Try as you might, it was impossible not to draw parallels between the EU Commission-led Coronavirus Global Response earlier in May and the Eurovision song contest. Host, Ursula von der Leyen, the President of the European Commission, smiled radiantly throughout the three-hour online pledging marathon as one after another, prime ministers, presidents, ambassadors and royals pledged contributions towards the €7.5 billion target to fund the development and deployment of diagnostics, treatments and a vaccine. The event was peppered throughout with heart-warming talk of ‘solidarity’ ‘togetherness’ and ‘a world united.’
In the final few minutes, Mrs von der Leyen announced a pledge from Madonna of $1mn which took the total to €7.4bn, just shy of the target. “Today we can truly say the world is united against the Coronavirus. And the world will win,” she declared, as the event came to an end.
But behind the smiles, celebrity and all-in-this-togetherness, the cracks were already showing. China was represented, but by nobody more senior than its Ambassador to the EU, and representatives from the US, Russia and India were conspicuous by their absence. The almost-met-total was reached only thanks to the inclusion of money that had previously been donated, but at least there was the display of European-unity — something lacking in discussions happening elsewhere about bail-out funds. Of the €7.4bn pledged, €4bn will go towards finding a vaccine, seen by many as the ultimate exit strategy from a cycle of lock-downs.
Market mechanisms rarely work for vaccines; very few that look promising at the start actually make it onto the market. “Compared to other medications, they are not a goldmine. That is why there aren’t that many that are doing it,” Inge Johansen, a senior adviser at a Norwegian pharmaceutical industry umbrella organisation told Investigate Europe.
Recent outbreaks of Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV) were caused by coronaviruses, and there was always the possibility that one more virulent, such as Covid-19 would emerge. But research into developing a Coronavirus vaccine has been relatively limited.
Norway is also home to the Coalition for Epidemic Preparedness Innovations (CEPI), a partnership between governments, industry, and philanthropy set up in the wake of the 2014-16 Ebola outbreak, another miserably unprepared-for epidemic in West Africa and a forerunner to the current pandemic with people dying lonely deaths, and images of health workers in protective suits. ‘A vaccine that had been under development for more than a decade was not deployed until over a year into the epidemic,’ according to a statement on CEPI’s website. Had that vaccine been deployed earlier, it’s possible that many of the reported 11,000 plus deaths could have been avoided. Médecins sans Frontières (MSF) describes the role of CEPI as to ‘plug the gap that the pharmaceuticals left’ for future epidemics.
It is through CEPI that much of the funding for vaccine development, including Covid-19, is channelled. This money has been given by governments and philanthropic organisations such as the Bill and Melinda Gates Foundation.
A lot of public money is being put into research for a Covid-19 vaccine, but given the financial risk for the research and development for all vaccines, this is nothing new. Just how much is hard to track, says Viviana Galli, Coordinator at the Brussels-based European Alliance For Responsible R&D and Affordable Medicines. The lack of transparency is, she says, a problem: “Nobody really knows, except maybe for the companies that develop it, as the funds are not tracked in one coherent way. This and other pieces of information — such as the total cost of research — are not known by governments. This means they are blindfolded when they negotiate prices with the companies,” Galli told Investigate Europe.
Behind the smiles, celebrity and all-in-this-togetherness, the cracks were already showing. China was represented, but by nobody more senior than its Ambassador to the EU, and representatives from the US, Russia and India were conspicuous by their absence
This can result in the public paying twice, first for the development and then again for the drugs: “Big Pharma is double-dipping in taxpayers’ pockets for the medicines they sell us,” claims MSF, one of several organisations campaigning to make governments demand a much bigger return on the public money spent on research and development of medication, including vaccines.
Horizon 2020, the EU’s enormous research and innovation programme, allocates billions of taxpayer euros for medical research. In the pandemic, the EU has redirected funds to projects that specifically target the Coronavirus. Unlike money awarded through CEPI, much of the EU funding comes without an affordability clause.
This is the first time that the whole world needs a vaccine at the same time. The stakes could scarcely be higher, and with so much public money flooding into vaccine research, some think the pandemic is seen as a great business opportunity for drug giants. “The first company that develops a Covid-19 vaccine will have enormous bargaining power,” says Ancel La Santos at BEUC, the European Consumers’ Organisation. “Any company with a monopoly can easily ask a huge amount of money for the vaccine.”
Public health campaigners see Covid-19 as a historic opportunity to influence a system which is led by market forces rather than public health, describing the pandemic as a ‘wake-up call.’ In a letter to the EU sixty-one organisations stated: “It is high time for health needs to take priority over profit. The mistakes in responding to previous epidemics cannot be repeated.” They recommend: “Pro-public safeguards, such as transparency, regarding public contributions, accessibility and affordability clauses and non-exclusive licences for exploitation of end-result products.”
The public pay, so the public should also have a say, claims MSF: “If drug corporations are using research funded by our taxes, then we as the public should have a say in making sure that those medicines are affordable and accessible to everyone in need.”
A world war?
“This is like a world war, except in this case, we’re all on the same side”, wrote Bill Gates, on the Gates Foundation blog.
But are we?
The development of a vaccine is just the first step — what follows is the huge task of vaccine production that needs to be scaled quickly. Otherwise, according to John-Arne Røttingen, Coordinator of WHO’s global clinical trial of drugs against Covid-19, it might be “necessary to ration the vaccine, and states which are able to take control over production capacities might want to prioritise themselves.”
The track record on fair distribution of vaccines is not great. Looking back to the 2009 flu outbreak, there were commitments early on to donate a proportion of the vaccines to low-and-middle-income countries, but when it came down to it, many countries put their own populations first.
“When a vaccine is developed, there won’t be enough to meet demand from every country in the world. How are we going to ensure that the people who need this vaccine most get it first, no matter where they live?” asked Mark Jit, Professor of Vaccine Epidemiology at LSHTM and visiting professor at the School of Public Health, University of Hong Kong.
The unseemly scramble for PPE and medical equipment in the early days of the pandemic was more a case of every government for themselves than the display of ‘solidarity’ ‘togetherness’ and ‘a world united’ that Ursula von der Leyen hoped to rally.
“When a vaccine is developed, there won’t be enough to meet demand from every country in the world. How are we going to ensure that the people who need this vaccine most get it first, no matter where they live?”
If we do not want a repeat of what happened in 2009, we need to ensure that mechanisms are put in place today, and not wait until a vaccine becomes available. Products to prevent and treat Coronavirus patients should be global public goods, says Ellen ‘t Hoen, a Dutch medical activist and expert on intellectual property law. “Experience in previous pandemics shows that unless deliberate steps are taken, universal access will not happen,” she told Investigate Europe.
She strongly supports an idea from the government of Costa Rica, that the World Health Organisation (WHO) puts together a Covid-19 technology pool, encouraging companies to share patents and other necessary knowledge, so that intellectual property will not stand in the way of people getting a vaccine. The EU has taken the lead on this and is calling for all Covid drugs and vaccines to be shared equally, but countries with big pharmaceutical companies are pushing against open licensing, arguing that only through patents can prices be guaranteed that will offset the cost of research and development.
Even the most optimistic estimates put the development of a vaccine at around 18-months. That gives us the time to create a system for delivering vaccines that are health-led rather than profit-led and available and accessible to everyone everywhere.