect itself, it remains dependent
on the world with its sales markets and suppliers. If there were an "Island
of the Blessed", it would also suffer from a prolonged global recession and
a continuing pandemic[9] <#_ftn9>.

At the beginning of August, WHO Director-General Dr. Tedros emphasized once
again that in all probability there would be no "silver bullet", i.e. a
vaccine that is one hundred percent effective in all people[10] <#_ftn10>.
This is one of the reasons why it would be in the "enlightened
self-interest" of all players to consistently rely on cooperation. The fact
that the German government is not involved in either the COVAX initiative
or the Covid19 Technology Patent Pool for the global benefit of health
knowledge shows how questionable the role of a self-proclaimed "Global
Health Champion" is.

------------------------------

[1] <#_ftnref1>
https://www.themoscowtimes.com/2020/08/12/russias-covid-19-vaccine-breaches-crucial-scientific-and-ethical-international-standards-a71121

[2] <#_ftnref2>
https://www.dw.com/en/philippines-duterte-volunteers-to-be-putins-coronavirus-vaccine-guinea-pig/a-54523030

[3] <#_ftnref3> https://global-response.europa.eu/index_de

[4] <#_ftnref4>  https://www.who.int/initiatives/act-accelerator

[5] <#_ftnref5>
https://www.nytimes.com/2020/08/02/world/europe/russia-trials-vaccine-October.html
; https://www.nature.com/articles/d41586-020-02244-1

[6] <#_ftnref6>
https://ec.europa.eu/commission/presscorner/detail/en/ip_20_1439

[7] <#_ftnref7>
https://www.who.int/news-room/detail/15-07-2020-more-than-150-countries-engaged-in-covid-19-vaccine-global-access-facility

[8] <#_ftnref8>
https://msfaccess.org/analysis-and-critique-advance-market-commitment-amc-pneumococcal-conjugate-vaccines

[9] <#_ftnref9>
https://www.foreignaffairs.com/articles/united-states/2020-07-27/vaccine-nationalism-pandemic

[10] <#_ftnref10>
https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-august-2020
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