Unilateral action won't work: World must collaborate on COVID-19 vaccines

Multilateral agreements, international cooperation and vaccine patent waivers will deliver better outcomes on COVID-19, write Francesco Paolucci, Chiara Berardi, Marcello Antonini and Marwa Atef Eid.

THE WORLD WAITED with bated breath the results of clinical trials to test the effectiveness and safety of the Pfizer/BionTech, Moderna and AstraZeneca vaccines. From November 2020, many months have passed and there are around eight vaccines being used to prevent infection from COVID-19 worldwide.

The COVID-19 vaccines represent a unique resource to stop the catastrophe we are witnessing. However, vaccine protectionism and vaccine nationalism are hampering the efficient and equitable management of the public health response to the pandemic. The rush toward ensuring the COVID-19 vaccine doses through unilateral agreements with private companies is another clear example of the end of the multilateralism and bilateralism principles.

It is a betrayal of those principles that the wealthiest nations used their power to establish agreements that largely favour themselves. To date, the World Health Organisation declared that only one per cent of the vaccine doses administered have been used in Africa.

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The Global Health Summit hosted in Rome, Italy on 21 May 2021 was a great opportunity for the leaders of the wealthiest countries to make a clear political decision to support fairness and equity, reinforcing multilateral cooperation.

At the centre of the debate, there were the next steps of the global response, including access to coronavirus treatments, tests and vaccines, WHO financing, the role of multilateral institutions and frameworks.

The key themes were endorsed by the recent positions of the new U.S. President Joe Biden: the increase of the funds for the Access to COVID-19 Tools (ACT) Accelerator and a temporary waiver for COVID-19 vaccines patents.

Let’s start with the first theme. In April 2020, the WHO, The European Commission and France launched the COVAX plan, the third pillar of the ACT Accelerator. COVAX is meant to be a “lifeline” for low and middle-income countries that otherwise would not be able to afford the vaccines and also for high-income countries that have not yet established a contract with manufacturers.

COVAX has secured the AstraZeneca and Pfizer vaccines and it has recently signed with Moderna, however, the doses from Moderna will be only available from 2022. The protectionism put in place by the wealthiest countries through the establishment of exclusive agreements with vaccine manufacturers has undoubtedly caused a severe underfunding of the COVAX project.

This has undermined the WHO's ability to achieve its targets. $15 billion pledged to be given to the program remains outstanding. The situation is so critical that the new term “vaccine apartheid” was coined by the WHO Director-General, Tedros Adhanom Ghebreyesus.

The second theme – the waiver of patents for the COVID-19 vaccine – was the most debated and could represent the solution for the COVAX project. India and South Africa launched this initiative in December 2020, with the support of many low and middle-income countries.

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A crucial turning point on this issue was the election of Joe Biden as the U.S. President. The U.S. changed their strategy, pushing for the temporary waiver of the patents to ensure a boost of production and fairer access to the vaccines.

The richest nations, such as EU countries, Canada and other vaccine maker countries maintained that the intellectual property rules aren't hampering the development of COVID-19 vaccines and that it does not represent a barrier to manufacturing vaccines.

Rather, they advocate that a much quicker ramping up of global production would be ensured by the transfer of know-how, voluntary cooperation among vaccine makers and the removal of export restrictions on vaccine raw materials, particularly from the U.S. The same position has been taken by some commentators and researchers.

The great debate ended with the signature and the launch of the Rome Declaration.

The Principles therein serve as a:

...voluntary orientation for current and future action for global health to support the financing, building, and sustaining of effective health system capabilities and capacities and Universal Health Coverage to improve preparedness, early warning of, prevention, detection, coordinated response, and resilience to, and recovery from, the current pandemic and future potential public health emergencies.

There is still a not clear and mandatory commitment toward cooperation and multilateral agreements. On the contrary, each country announced its own new strategies to help low and middle-income countries to have access to technologies and a fair distribution of the vaccines, whilst drug makers offered doses at lower prices.

Further, leaders called for voluntary licensing and technology transfers to boost vaccine production, again, unilateral action to fight a global pandemic.

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Intellectual property (IP) rights are a system of incentives to research and development (R&D) in the form of a period of exclusivity to sell the product in the market. In the context of biopharmaceutical innovation, the rationale for these patents is predicated on the extremely high R&D costs matched with a high risk of failure which may drive investors away if no form of market exclusivity is offered.

Here, there are two extraordinary circumstances. First, the epidemiological situation is dramatic as the death toll increases from COVID-19 every day and the burden on the population is heavy. For those who are interested in the economic side, there will not be a recovery without global immunisation and the cost of vaccine nationalism is much higher than the benefit of protecting the patents.

Moreover, as with any other forms of intellectual property, like songs, vaccine reproduction entails zero or very low cost. The production cost is an issue, but it is here that the transfer of technology and know-how can overcome such concerns. It is worth pointing out that R&D for the COVID-19 vaccines has been heavily financed by public funding.

Without the interventions of the governments, there would have been little or low chance of developing these vaccines in such a short time.

The patent waiver for COVID-19 vaccines, the collaboration among vaccine makers, the transfer of know-how and the removal of export restrictions on vaccine raw materials are all processes that must be undertaken as part of the global response to the COVID-19 pandemic.

Vaccine nationalism must cease and multilateral agreements, forged by the WHO, should be put in place immediately. Cooperation is the only solution to ensure a fair and equitable response to the COVID-19 pandemic.

Francesco Paolucci is Professor of Health Economics & Policy at the Faculty of Business & Law, University of Newcastle and the School of Economics & Management, University of Bologna.

Chiara Berardi is an Italian researcher at the University of Newcastle, who is particularly interested in health economics and policy topics.

Marcello Antonini is a PhD candidate in Health Economics at the University of Newcastle.

Marwa Atef Eid is a pharmacist and a health economics researcher.