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Winner takes it all?

With the Covid-19 vaccine race heating up, governments are jostling to bag a life-saving prize

In the 160-contender race of Covid-19 vaccine candidates, everyone is watching the breakaway group that has entered human trials. And governments around the world are offering eye-catching sums to developers in the hope of capturing some of their glory, and a lifeline for their citizens.

By 10 July, the World Health Organization (WHO) counted 20 candidates in a frontrunner pack, including contenders from Australia, China, Germany, India, Russia, South Korea, the United States and the UK. The only one to have entered phase-three efficacy trials—in which the vaccine is tested for safety and efficacy on large numbers of people—has been developed by the University of Oxford in England and the multinational pharmaceutical company AstraZeneca. However, candidates from the Chinese companies Sinovac and Sinopharm and the US company Moderna have phase-three approval.

All are desperately trying to compress the development period, which is usually about 10 years for vaccines. Fuelling the unprecedented speed of their efforts is unprecedented funding: almost $5 billion (€4.4bn) so far, according to the non-profit Policy Cures Research. Of this, the biggest chunk is for scaling up production to deliver the billions of doses needed globally.

But the global vaccine initiative Gavi—which is working with the WHO and international foundation the Coalition for Epidemic Preparedness Innovations (Cepi) on equitable global provision—has estimated that even in the best case scenario “no more than a few hundred million doses will be available by December 2020”. The WHO says it needs $18.1bn to supply two billion vaccine doses worldwide by the end of 2021, of which only $2.6bn has so far been committed. 

With the first effective vaccines expected to be in short supply, a power struggle has developed between vaccine nationalists and equal access initiatives, leading to questions over where the first doses will go. Many countries have entered bilateral advance purchase agreements with pharmaceutical companies, providing funding in return for a guaranteed number of doses. Governments are happily accepting possible financial losses from backing vaccine candidates that fail by financing supply chains before trials are completed.

Being furthest along the development pipeline, AstraZeneca has agreed seven partnerships—with countries including Brazil, India, Japan, the US and the UK—to supply two billion doses of its candidate vaccine. Asked how it will prioritise distribution of the first doses, a spokesperson said the company “is building…supply chains in parallel across the world to support broad and equitable access”.

There is increasing concern in many quarters that governments with the most money or the most belligerent leaders will put their own countries first.

“We have seen with the drug Remdesivir what happens when demand outstrips supply—we anticipate an even greater challenge when we have a successful vaccine,” Richard Hatchett, chief executive of Cepi, told Research Europe, referring to the US government’s move to buy up the entire global supply of an antiviral drug found to hasten Covid-19 recovery.

In fact, the US has already revealed its strategy to go it alone on a vaccine. It is yet to financially support the WHO-led initiatives, instead pouring $3.9bn into developing vaccine candidates and securing manufacturing capacity on its own soil (see box). 

“Our priorities are very clear,” a senior administration official at the US Department of Health and Human Services said in a statement. “Let’s take care of Americans first. To the extent there is surplus, we have an interest in ensuring folks around the world are vaccinated.”

With a surplus looking unlikely, some are now striving to ensure a more equitable sharing of the prize, whoever wins the race.

Toeing the line

One of the latest major international initiatives to be announced is an EU vaccine strategy, which aims to secure supplies for member states and production capacity in the EU using a €2.7bn fund. The European Commission is trying to walk the line between prioritising EU member states and supporting equal global access in its statements, saying it will partner only with companies committed to ‘global solidarity’.

“The commitment of vaccine developers to make future doses of vaccine available to partner countries is one of the criteria for our decision whether to fund them,” a Commission spokesperson said, although exactly how any split between member states and other nations would work is vague.

Just working out access for member states is a challenge that still needs resolving. The EU vaccine strategy came in the wake of the Inclusive Vaccines Alliance, an initiative by France, Germany, Italy and the Netherlands. In June, this alliance secured a deal with AstraZeneca to supply 400 million vaccine doses, and talks are ongoing about how and whether the EU will take over the deal and open it up to other member states.

At the launch of the EU vaccine strategy on 17 June, Commission president Ursula von der Leyen also raised the idea of an “international buyers’ group” that would “pool resources for jointly reserving future vaccines from companies while making advance reservations for low and middle-income countries”.

It is unclear how such a buyers’ group would relate to efforts coordinated by the WHO, although the EU worked with the global health agency on pledging events in May and June that raised nearly €16bn for international Covid-19 recovery. In a statement, the WHO said there was “ongoing communication and interactions” with the Commission “to strengthen alignment and complementariness even further”.

Working together

The WHO, Gavi and Cepi have launched an initiative called Covax to spread manufacturing and supply across regions with a wide range of vaccine developers, including AstraZeneca. 

In June, WHO chief scientist Soumya Swaminathan said the WHO had held discussions with Chinese and Indian companies and regulators and was “in the process of exchanging documents, of signing confidentiality agreements”.

“The more of a diverse portfolio of vaccines we back the more likely we are to get a successful Covid-19 vaccine,” Gavi chief executive Seth Berkley said in the same month. He pointed out there are incentives for vaccine developers to join a global initiative, warning of a “public relations disaster” if companies work with only a few countries.

Countries participating in Covax would be guaranteed enough doses to protect up to 20 per cent of their population, with the inclusion of lower-income countries supported through aid money. The incentive for richer countries to participate is that Covax provides an insurance policy against the failure of individual vaccines funded through bilateral agreements.

“We need to stamp out the coronavirus everywhere, not just in the countries that can afford to procure large volumes of a vaccine,” says Hatchett, adding that joining Covax is “in [countries’] own and the global interest”.

This ambition could benefit from the tendency of most nations to hedge their bets as they try to back the winning horse. 

Warped strategy?

Funding through the US vaccine initiative, Operation Warp Speed, is skewed towards US companies. At a congressional hearing on 2 July, Senator Patty Murray raised concerns, saying US investments had been made “solely in vaccine technologies that have only been studied experimentally and never made it to market, while not pursuing older proven technologies”.

International efforts are taking a broader outlook. Speaking in June, Andrew Witty, a former chief executive of pharmaceutical company GSK who is co-leading the WHO’s Covid-19 vaccine efforts, said that until results from phase-three trials are available it is important to “remain quite humble” when considering which vaccines are most likely to work.

“This is all very much still an experimental phase,” he said. “It’s important not to lose sight of the big, diversified pool.”

This article also appeared in Research Europe and a version appeared in Research Fortnight