In December 2006, the Indonesian authorities refused to hand over samples of the bird flu virus without guarantees that it would benefit from any vaccine produced from them. Amid the swine flu outbreak in 2009, the Australian government ordered a vaccine manufacturer to meet its demand before fulfilling orders overseas. That November, after several rich nations had secured vaccines, officials from the World Health Organization aired concerns that disaster could lie ahead.
“Things would be much worse if the pandemic had been more severe, and it would be more difficult to create some fairness in the distribution of vaccine,” said Marie-Paule Kieny, the then head of the WHO’s initiative for vaccine research. “Governments might be less inclined to share the vaccine that they have.”
With vaccines seen as one of the few real routes out of the coronavirus crisis, fears of “vaccine nationalism” are already increasing. Each step of creating, testing and mass-producing a vaccine is an epic challenge – but the political and ethical decisions around its subsequent distribution pose another. Governments, including in the UK, are being questioned about how they will get to the front of the queue. How will any eventual vaccine be shared out? Who decides? Will supplies go to the highest bidder? Are rich nations buying up potential vaccines already? And what will stop governments from simply seizing vaccines made in their country?
According to experts and industry, it will take at least a year to vaccinate the world from the moment vaccines become available. That’s a 12-month queue, if things go well – after a vaccine is found. “The reality is that there is no process established for this,” says Steven Jones, a Canadian member of a team that created a successful Ebola vaccine.
The potential problems have been spotted. On Friday, a parade of world leaders, charity bosses and industry chiefs, including French president Emmanuel Macron, German chancellor Angela Merkel and philanthropist Melinda Gates, united to back a WHO initiative to ensure any treatments and vaccines are shared equitably around the world. Dominic Raab also supported it. Yet just as notable were the nations not in attendance – the US, China, Russia and India.
A delicate system of international cooperation is having to be pursued in the middle of a crisis. “We are talking about billions of doses being available to all,” says Charlie Weller, the Wellcome Trust’s head of vaccines. “We haven’t got a roadmap for how to do that. Many of these discussions are being worked out now.”
There are organisations designed to help the fair distribution of a vaccine – most notably Gavi, which aims to increase access to poor countries, and the Coalition for Epidemic Preparedness Innovation, which the UK helps to fund. However, some are blunt about the hopes of centrally-managed global cooperation. “Can you imagine the WHO telling Donald Trump that he can only have one tenth of the vaccine that he wants,” says David Salisbury, the former director of immunisation at the Department of Health. “Surely, he’s going to look to see who can make a vaccine in the quantities needed in America, and he’s not going to let the vaccine out. That will happen.”
Jones is also pessimistic. “The WHO can try to take a leadership role but they are in a difficult situation. They can try to apply moral and ethical guidelines.”
UK ministers, too, have already been under pressure to guarantee that Britain will benefit first from vaccines discovered here. Matt Hancock has said he is “ensuring the UK is both contributing to and benefiting from efforts around the globe”.
It is inevitable that some nations will try to use “advance purchase agreements” to secure supplies, paying potential vaccine producers on the off-chance that their product works. Such agreements provide funds for research, but there is no system for policing their impact on fair distribution.
Unfortunately, a vaccine queue is inevitable. Making billions of doses, rather than millions, adds another order of difficulty. Hence, Weller told a briefing last week: “For at least a year after the Covid-19 vaccine becomes available, it is very likely that there’ll be insufficient supply to meet the global demand of billions of doses.”
Thomas Breuer, chief medical officer of GSK Vaccines, paints an even starker picture. His company is working with fellow pharmaceutical giant Sanofi to develop a production process that could deliver big quantities. “Let’s say the GSK-Sanofi approach succeeds, that alone will not be enough to supply 20% of the world’s population within one year,” he says. “Several of the large-scale solutions have to come into play if we want to cater for the world’s population over a period of one to two years. One company alone is not enough.”
There is also concern from industry about being thrust into the middle of an impossible political tug of war. “They are going to have huge numbers of customers, a lot of whom are going to be waving dollar bills, euros and pounds,” says Salisbury. Hence, many are praying for an international agreement. “Now is the time to be having the government conversation about those allocation principles,” says Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry. “Let’s not wait until we’ve got something to fight over.” He adds that it simply will not be left to manufacturers to decide who gets what. “They will start from the point of saying, we want to maximise global access.”
The threat of export bans on vaccines is clearly a concern. “It would really be a mistake for global leaders to be tempted into that sort of behaviour,” says Torbett. He hopes that, in the end, the need for multiple vaccines from many different global sources could encourage international cooperation: “Every country will want to have fair allocation.”
While some leaders may be tempted to go it alone, Weller says such actions could ultimately come back to haunt them: “As long as Covid is out of control somewhere, it threatens everyone, everywhere. That’s what it comes down to.”