Alan Boyd
China has emerged as the leading contender to produce a Covid-19 vaccine as concerns grow that nationalism and commercial interests could frustrate efforts to ensure equal access to an eventual treatment.
With three vaccine candidates approved for human testing — from consortia led by CanSino Biologics, Sinovac and the Wuhan Institute of Biological Products — Beijing may have the biggest say in that process. “We must be aware that the development of a vaccine is a battle that China cannot afford to lose,” commentator Mu Lu wrote in Global Times, a newspaper run by the ruling Communist Party, after the first trials were approved in late March. He described it as a “life-and-death” challenge.
Across the Pacific, meanwhile, US President Donald Trump announced an extraordinary national campaign last week involving drug companies, government agencies and the military, code-named “Operation Warp Speed”, to get an approved American vaccine in production by January.
Remarkably, the costs of the research will be underwritten by taxpayers, thus shielding private pharmaceutical firms from financial risks incurred, a strategy that mirrors the military-commercial axis employed by China. Health agencies are worried that both countries will give any vaccines to their own populations first, even if there is a greater need elsewhere.
“There should not be a divide between the haves and the have-nots,” said World Health Organization (WHO) director-general Tedros Adhanom Ghebreyesus, warning that the polarization of research, after early signs of a global partnership, would have deep consequences. “WHO is committed to ensuring that as medicines and vaccines are developed they’re shared equitably with all countries and people.”
On April 23, the United Nations health agency launched a collaboration aimed at ensuring that any technologies effective against the virus were “accessible to everyone who needs them”, but didn’t say how this would be achieved. A Covid-19 Vaccine Development Taskforce has also been formed by health agencies and donors to work out a strategy for how vaccines can be manufactured and financed for use by all countries on a needs basis.
Coalition for Epidemic Preparedness Innovations (CEPI), which is involved in both initiatives, has estimated that funding of at least US$2 billion will be needed to develop up to three vaccines in the next 12–18 months. This would cover the cost of research, but not the manufacturing of vaccines, the coalition said. CEPI chair Jane Halton, an Australian health professional, said the strategy was needed to ensure commercial interests did not dictate vaccine access.
“We are acutely aware of this and it is literally a topic that is being discussed on a daily basis. 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,” Halton said in a media interview.
Her organization was set up after pharmaceutical firms stopped working on a vaccine to counter a 2014 ebola outbreak in West Africa because it would not allow them to make a profit. Under development for a decade, the vaccine was finished after the ebola crisis had ended, killing 11,325 people.
Governments have also previously been guilty of putting their own interests first. In 2009, Western countries arranged for advance stockpiles of a vaccine developed to counter the H1N1 virus, commonly known as swine flu, leaving little for the poorer third world nations that the infection mostly affected. Unusually, some of the pressure for pharmaceutical companies to put aside their market rivalries and jointly develop a vaccine is coming from the shareholders who have more to gain than most from the pandemic.
Achmea Investment Management, a group that has stakes in 15 major drug companies, issued a list of principles that it wants them to follow, including prioritizing the development of tests, medicines and vaccines. The Dutch-based group said in a statement on April 16 that it had “unfortunately … seen some examples of priority being given to short-term financial and competitive considerations” by drug companies. Companies in Europe and North America are developing most of the 119 vaccine candidates that are under development.
CanSino Biologics and its partner Beijing Institute of Biotechnology have now reached phase two of testing with large-scale human trials, and six firms from the US, Canada, China and the UK are doing more limited phase one testing on humans.
Several more candidates will enter phase one trials in the next few weeks, including a vaccine being developed by Australia’s University of Queensland.
While the world waits for a vaccine — unlikely for at least six months, and perhaps even longer — health activists are lobbying for a loosening of patent protection laws so that poorer countries can make their own generic versions of medicines.
Countries like India, Israel and Thailand have used compulsory licensing laws in the past to override Big Pharma patent protections, mostly notably to secure drugs to treat HIV/AIDS, but there are signs that drug firms will play hard ball on a Covid-19 vaccine.
US-based biotechnology firm Gilead arranged for remdesivir, now being plugged by Trump as a Covid-19 treatment, to be designated an “orphan drug” soon after the pandemic began, which would extend all patent protection on the grounds that it was being used to fight a “rare disease.” Gilead backed down after a public outcry and asked for the designation to be lifted. US health authorities did not question either of its demands.
