Eva Sigel reflects on the webinar, Addressing the pandemic: the pharmaceutical challenges, and discusses the global race to develop a vaccine
As death tolls continue to rise and the crippling economic and social effects of the pandemic become apparent, the question, “when will we get a vaccine against Covid-19?”, is more pressing than ever. However, for billions of people living in low- and middle-income countries the issue is framed differently: “when a vaccine is found, are we going to get it?” This reality, as pointed out by Ken Shadlen, Professor of Development Studies at the LSE, set the stage for the webinar Addressing the pandemic: the pharmaceutical challenges which took place on 26 May 2020 as part of the LSE’s COVID-19: The Policy Response public event series. The discussion was a prime example in demonstrating the interrelation of international economic policy and public health; two central concerns I grapple with as a student of the MSc in Health and International Development. In this blogpost, I share my five lessons learned.
Lesson #1: Access must matter from the beginning
As pointed out by Panos Kanavos, Associate Professor of International Health Policy at the LSE, there is a vibrant pipeline of therapeutics and vaccine candidates to fight COVID-19. However, innovation and production capabilities as well as purchasing power are highly concentrated in countries of the Global North. The threat of unequal access to life-saving medicines evokes painful memories of the HIV/AIDS epidemic in the early 2000s. Through antiretroviral therapy, the disease became a chronic condition in rich countries while it remained a death sentence for most in the Global South. The panellists urged that we cannot afford to relive this scenario in the current pandemic. Making treatment accessible to every country is necessary on the grounds of solidarity and justice. In our interconnected world the virus knows no borders.
Lesson #2: Markets alone won’t solve it
The investment requirements to develop a vaccine are massive. To ensure a high probability of success, research and development (R&D) for dozens of vaccine candidates needs to be supported. Moreover, ensuring that a successful vaccine becomes rapidly available to billions of people requires building far more manufacturing and distribution capabilities than what is economically viable for individual companies.
Next to the risk involved in R&D, the market for vaccines is highly uncertain. Professor Kalipso Chalkidou, Director of Global Health Policy at the Center for Global Development, suspected that if herd immunity develops or an effective treatment is found, the demand for a vaccine will be much lower. Therefore, we cannot rely on the private sector alone to act in the interest of public health, but need bold government intervention.
The threat of unequal access to life-saving medicines evokes painful memories of the HIV/AIDS epidemic in the early 2000s.
Lesson #3: Patent barriers need to be dismantled, but nationalism is the largest threat
Professor Shadlen emphasised that during the HIV/AIDS epidemic the availability of cheap generics was a turning point for equal access. In the current pandemic, policymakers and civil society organisations reemphasise the need for pharmaceutical companies to drop patent monopolies to prevent excessive pricing. Several countries took pre-emptive measures through compulsory licensing (suspending the monopoly effect of patents) of potential treatments. Some companies have voluntarily dropped their patent rights either directly to generics producers (such as Gilead for Remdesivir in some countries) or via WHO’s Medicines Patent Pool (such as AbbVie for Kaletra).
However, Professor Margaret Kyle, Chair in Intellectual Property and Markets for Technology at MINES ParisTech argued that protectionist trade policy might be even more harmful to access than patents. According to Global Trade Alert, 75 countries have introduced export controls for medical devices, protective equipment, and pharmaceuticals since the start of the pandemic. This gives a glimpse into what might happen to access once a successful treatment is available unless collective action is taken now.
Lesson #4: We need truly global solutions
Instead of turning to national self-interest, this pandemic can only be fought through truly global solutions. Professor Chalkidou presented the CGD’s vision of how such a solution might look like. A large-scale Advance Market Commitment (AMC) could align public and private interests by defining countries’ commitments to purchasing a certain volume of a vaccine at a certain price, once available. In the past, AMCs have helped to bring the pneumococcal and Ebola vaccines to market. Recently, Gavi, the Vaccine Alliance has launched a donor-supported AMC for a COVID-19 vaccine. However, Chalkidou stressed that we need to go beyond aid. To signal a predictable market to the private sector and avoid bidding wars, high and middle-income countries should make commitments via their national health budgets.
By clearly signalling what is expected from a vaccine, an AMC would ensure that only effective products will be supported. Instead of “picking winners” of vaccine candidates, a well-designed AMC would hedge against the risk of late-stage failure by setting incentives for many innovators to remain involved. Besides, the value of a vaccine will be highly dependent on local contexts including how much additional health it will create compared to current treatments and how it might decrease or increase health spending elsewhere. Moreover, countries not only have differential abilities to pay but also different needs related to e.g., cold chain requirements or the population’s age structure. Through a value-based tiered pricing system (i.e. pricing based on locally-defined health benefits), these needs could be incorporated into the price of a vaccine.
The panel agreed that in the current climate of national self-interest and the recent attacks on WHO, a truly global solution will represent an enormous challenge. Creating incentives for both the US and China to become involved will be critical given the high likelihood that a successful vaccine will be developed in one of these countries.
As scientists warn that pandemics will occur more frequently in the future, the discussion concluded by asking how we can be better prepared next time. Panellists advocated for the build-up of strategic stockpiles of critical medical goods, diversification of global value chains and international harmonisation of pharmaceutical regulatory standards. Moreover, rebuilding trust in international institutions and strengthening global governance will be critical. Finally, COVID-19 has brought new attention to the interconnectedness of health and economic development. As countries’ responses were highly depended on having a vibrant industrial sector, these links deserve more attention to fight global health inequities, also beyond the pandemic.
The views, thoughts and opinions expressed in this blog post are those of the author(s) only, and do not reflect LSE’s or those of the LSE Global Health Initiative.