US drug buy-up could prompt rise of ‘vaccine nationalism’

The news that the US has aggressively bought up much of the world’s stock of remdesivir, one of just two drugs known to help treat Covid-19, does not bode well for an equitable distribution of vaccines.

While it’s true the US has bought up more than 500,000 doses, mopping up all production in July and 90 per cent in August and September, it is not the case that it leaves none for others.

Five generic companies in India and Pakistan are allowed to manufacture and distribute the experimental medicine to 127 developing countries. The UK and other European countries also have supplies. There are questions about the antiviral’s efficacy. There is solid evidence to show it reduces time patients spend in hospital but there is nothing yet to prove it saves lives.

The only drug shown to do that is the cheap-as-chips steroid dexamethasone, which has been used by intensive care doctors around the world.

Nevertheless, the precedent that the remdesivir buy-up sets is not a good one. It threatens a chain reaction in which treatment and vaccine nationalism becomes the norm. “The World Health Organisation (WHO) is trying to bring [people] together and some governments are leading on this, including France and the UK,” notes Prof Devi Sridhar, chairman of Global Public Health at Edinburgh

University. “But all you need is one government not to cooperate . . . to misbehave and not play by the rules of the game, and it becomes very hard for everyone else, too.”

That game is getting ever more tense as dozens of vaccines move from the laboratory and into human trials.

China announced this week that its leading vaccine candidate — one of 19 — would be administered to its army after it was found to prompt a reasonably solid antibody response in small-scale, phase-two human trials.

Opinion is divided as to the motive. Some see it as a clever way of fast-tracking a large-scale phase-three trial to prove efficacy and safety. Others think it’s being used to provide a degree of immunity for a crucial national cohort.

On the bright side, most countries, bar the US, are making the right noises on the principle of equitable distribution of treatments and vaccines according to need, including China.

There has, as yet, been no formal agreement signed, but the vast majority of countries and companies involved in the race to produce a vaccine have agreed, in principle, to share. Large-scale production facilities are being thrown up around the world, distribution networks are being put in place and — perhaps most important of all — all the scientific teams at the coal face are said to be collaborating well.

The remdesivir purchase could upset this. The drug’s efficacy was established through WHOorganised clinical trials, involving thousands of cooperative governments, physicians and patients around the world. Many of those involved — not least the families of patients who only received a placebo — may feel aggrieved.

But this is realpolitik. Just as the quest for gold brings prospectors together, a strike is likely to bring the knives out. We can only hope that better sense, nurtured through careful diplomacy, prevails when a proven cure or vaccine for Covid-19 arrives.