the popular vaccine

Dora Longo Bahia. 8. Ofélia, 1994 Oil on canvas 193 x 284 cm


Developing vaccines for people, not for profit

Recent announcements about the proven efficacy of vaccine tests for Covid-19 have raised hopes for a return to normalcy. Preliminary data for the new messenger RNA vaccines from Pfizer/BioNTech and Moderna are extremely encouraging, suggesting that their approval for emergency use is on the way. And more recent news about the vaccine's effectiveness (albeit at a slightly lower rate) from AstraZeneca and the University of Oxford has fueled optimism that even more breakthroughs are emerging.

In theory, the arrival of a safe and effective vaccine would represent the beginning of the end of the Covid-19 pandemic. In reality, we are not even at the end of the beginning of delivering what is needed: a “people's vaccine” that is equally distributed and freely available to all who need it.

Let it be clear, the effort to create vaccines in a matter of months deserves praise. Humanity has made a monumental technological leap into the future. But its springboard was decades of massive public investment in research and development.

Most of the featured vaccines bolster the immune system's defenses against the viral spike protein, a strategy made possible by years of research at the US National Institutes of Health. More immediately, BioNTech received US$445 million from the German government, and Moderna received US$1 million from Coalition for Epidemic Preparedness Innovations and more than 1 billion dollars the US Biomedical Advanced Research and Development Authority and the US Defense Advanced Research Projects Agency. The AstraZeneca-Oxford vaccine received over 1 billion pounds sterling em public funding.

But for technological advances to be translated into Health for all, collectively created innovations must be governed by the public interest, not private profit. This is especially true when it comes to the development, production and distribution of a vaccine in the context of a pandemic.

No country, acting alone, can resolve this crisis. That's why we need vaccines that are freely and universally available. However, the current system of innovations prioritizes the interests of rich countries over those of the rest of the world, and profits over public health.

The first step towards a popular vaccine is to ensure full transparency of clinical trial results, which would allow independent and rapid assessments of its safety and effectiveness. Publishing scanty, preliminary data via press releases is directed at financial markets, not the public health community. Such a practice creates a bad precedent. As pharmaceutical stock prices explode, healthcare professionals and the public are forced to question the reported results. As more details about the failures in the design and implementation of clinical trials for the AstraZeneca-Oxford vaccine emerge, so do demands for open science and immediate sharing of protocols and results.

In addition, critical questions about major candidate vaccines remain unanswered. Responding to political and economic pressure in rich countries, pharmaceutical companies are rushing their candidate vaccines. For that, they designed their phase 3 clinical trials to deliver the positive report as soon as possible rather than facing most relevant questions, such as whether the vaccine is able to prevent infections or just protects the individual from the disease. It's also unclear how long the protection will last; whether the vaccine works equally in young and old, or in people with comorbidities; and how the main candidates compare to each other (critical to the design of effective immunization strategies).

Furthermore, national interests – especially those of developed countries – remain the dominant factor in the release of vaccines. Although the international purchase and distribution platform COVAX represents an important step forward, its impact has been overshadowed by the massive bilateral pre-purchase agreements of rich countries that manage to finance the bet on multiple vaccines. For example, rich countries have already bought about 80% of vaccine doses from Pfizer / BioNTech and Modern which will be made available during the first year.

Altogether, these countries claimed 3.8 billion doses from different vaccine manufacturers, compared to 3.2 billion (including about 700 million doses for COVAX) for the rest of the world. In other words, high-income countries have bought up enough doses in advance to cover their entire population several times over, leaving the rest of the world with potentially less than enough to cover even their most at-risk communities.

At the same time, as the vaccine race is focused primarily on Western markets, some candidates are hardly viable outside the context of a developed country. The Pfizer/BioNTech vaccine must be kept at -70°C, a ttemperature lower than that of an Antarctic winter. Deploying this vaccine will produce costly and complex logistical challenges, especially for low- and middle-income countries. As much as other candidates – such as the AstraZeneca-Oxford vaccine – are stable at higher temperatures, it is notable that such glaring characteristics of market discrimination will be inscribed in the first product to reach the approval stage.

In addition to the national interest, there is hidden the problem of even narrower private interests, which arise from an excessively financialized biopharmacological model of innovation. The business model for developing future vaccines is already being expanded, now that the pandemic has revealed a potential opportunity for investors. But while they benefit from actions that take off from very high capital gains, It's from dumping shares on the same day as promising preliminary clinical trial results are announced, delivering a popular vaccine has become a secondary concern.

The COVID-19 crisis is a perfect test case for whether a more public health-oriented innovation strategy will prevail in the years to come. While the Pfizer insists on the model of maximizing shareholder value, AstraZeneca has at least committed not to profit from its vaccine “during the pandemic”. However, despite all the public investment behind these innovations, the will remain opaque, leaving us to doubt whether AstraZeneca is really ready to prioritize public health over profits and offer its vaccine at cost price.

While the recent vaccine news brought hope, it also exposed the business model of the pharmaceutical industry, putting in check the perspective of delivering a popular vaccine and the achievement of Health for All. O business as usual it may even allow us to survive this crisis. But there is a better way of doing things. Before the next pandemic arrives, we must recognize that vaccines are the global health commons, and begin to reorient the innovation system towards symbiotic public-private partnerships driven by the public interest.

US President-elect Joe Biden may have promised a “return to normality”, but the truth is that there is no turning back. The world is undergoing fundamental transformations, and actions taken in the coming years will be critical to laying the foundations for a sustainable, secure and prosperous future.

*Mariana Mazzucato is professor of economics at the University of Sussex (USA). She is the author, among other books, of the entrepreneurial state(Company of Letters).

*Henry Lishi Li is a research fellow at University College London (UCL).

*Els Torreele is a visiting scholar at University College London (UCL).



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