A question of survival: 89 vaccines under development, but for who?

Otherwise, reservoirs of the virus will remain and continue to spread If an effective and safe coronavirus vaccine were available today,would it be enough to stop

this pandemic? That would depend on whether everyone who needs it can get it. But if what took place during the 2009 H1N1 pandemic happens again, then the answer is no. As swine flu swept across the globe, the vaccines that were developed ended up mostly in wealthy countries, while the rest of the world went without them. That’s what goes wrong when manufacturing agreements or domestic export policies in countries producing vaccines place restrictions on their international availability.

Fortunately, the H1N1 pandemic turned out not to be much more severe than a normal flu season — as many as 285,000 may have died worldwide — though it struck people younger than 65 particularly hard. But if the same thing happens with a coronavirus vaccine as happened with the swine flu vaccine, the current pandemic, which has already killed at least 212,000 people worldwide, will continue to spread and kill across the globe.

The first priority for any country, of course, is to protect its own citizens. But countries must think globally when the world faces an infectious disease. An outbreak anywhere is a risk everywhere. World leaders need to act now to ensure that everyone who needs the vaccine when it becomes available gets it.

The potential for outbreaks to spread uncontrollably is particularly high in low-income countries where inadequate public health systems are unable to effectively track and respond to new diseases or to treat people who are infected. These countries are also limited in their ability to pay for vaccines, which is why the organisation I run, Gavi, the Vaccine Alliance, provides subsidies to countries to purchase them. Substantially more financial help will be required if large numbers of vulnerable people are to be vaccinated. Else, reservoirs of the virus will remain and continue to spread. With cases of coronavirus infection now confirmed in more than five dozen lower-income countries, that is a big concern.

At least 89 coronavirus vaccines are in development, according to the World Health Organization, and possibly double that number.

So when the first gets regulatory approval for widespread use, how do we ensure equal access? Initially, the challenge will be how to distribute the limited number of doses that are available. The danger is that richer nations will buy up the supply for their own use or prevent exports of vaccines developed within their borders as countries scramble to protect their citizens or stockpile for future outbreaks.

Another concern is that manufacturers might restrict sales to the highest bidder. In the long term this may point to the need to expand the vaccine manufacturing base to a wider range of countries and regions. Because it is likely that the first vaccines will be produced in wealthy countries, we will fall short of producing a global supply if we rely only on their manufacturing capabilities. What we will need is a technology transfer to manufacturers around the world if we have any hope of having adequate quantities and global access.

For now, the Coalition for Epidemic Preparedness Innovations is trying to expedite the development of vaccines against emerging infectious diseases. The coalition has kick-started the development of at least nine coronavirus vaccines but needs to raise $2 billion to help up to three of these candidates make it through the regulatory and quality requirements and to complete efficacy trials. The world would then need to ensure funds to guarantee manufacturing capacity for global production to make billions of doses available within the next 18 to 24 months.

In addition to this, the coalition is working to create a mechanism to ensure equal access to these vaccines. It is unclear precisely how this would be achieved and whether, for dozens of other vaccines under development through other efforts, others making vaccines will follow suit once a mechanism is developed.

It is also unclear how poorer countries will pay for them. But in global health crises where emergency vaccines are a global public good that keeps us all safe, the answer has to be largely through public funding.

That is why it is encouraging that the health ministers of the Group of 20 wealthy nations called for accelerating the development, manufacturing and equitable distribution of vaccines against the coronavirus at its April 19 meeting and that last Friday, more than 15 heads of state, the president of the European Union, the director general of the World Health Organization and leaders of other international institutions committed to join together to do the same.

For the governments of high-income donor countries, many of which are already scrambling to divert funds from other uses to cope with the coronavirus crisis within their borders, raising additional billions of dollars will be difficult. But to keep the global population safe, it must be done. Innovative financing mechanisms exist that can translate long-term government commitments into immediate funding by issuing bonds on capital markets.

The Ebola vaccine we have today was made possible by such an approach. A broad range of partners, including biomedical research institutions and health agencies in the US, the EU, China and the pharmaceutical industry, working in coordination offers the best chance at developing a vaccine or vaccines. The best of those vaccines then need to be moved into advanced clinical trials to see what works, along with the scaling up of production capabilities to meet the global need. Estimates put the cost of Covid-19 to the global economy at up to $2 trillion this year.

If we can advance the mass distribution of an effective vaccine or vaccines by as little as two weeks, not only would we would save countless lives, but the effort would almost pay for itself by getting the world back to work.

But that also means ensuring that affordability and access do not become barriers to widespread availability. Only by protecting everyone at risk will we end this outbreak and respond effectively to future outbreaks.

In the race to develop a coronavirus vaccine, everyone everywhere should be winners.