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After a COVID-19 Vaccine: Collaboration Or Competition?

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After a COVID-19 Vaccine: Collaboration Or Competition? Entry Point nations like the US move to lock up fu- ture supplies of experimental COVID-19 vaccines through individual deals with manufacturers even as other countries pool their resources to develop and eq- uitably distribute vaccines through the World Health Organization (WHO)– sponsored COVID-19 Vaccine Global Ac- cess Facility (COVAX).1,2 Experts discussed these unprecedent- ed opportunities and challenges at a Health Affairs online symposium, “Pro- moting Innovation and Equity as COVID- 19 Vaccines and Treatment Emerge,” presented August 24, 2020. There was excitement among the speakers about the rapid, pandemic- driven advances in science, clinical trial, and regulatory processes and collabora- tions among governments, manufac- turers, and nongovernmental organiza- tions that could improve global health in the future. But there were deep concerns about whether the US, China, and other countries will be able to transcend na- tionalist rivalries to defeat their com- Vaccine: Volunteer Melissa Harting, from Harpersville, New York, receives a COVID-19 vaccine mon viral foe and whether profit incen- injection from nurse Kathe Olmstead. Harting is participating in the world’s largest study of a possible COVID-19 vaccine, developed by the National Institutes of Health and Moderna Inc. tives will get in the way. “We can choose to collaborate and bring the world back to health equitably, doi: 10.1377/hlthaff.2020.01732 or we can compete and exacerbate in- equities,” Orin Levine, director of Glob- al Delivery Programs at the Bill & After A COVID-19 Vaccine: Melinda Gates Foundation, said in his opening remarks. “A moment is coming soon when we have a breakthrough on a Collaboration Or lifesaving vaccine. Then humanity will Competition? be tested on the question of equity.” ‘Missed Opportunity’ As COVID-19 vaccines and therapies emerge, critical questions remain On September 1, 2020, a White House about access and affordability around the world. spokesperson said that the US would not BY HARRIS MEYER join COVAX to develop and equitably distribute a vaccine because the effort is “influenced by the corrupt World Health Organization and China.”3 ffective international col- livery. Alternatively, lack of cooperation Meanwhile, Germany, Japan, and the laboration not only could and coordination by governments, non- European Commission have announced end the coronavirus disease governmental organizations, and man- their participation, although the terms of 2019 (COVID-19) pandemic ufacturers could prolong the pandemic, their cooperation remain undisclosed. and restore the global econ- producing an outcome where more peo- A total of seventy-eight higher-income Eomy but also could lead to revolutionary ple die and economic devastation con- countries and ninety-two lower-income improvements in vaccine and therapeu- tinues indefinitely. countries have expressed interest in par- tic drug development, drug regulation, Those sharply different scenarios ticipating, according to Gavi, the Vac- clinical trial design, and health care de- both remain possible as some wealthy cine Alliance, which co-leads COVAX Photograph by AP Photo/Hans Pennink November 2020 39:11 Health Affairs 1 Downloaded from HealthAffairs.org on September 28, 2020. Copyright Project HOPE—The People-to-People Health Foundation, Inc. For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org. Entry Point with the WHO and the Coalition for Epi- trials, with a pledge to buy those that the symposium, said in an interview. demic Preparedness Innovations (CEPI) prove effective. The nine candidates In a new paper, Yamey and several (Gavi spokesperson, personal commu- include vaccines being developed by Duke colleagues urge that such deals nication, September 16, 2020). Coun- Moderna, AstraZeneca, Inovio, and include provisions to promote the shar- tries had until September 18 to make a Novavax. ing of data and technology with other binding legal commitment—a date that One of those potential vaccines, devel- manufacturers and countries, enabling was pushed back from the original Au- oped by AstraZeneca and the University others to rapidly produce and distribute gust 31 deadline. of Oxford, suffered a setback in early effective vaccines throughout the Resistance from wealthy nations re- September when Phase III trials in the world.11 portedly forced the COVAX sponsors US were put on hold because of a sus- “There are dramatic opportunities for to redesign the program and delay the pected serious adverse reaction to the all to win, and also dramatic opportuni- deadlines. Among the changes made is a product by a participant in the United ties for all to lose,” said David McAdams, more flexible payment model enabling Kingdom.7 Although the hold could be an economics professor at Duke who countries to opt out of vaccines they al- temporary, it may delay efficacy results coauthored the paper. ready have acquired through individual as trials of other candidates race ahead. purchase deals and to trade any excess An additional nine candidate vaccines ‘The Same Access Questions’ vaccines from their own deals through a are being evaluated for inclusion by Food and Drug Administration (FDA) COVAX exchange platform.4 COVAX. Governments, vaccine manu- Commissioner Stephen Hahn recently Many public health experts lamented facturers, other organizations, and indi- said that he will consider granting emer- the Trump administration’s decision viduals have committed $1.4 billion to- gency authorization for a COVID-19 vac- not to join COVAX, which some criti- ward vaccine research and development cine even before clinical trials have been cized as vaccine nationalism. “If COVID so far, but an additional $1 billion is completed if the benefits outweigh the has taught us anything, it’s that we’re all needed to move the research and devel- risks. “This is going to be a science, med- interdependent,” Nicole Lurie, a CEPI opment portfolio forward, according to icine, data decision,” Hahn recently told strategic adviser and former Depart- the WHO. the Financial Times, even though he pre- ment of Health and Human Services as- At the same time, wealthy nations viously acknowledged he is under pres- sistant secretary who spoke at the sym- have struck their own deals with manu- sure to deploy a vaccine as fast as possi- posium, said in an emailed comment. facturers to develop and purchase ble. “This is not going to be a political “This is a huge missed opportunity to COVID-19 vaccine candidates should decision.”12 change the way the world works togeth- they be approved, potentially locking Robert Redfield, director of the Cen- er to respond to pandemics.” up billions of doses. The Trump admin- ters for Disease Control and Prevention The COVAX initiative grew out of the istration’s Operation Warp Speed initia- (CDC), recently urged states to get their world’s experience in dealing with the tive has reached deals for at least seven vaccine distribution sites ready by No- H1N1 influenza pandemic in 2009, candidates in various stages of develop- vember 1.13 State and local officials say when the US delayed for months in shar- ment, including products being devel- that will be a daunting challenge, given ing with less wealthy nations the vaccine oped by Moderna and Pfizer that are vaccine cold storage requirements, lack it had developed to combat that virus.5 in Phase III clinical trials in the US.8 of vaccine administration tracking The initiative’s approach is for wealth- The European Commission, negotiat- tools, public health departments’ limit- ier countries to provide up-front fund- ing on behalf of all twenty-seven Euro- ed staffing and resources, and other lo- ing and purchasing guarantees to a pean Union states, has agreed to buy at gistical issues.14 range of COVID-19 vaccine developers least 300 million doses of AstraZeneca’s Vaccines are hardly the only tough is- with the stated goal of guaranteeing potential vaccine, with an option to buy sue. Symposium speakers stressed the all countries enough doses of proven an additional 100 million doses. That importance of rapidly testing and pro- vaccines to inoculate at least 20 percent product has just started Phase III trials ducing therapeutic products for COVID- of their populations.2 Advocates claim in the US.9 19 and making them affordable for peo- that everyone wins: Wealthier countries In total, the US, the European Union, ple all over the world. There are 184 get the promise of guaranteed access to a Japan, and the United Kingdom have treatments for COVID-19 in clinical tri- broader pool of potentially effective vac- agreed to buy more than three billion als, as well as forty-three antiviral prod- cines, and the entire world’s population doses of various vaccine candidates, ucts in trials, according to the Biotech- gets vaccinated, enabling the global whereas China and India, which are nology Innovation Organization, a economy to reopen. working on their own vaccines, likely pharmaceutical industry trade group. “With infectious disease, no one is will keep much of their production for Many of the COVID-19 therapeutics safe until everyone is safe,” Seth their own populations.10 in development are monoclonal anti- Berkley, Gavi’s chief executive officer, “If these giant bilateral deals result in bodies—biologically derived treatments wrote in July 2020.6 hundreds of millions of doses being that can cost more than $100,000 a year. COVAX currently is providing re- hoarded by rich countries, that’s a threat Previously approved monoclonal anti- search, development, and manufactur- to achieving global herd immunity,” body treatments for other diseases, such ing funding for nine candidate vaccines, Gavin Mark Yamey, a professor of global as for rheumatoid arthritis, are largely seven of which are now are in clinical health at Duke University who spoke at unavailable in poorer countries and 2 Health Affairs November 2020 39:11 Downloaded from HealthAffairs.org on September 28, 2020. Copyright Project HOPE—The People-to-People Health Foundation, Inc.
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