COVID19 - Can the Market Bring the Cure?

Jane Halton is a former secretary of Australia’s health and finance departments, is chair of the coalition for epidemic preparedness innovations, a global body playing a critical role in financing and coordinating Covid-19 vaccine development.

The question she and  her team come back to time and again is when the successful vaccines emerge, what can be done to ensure they don’t simply go to those with the deepest pockets? If market power is allowed to dictate access, how can those most vulnerable to Covid-19 be assured of protection?

“We are acutely aware of this and it is literally a topic that is being discussed on a daily basis,” she tells the Guardian. “Because to us it is just unacceptable that there is not fair access to a successful vaccine across the world’s population. “The notion that this would be a question of going to the highest bidder, to us is just totally unacceptable.”

A paper published in the Lancet last month warned of the significant prospect that wealthy countries would monopolise global supply of Covid-19 vaccines.

“This risk is real,” the paper warned. “Such an outcome would result in a suboptimal allocation of an initially scarce resource.”

The world has witnessed what happens when the market is left to dictate vaccine distribution. During the H1N1 pandemic in 2009, wealthy nations negotiated large advance orders of the vaccine, effectively crowding out poorer countries.

The West African ebola crisis – an outbreak that killed
11,325 people – exposed its own galling market failure. As the death toll in West Africa grew and grew, big pharmaceuticals could not see a way to recoup the considerable losses they would face attempting to find a vaccine.

The leader of Britain’s ebola response, Adrian Hill, said there was simply no “big market” to make it worthwhile for massive corporations.

“There was no business case to make an ebola vaccine for the people who needed it most,” he said.

The coalition for epidemic preparedness innovations explained at the time , “The world’s response to this crisis fell tragically short. A vaccine that had been under development for more than a decade was not deployed until over a year into the epidemic. That vaccine was shown to be 100% effective, suggesting that much of the epidemic could have been prevented. It was evident that we needed a better system to speed the development of vaccines against known epidemic threats.”

Halton predicts the pressure to secure access to successful vaccines will be “astronomical”.

“One of the things I’m worried about is vaccine nationalism and I’ve started to use that terminology when I talk to people,” she says. “We’ve been worrying about this issue now for months and months...What is a mechanism to ensure equitable access?”

For private companies, vaccine development is considered risky, protracted and hugely expensive. Companies are faced with the prospect of spending extraordinary amounts to develop vaccines, with a low likelihood of success.

“As a company, you are not going to spend the hundreds of millions and sometimes billions of dollars that are needed to develop a vaccine,” Halton says. “One, because you think your chances of being successful are about 5%. Secondly, because you don’t even think there’s going to be a market for it. So this part of market failure is completely understandable. And that’s why the coalition for epidemic preparedness innovations was set up.”

The World Health Organisation announced it planned to design mechanisms to ensure equitable distribution.

“While we’re looking for vaccines, unless we break the barriers to equitable distribution of the products, whether it’s vaccines or therapeutics, we will have a problem, so we need to address the problem ahead of time,” WHO’s director general, Tedros Adhanom Ghebreyesus, said. “There should not be a divide between the haves and the have-nots.”