Coronavirus exit strategy depends on getting vaccine to whole world

By James Paton

Coming up with a vaccine to halt Covid-19 in a matter of months isn’t the only colossal challenge. The next big test: getting billions of doses to every corner of the world at a time when countries increasingly are putting their own interests first.

A variety of financing tools are under consideration to spur production of large quantities of potential vaccines and ensure they’re distributed equitably. In one arrangement, developers would agree to provide shots at affordable prices in return for funding commitments from governments or other donors.

The stakes are immense with the coronavirus sickening more than 3 million people, even as billions hide from the pathogen indoors. Health advocates are concerned about richer countries monopolizing the global supply of Covid-19 vaccines if companies succeed, a scenario that played out during the 2009 swine flu pandemic. Distributing shots widely, they say, isn’t just the right thing to do. It’s also crucial in curbing the spread of the contagion.

“There’s a lot of awareness of the potential injustice and inequity ahead,” said Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health. “There’s been less awareness of the critical notion that you actually need to allocate the vaccine in a way that makes public-health sense.”

Lack of access to vital drugs and vaccines is a perennial issue for the world’s poor. More than two decades ago, the high price of HIV drugs sparked an outcry as millions in Africa and other regions who couldn’t afford them died, leading much later to programs to help those populations.

With Covid-19, the worry is that wealthy countries will put their own interests ahead of global unity. French President Emmanuel Macron and German Chancellor Angela Merkel last week joined the World Health Organization in calling for fair distribution of vaccines.

“It has the potential to get very ugly,” said Michael Kinch, a vaccine specialist and associate vice chancellor at Washington University in St. Louis. “There’s going to be a lag between when we have a vaccine and when we have the ability to protect 7 billion people.”

Still, he said, “there are ways of heading it off,” such as creating manufacturing facilities all around the world. The Coalition for Epidemic Preparedness Innovations, an Oslo-based group that’s funding a number of experimental coronavirus vaccines, has said that’s the goal.

The coalition sees promise in so-called advance market commitments, according to Chief Executive Officer Richard Hatchett. In that type of program, donors promise funds to guarantee the price of vaccines once they have been developed. CEPI is talking with other organizations including the World Bank, which is exploring how to set up such agreements, he said.

“The virus does not respect borders and it cuts across all classes of society, and all age groups,” Hatchett said. “There really does seem to be a rapidly evolving consensus around the importance of delivering a vaccine globally to all countries as quickly as it can become available.”

Gavi, the Vaccine Alliance, a group that works to prevent disease in poor countries, established a similar arrangement to tackle Ebola in Africa. The nonprofit signed an advance purchase commitment with Merck & Co., creating a stockpile of doses used in the Democratic Republic of Congo. Merck initially agreed to provide 300,000 doses of the vaccine available for use in expanded clinical trials or on an emergency basis while development continued.

In an agreement with Gavi a decade ago, Pfizer Inc. and GlaxoSmithKline Plc slashed the price of their pneumonia vaccines by up to 90% in developing nations, each committing to supply 30 million doses a year over a decade.

Manufacturing and supplying vaccines to meet global demand is expected to be an unprecedented mobilization, according to Joe Cerrell, managing director of global policy and advocacy at the Bill & Melinda Gates Foundation. The cost to secure the doses needed could be as much as $25 billion, he estimated.

“Time is not on our side,” he said by phone. “We don’t have a year or so to figure this out.”

The International Finance Facility for Immunization, which raises money to purchase and deliver vaccines by selling bonds, is another option that could work with Covid-19, Cerrell said. The group funds programs through Gavi.

Those kinds of tools are “innovative mechanisms for taking long-term pledges and turning them into front-loaded cash,” Duke’s Yamey said. “We’re going to need large amounts of money now.”

Dozens of companies, including Sanofi, Johnson & Johnson and Moderna Inc., are in the race to come up with a vaccine, along with researchers at institutions ranging from the University of Oxford to the University of Queensland in Australia.

One of the biggest companies in the hunt, London-based Glaxo, is talking with governments on the issue of supply, according to Chief Executive Officer Emma Walmsley.

“We do think this needs to be a global approach,” she told reporters. “We’re expecting those conversations to go on in parallel and ahead of data concluding, and we’re looking forward to collaborating with governments to be part of the solution.”

While a vaccine is a crucial part of the exit strategy, the world lacks a global system for managing distribution in a crisis, said Gayle Smith, who leads the ONE Campaign, an advocacy group. During the flu pandemic more than a decade ago, wealthy nations secured the bulk of the supply before later moving to try to allocate shots to the rest of the world, she told reporters this week.

It’s important a vaccine is “available equitably and equally everywhere,” she said. “We can’t think of this pandemic as something that exists simply within our own borders.”

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