[Dash of SAS] The questions to ask in the race to develop a coronavirus vaccine
A few days ago, President Rodrigo Duterte announced a P10 million reward for any Filipino who could discover a vaccine for COVID-19. Today, he raised the reward to P50 million.
While well-intentioned, vaccines aren’t exactly “discovered” or “found.” It will take more than a reward (and not “bounty,” as a vaccine is not a fugitive on the loose) to come up with a vaccine. (READ: What you need to know: Coronavirus cures, vaccines being tested)
Vaccines take years to develop and follow a step by step process which includes research, clinical trials, efficacy trials, regulatory review, and approval – an intensive and iterative process before going into mass production and then distribution. The foundation for all of this is robust and well-funded scientific research bolstered by scientific testing tools and equipment. (READ: Vaccine Testing and Approval Process by the Center for Disease Control and Prevention)
Never before has the world needed a vaccine and cure more than it does now for COVID-19.
Even with the breakneck speed at which scientists around the world are working to develop a vaccine for COVID-19, immunologists say that a vaccine isn’t likely to be available for another 12-18 months.
Rappler spoke with Kate Elder, Senior Vaccines Policy Advisor for Doctors Without Borders, about what the global health community already needs to think about now in the development process to ensure that everyone has equitable access to a COVID-19 vaccine. Doctors Without Borders (also known as Medecins Sans Frontieres or MSF) is an international medical humanitarian organization that provides critical medical assistance to people affected by conflict, epidemics, and disasters.
While scientists around the world are working on a COVID-19 vaccine, what are the watchpoints that we need to think about and prepare for as early as now to make sure that COVID-19 vaccines are accessible to all?
Kate Elder: At this stage, for these future vaccines to be accessible by everyone, we already need to think about the prices they will be sold at, if they are going to be produced in adequate quantities and if they are going to be easy enough to use in low resource settings that are already incredibly challenged in terms of health care.
KE: In preparing for future COVID-19 vaccines, we already have to lay the groundwork to ensure their accessibility. Rather than relying on private pharmaceutical companies to set the terms, we have to ensure that the funding that goes into vaccine development comes with no strings attached so those products will be affordable and available in enough supply.
In places where MSF works, it's incredibly difficult to do vaccination. Sometimes vaccines require a cold chain which means they need to be refrigerated. Many vaccines require multiple doses administered over a period of time to get full protection. These are considerations that maybe we don't think about in high income countries that have adequate health care. However, this is a challenge in many of the countries where MSF works and a challenge in the places where the majority of the world’s population lives. (READ: Only a coronavirus vaccine will allow return to 'normalcy' – U.N. chief)
KE: We need to be thinking about pricing already as vaccines can be quite expensive. We already know that in markets where there are only a few manufacturers, there's a sort of monopolistic market dynamic that allows prices to be rather high.
We've seen this in other vaccines such as the pneumococcal conjugate vaccine, the pneumonia vaccine, and the human papillomavirus vaccine. There are only a couple of manufacturers so prices stay quite high.
Of course, there's a different context right now with COVID-19. There is a race to develop the new vaccines and the world is waiting, but we have to make sure that we don't have a monopolistic environment wherein private companies can charge essentially whatever they want making these vaccines out of reach for the majority of the world.
What can we do to prevent this?
KE: We have to make sure that much of the funding for development and testing of these vaccines comes from public and taxpayer funding. This will help ensure the vaccine’s affordability and availability.
From our experience in the vaccines field, we know that vaccines are highly patented. Companies take out patents at every single step of the vaccine development process. These patents make it incredibly difficult for other companies to replicate these vaccines and produce them. So we have to take a very hard look at intellectual property. If we pursue this same traditional patent route for the COVID-19, we are going to have a lot of difficulty making sure that those vaccines are available worldwide. (READ: U.N. member states demand 'equitable' access to future coronavirus vaccines)
Governments should use their regulatory powers to suspend or override patents for COVID-19 medical tools, the medicines, and the vaccines as well.
(NOTE: Read about the global efforts to share IP rights to enable low-cost generic production of medicines and vaccines here.)
Supply and demand
KE: To be honest, it is often challenging to secure access to the newest vaccines for people affected by crisis or living in developing countries where MSF works. Often, we are told there's no supply for us and the people that we serve.
For example, for years, MSF struggled to access the pneumonia vaccine, the pneumococcal conjugate vaccine (PCV) made by Pfizer and GlaxoSmithKline. Most recently, a new Indian manufacturer developed a PCV vaccine which just entered the market. We're hopeful that when there are more companies that make vaccines, that will help drive their price down and ensure there's enough supply for everyone.
Let’s take the case of middle income countries or the group of countries that are not poor enough to be eligible for donor support, and yet not wealthy enough to afford the incredibly high prices that companies try to charge for medicines or vaccines.
It's very difficult to get prices on vaccines. If you look at some of the pricing data when it's available, you will see that sometimes in a middle income country, the price of a vaccine can be as much as fourfold more expensive than it is for a country that might even be its neighbor, but just slightly poor.
Part of equitable pricing is to increase the transparency around vaccine pricing so that countries can better negotiate prices. In the case of COVID-19, and the global effect that it's having, hopefully these will all be discussed and determined beforehand.
As an example, in the Philippines, the pneumococcal conjugate vaccine is not widely available. It's only in some districts largely due to the high price as there were only two manufacturers globally who make the PCV vaccine. We need to take the necessary steps now so that future COVID-19 vaccines are affordable enough so that everybody can get them as rapidly as possible.
The global vaccine community is made up of philanthropic giants like the Bill & Melinda Gates Foundation and organizations like MSF, World Health Organization (WHO). These are entities or organizations that are mostly funded by donor governments of the richest countries. How can we ensure that the major donor countries will not "influence" the accessibility of a COVID19 vaccine?
KE: A lot of the funding going into developing these COVID-19 vaccines, indeed, comes from governments and other philanthropic actors. How the fruits of the research and development is distributed is a very good question that we have to be planning for right now.
We cannot have high income and the most developed countries of the world as the only ones that are able to buy these vaccines and determine who gets them and who does not.
That will mean that the majority of the world's poor people in places where MSF works won't have access or will have incredibly delayed access. These people tend to be of course, the most marginal, the most vulnerable and the ones that don't have any access to health care otherwise.
So we need to be preparing right now as a global community to set up a mechanism for the distribution of those future vaccines. Parallel to the scientific role of watching these COVID-19 vaccines being developed, the WHO needs to take on the role of seeing where the supply goes and the equitable access of vaccines.
Anti-vaccination groups have gained a lot of traction in the last couple of years in discrediting vaccines as a preventive response. Do you see the anti-vaxx movement as a problem when it comes to acceptability for the COVID-19 response?
KE: I think it's important to remember how vaccines function as a public health tool. Vaccines have the greatest potential to achieve herd immunity.
Herd immunity is when so many people in a community become immune to a virus or infectious disease that it stops the disease from spreading. Herd immunity also ensures that the virus will not infect people who are susceptible to the virus but cannot be vaccinated for certain reasons.
The entire premise of vaccination is really founded upon the idea of the mass population having access to it. We won't reach the full potential of COVID-19 vaccines unless they are accessible widely. Pursuing COVID-19 medicines and vaccines from a nationalistic perspective, from only protecting one's own population, really defeats the entire premise of vaccination. – Rappler.com
This interview has been edited for brevity and clarity.
Ana P. Santos writes about sexual health rights, sexuality, and gender for Rappler. She is the 2014 Miel Fellow under the Pulitzer Center on Crisis Reporting and a 2018 Senior Atlantic Fellow for Health Equity in Southeast Asia. Follow her on Twitter at @iamAnaSantos and on Facebook at @SexandSensibilities.com