Thursday, June 25, 2020

Who will get the Vaccines?

 Billions of dollars are flowing into research to develop a vaccine for COVID-19 and over 100 efforts are under way. But how will these vaccines reach the poorest people on the planet?

 Ask pharmaceutical corporations about how they will ensure access to Covid-19 vaccines, and they say “Gavi”. Ask the wealthiest governments in the world what they are doing to ensure global equity, and they too say “Gavi”.

Gavi, the Vaccines Alliance, is a 20-year old public-private partnership that believes the marriage of markets and philanthropy will bring vaccines to everyone in the world. At the Global Vaccine Summit held earlier this month, Gavi raised a record-breaking $8.8bn.   Gavi launched its newest initiative, a fund for future Covid-19 vaccines – the Covax Facility – which invites countries to invest in a wide portfolio of potential vaccines, pool their risk, and gain dedicated access to eventual products.

Pharmaceutical companies say they will make no money off the pandemic, that they will supply vaccines at a cost. Yet, they have already seen multibillion dollar increases in their market capitalisation, and are unwilling to relinquish the monopolies that drive their outsize profits. Leaders of rich countries (apart from the US) have said all the right things about equitable access to vaccines. Yet they are entering into multiple advance deals to stock up on possibly far more vaccines than they will ever need

The first deal – a US$750m agreement with AstraZeneca for 300 million doses of the potential Oxford University vaccine – was heralded as a commitment by industry to meet the needs of the world’s poorest countries. But it came at a high price, representing only a minor discount over the full price paid by the US government. The problem is, we know very little about this deal because the agreement isn’t public, despite all the public money involved. We don’t know if, for example, AstraZeneca gets to keep the money if its vaccine fails. We don’t even know for a fact that all the vaccines bought are intended for use in poor countries.

The World Health Organization’s forthcoming Global Allocation Framework will specify that the most vulnerable people in the world be given the vaccines first and in a fair and equitable way.  Yet, a report prepared for the Gavi board meeting that starts this week, and circulated ahead by Gavi to stakeholders, including civil society organisations, proposes that rich countries can ignore the WHO framework, with only poor countries having to abide by it. According to the document, it seems Gavi will allocate rich countries enough vaccines for a fixed percentage of their population, which their “national advisory bodies” will decide. Poor countries, meanwhile, will only get vaccines for their highest priority people, after demonstrating proof.

Rich countries are “encouraged (but not required)” to donate vaccines if they have more than they need, but we do not know when poor countries will get these donated vaccines: will it be at the same time as the rich countries, or only after they have used up all the vaccines they need? 

The prospect of a two-tiered system puts into question the fundamental issue that Gavi was founded to address: equitable access to vaccines.

Three decades of getting medicines and vaccines to poor people have revealed the problem and the solution: monopolies over vaccines in the pharmaceutical industry, enforced through patents which, when suspended, result in prices going down and supply going up. The rich countries and organisations who fund Gavi are equally culpable: the US, UK and EU have committed billions towards vaccine research, almost all of which has gone to private pharmaceutical companies – without any conditions to prevent them from monopolising their vaccines. All these countries have further stockpiled future vaccines by making direct deals with manufacturers, again without any access conditions whatsoever. At best, Gavi has failed at negotiating control over the vaccines it funds. At worst, it believes that pharmaceutical monopolies, which have thwarted equitable access, are somehow essential to achieving it.

Seth Berkley, the Gavi CEO, cannot claim to want “the world to come together” with “no barriers” while failing to tackle both rich country nationalism and pharmaceutical industry greed.

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