Rich countries ignore the ‘nobody is safe until we are all safe’ message
In early 2009 when a strain of H1N1 flu, the same kind that caused the 1918 Spanish flu pandemic, emerged in Mexico, governments across the world feared the worst. Scientists warned that a repeat of 1918 and a second, far deadlier wave come the winter was entirely possible.
A scramble to develop and distribute a vaccine began quickly but a global effort to ensure that the whole world gained equal access to a vaccine failed to emerge. Wealthy countries were already well served by “pre-production contracts” which gave them claims to the limited production that would be available, but poorer countries found themselves on the outside looking in.
Eventually, a number of rich nations pledged to donate 10 per cent of the doses they bought to the developing world, via the World Health Organisation. However, it soon became clear that for many donors this would happen only once they had fully served their own populations.
The developing world eventually got access to vaccines in late 2009, but not before the rich world had taken care of itself. That pandemic turned out to be a mild one, but the fear of such a scenario repeating itself once again grips the scientific community.
“This terrifies me,” says Peter Jay Hotez, a professor at Baylor College of Medicine in Texas who is working on a vaccine deliberately aimed at low- and middle-income countries. “It’s why our team has been in the lab night and day. It could be incredibly destabilising.”
Developing a vaccine may well prove the easy part. It is the manufacture and distribution in an equitable manner that could prove by far the bigger challenge, says Prof Hotez. There is little the WHO can do to prevent wealthier countries from signing pre-production contracts and hoarding vaccines.
“There is a risk of politicians wanting to put their own populations first ahead of the global populations... but nobody is safe until we are all safe,” says Dr Mike Turner, the head of major science investments at the Wellcome Trust.
That phrase has become a mantra for those pushing for a coordinated global effort towards vaccination and it is one that some world leaders appear to be listening to. At a virtual vaccine summit hosted by the EU in early May, £6.5billion to fund research of Covid-19 vaccines and therapies was pledged along with assurances that it would be used to ensure poor countries received equal access. But neither the US nor India took part, and China sent only minor representation. Since then, the UK and other rich countries have once again rushed around the world signing bilateral pre-production contracts with pharmaceutical companies.
So far, the UK has signed four such deals, with the orders totalling 250 million doses. The EU has its own scheme that is yet to announce any deals, but an alliance of Germany, France, the Netherlands and Italy has signed one with AstraZeneca for 400 million doses. The United States, meanwhile, is pushing ahead with its own “Operation Warp Speed” strategy. The claim that nobody is safe until everybody is safe “clearly isn’t resonating with countries”, says Kate Elder, senior vaccines policy adviser at Médécins Sans Frontières.
Matt Hancock, the Health Secretary, insisted that the UK was “working to ensure that whoever’s vaccine is approved first, the whole world can have access”. However, he offered a clarification: “Naturally I’m determined to ensure that there is enough vaccine for the whole UK population, first and foremost”. The issue is that wealthier governments may believe that it makes more sense both politically and economically to pursue their own interests. Were the United States to develop a vaccine first, it might decide that “rather than sharing it with Mexico’s or Canada’s elderly we’re going to keep it to ourselves and give it to schoolteachers or students to get the economy going again”, says Prof Naor Bar-Zeev of Johns Hopkins University’s International Vaccine Access Center,
At the virtual Global Vaccine Summit hosted by the UK in early June, Gavi, the vaccine alliance, alongside the WHO and Coalition for Epidemic Preparedness Innovations launched the Covax facility, to act as a vaccine buying alliance. Wealthy countries would self-fund their vaccine purchase while also donating to cover the costs for up to 90 poorer countries. The case being sold to rich countries is two-fold. One, that the pandemic won’t be truly over and all countries safe until every nation has been vaccinated. And two, there’s no guarantee that in signing bilateral agreements countries will pick a winner, but if they pool their resources with Covax they can maximise their odds by backing a much larger number of candidate vaccines.
Even if Covax is a success, there may still be a significant slice of the world left out. While poor countries might be covered by aid and rich countries take care of themselves, “it’s the middleincome countries that might be in a real pinch,” says Prof Bar-Zeev, “because they won’t be underperforming enough that they could get Gavi support but they wouldn’t be able to compete in the open market.”
That’s an issue that could be compounded by the hi-tech nature of many vaccines, which could be either too expensive to buy or too complex to manufacture for middle-income countries, says Prof Hotez.