The Vaccine Race: Will it Make or Break Multilateralism?

Author

Deputy-Director for Employment, Labour and Social Affairs (ELS) at the Organisation for Economic Co-operation and Development (OECD)

Developing a vaccine against Covid-19 is at the forefront of most state’s interest at the moment. This inevitably raises questions about who will get the vaccine first, and how equal access to it can be ensured. International cooperation is surely primordial in this challenge, but can such cooperation be ensured in the current political climate, or will countries resort to "vaccine nationalism"? Mark Pearson, former Head of the Health Division at the OECD, weighs in on the matter by answering our questions.

Countries are running the race towards securing a vaccine against Covid-19. If an effective vaccine is developed over the next few years, will everyone be able to benefit from it quickly and at an affordable cost? What are the main challenges to securing access?

The competition in the development of a vaccine against Covid-19 is fierce. As we speak, roughly 200 candidates are under investigation, and a dozen of them have already reached the latest stages of development. This is already an incredible achievement for a disease that appeared only ten months ago. As a result of this massive R&D effort, it is not unreasonable to expect that the first effective and safe vaccines could reach the global market sometime next year.

It is perhaps inevitable, given the serious impact of Covid-19 on so many people and places, that some individual countries will want to be first in line to secure a stock of vaccines for themselves.

This is, however, only the first step. When found, ensuring that everyone will be able to benefit from it quickly and at an affordable cost is the main challenge governments and the international community have to address.

The first important action will be to ensure sufficient global supply for these products. This includes massive production of the vaccine constituents but also of the dispensing devices, such as syringes or intranasal sprays. Companies and Governments are already engaging in agreements with manufacturers and device producers, to ensure they scale-up their capacities to respond to the massive surge in demand they will face when the first candidates will be getting close to marketing authorization.

Yet, even with the best preparatory measures, at early stages of availability, the global demand will largely exceed supply. This is why the international community needs to cooperate, to define allocation strategies that are effective in terms of halting the outbreak as quickly as possible, both at national and international levels, by allocating scarce product volumes efficiently.

On that front, what we have witnessed so far remains rather worrisome. It is perhaps inevitable, given the serious impact of Covid-19 on so many people and places, that some individual countries will want to be first in line to secure a stock of vaccines for themselves. It is also understandable that countries with healthcare giants will "go national", with sweetheart deals between authorities, developers and producers. However, beyond the obvious ethical concerns such approaches raise, at this stage no one knows yet what the optimal immunization strategy will be to reduce and eventually halt propagation of the virus. Vaccinating priority groups at the global level could prove being more effective to swiftly bring the global economy back on track, compared to vaccinating the entire population in a handful of countries. In addition, securing access and cornering the market are not the same thing, and given the international nature of the healthcare industry, taking the latter approach could backfire against the very people that such efforts aim to help.

How can international cooperation be ensured at a time when the risk of the virus remains global? What are the legal and political tools that are needed?

As I mentioned, the current uncertainties around vaccine development and the best immunization strategies, as well as the global dimension of the disease, require a global strategy backed up by international co-operation. This is vital for beating the pandemic and getting our economies back on their feet. On the scientific side, such cooperation is normal practice, but we saw that the recent development of what is frequently referred to as "vaccine nationalism" puts our collective management of this crisis at risk.

There are no real legal mechanisms that would force countries to sit around the table and discuss the optimal allocation of the first successful vaccines. We already have a (theoretically) binding legal instrument to manage cross-border health threats (the International Health Regulations) and despite this we saw that almost all countries made decisions to handle the crisis at a national level and in rather uncoordinated fashion. The way forward here is political.

If we fail in ensuring people’s safety, this will foster further mistrust and have lasting consequences for the security and prosperity of our world.

We are at a time in history where multilateralism is often denigrated and science is sometimes ignored, while they are what we need most. We live in a totally interconnected and interdependent world and no solution to a global issue can be found in isolation. The responsibility of international organizations, including the OECD, is to advocate for more cooperation and multilateralism and provide evidence that this is the way forward.

Have countries been coordinating their policies on the innovation of R&D, manufacturing and market access? What remains to be done?

International cooperation between scientists and researchers has been strong. Very early during the outbreak, some international clinical trials launched and there has been massive sharing of information (the number of Covid-related scientific articles published is immense). Coordination of building manufacturing capacity and putting in place the needed logistics has been much more limited. As mentioned, most G7 countries engaged in bilateral discussions with the pharmaceutical industry to secure their positions. At the regional level, we do see, however, some interesting initiatives, like the commitments made by the European Commission with the industry on behalf of EU member states. The Gavi Covax facility, an effort to procure vaccines jointly and allocate them equitably at a global level, is being supported by more than 70 high- and middle-income countries. While it represents significant progress, unfortunately, Covax doesn’t go as far as it could. It competes with bilateral supply agreements many of the participant countries, and non-participating countries, signed in parallel. Also, Covax negotiates on behalf of participating countries individual supply agreements with selected pharmaceutical firms; it does not guarantee a market and return on investment for any successful vaccine candidate, like a genuine advance market commitment would.

The biggest concern currently remains ensuring the safety and efficacy of the products that will be brought to market and making them available to citizens. If we fail in ensuring people’s safety, this will foster further mistrust and have lasting consequences for the security and prosperity of our world. Governments therefore need to be much more transparent and upfront with their citizens about how resources are being allocated, how vaccines are being tested and based on what evidence they will receive marketing authorization. They also need to make sure that vaccines will be affordable and address the question of intellectual property, given that development is being almost entirely funded by public money.

Many of the decisions that will determine vaccine availability in countries have already been made, through signing of the various supply agreements. To ensure population access, and effective and efficient allocation of scarce product volumes, countries need to keep working together and devise vaccination strategies that will help stop propagation of the virus as quickly as possible.

Copyright: WANG ZHAO / AFP