COVID-19 May Change How Vaccines Are Sold & Distributed – But Can New Systems Really Achieve Global Access?
(left-right, top-down) Clemens Martin-Auer, Frederik Kristensen, Thomas Cueni, Kate Elder, Ilona Kickbusch

COVID-19 has the potential to change how vaccines are sold and distributed, but industry leaders, academics, policymakers, and advocates are still struggling to decide the direction those changes should take.

A successful COVID-19 vaccine should only be sold by companies to countries if it fits within an equitable distribution platform made by a neutral third party, such as the World Health Organization, said Kate Elder, senior Vaccines Policy Advisor at the Médecins sans Frontières Access Campaign, at a webinar hosted by the European Health Forum Gastein. This year’s European Health Forum Gastein will be hosted virtually from 30 September – 2 October.

“Equitable allocation needs to be done based upon public health criteria,” Elder said. “All countries need to agree that that might mean that they’re not first in line for a certain number of doses, and pharmaceutical corporations most certainly also need to cooperate with that and not sell in a priority manner those future doses to any one country or bloc of countries.”

But Thomas Cueni, director-general of the International Association of Pharmaceutical Manufacturers and Associations, said that it is unlikely that a successful COVID-19 vaccine will follow only one global distribution method.

“The notion of a global public good means that if you can get it, I can get it. But it’s simply not the case when you have limited doses,” said Cueni. “Ideally you would have one global allocation mechanism, but unfortunately that is not likely to happen…Of course, vaccine manufacturers have to respond to where do they get the support, where they get the orders from.”

The debate around allocation of a COVID-19 vaccine comes just a day after the first meeting of the Facilitation Council for the Access to COVID-19 Tools (ACT) Accelerator, which includes a key pillar working on COVID-19 vaccines access. The COVAX Facility, an initiative within the ACT Accelerator, aims to pool global demand for a vaccine from rich and poor countries alike, pooling the risk of investing in the wrong vaccine candidate for rich countries, and providing poorer countries more negotiating power and financing.

Supply Will Definitely Not Meet Demand – Proposed COVAX Facility Design May Introduce ‘Inequity’

There will certainly be a shortage of COVID-19 vaccine in 2021, even after it receives regulatory approval, according to Cueni.

“We talk about the need for 12 to 16 billion doses of COVID-19 vaccine based on the phase 1 clinical trials,” said Cueni. “[Within the COVAX Facility], somebody told me that he is optimistic that 3 billion doses should be possible by the end of next year.

“We’re delighted to [be able to] vaccinate the health professional frontline workers. That’s 1% of the global population.”

But expanding vaccination to include all people over 65 years old, a high risk group for COVID-19 severe disease and death, then proportion of the global population that requires the vaccine increases to 8%. And vaccinating all people with comorbidities and pre-eixisting conditions, such as diabetes, which predispose them to severe COVID-19 will increase the proportion of the world population in need to 20%.

However, Cueni added that he was “optimistic” that many rich countries would join the COVAX Facility, even after signing bilateral deals outside the Facility guaranteeing millions of doses of vaccine. Compromises had to be made to attract more donors to the Facility, said Cueni.

Japan is one example so far – the country has preordered vaccines directly from Moderna and AstraZeneca, and has pledged to participate in the COVAX Facility.

But medicines access advocates say that the terms of the COVAX Facility still lean in favor of rich countries, who can pay more to choose which of the dozen vaccines in the Facility’s portfolio that they want to back, and opt out of purchases of vaccines they may not want or need.

“We now have a new option that was pushed by high-income countries for how self -financing countries can join the COVAX facility,” said Elder. “By the terms of that new option, if they pay more money up front, they get to opt out of certain deals. They get to pick and choose which deals they want to benefit from now.

“I think we do need to honestly acknowledge that by giving the initial opportunity to countries to pay more upfront and give only them the choice to pick and choose which doses they’re going to benefit from, it is introduces inequity by definition.

“If you cannot afford that upfront, then you don’t get those choices.”

Still, the COVAX Facility may be the largest ever multilateral effort to coalesce global demand for any vaccine. And the pooled procurement mechanism can be a powerful strategy to negotiate lower prices, with the European Union already negotiating deals outside of the COVAX facility as a bloc of 27 countries, according to Clemens Martin-Auer, lead negotiator for COVID-19 deals for the European Union.

Commitment Made To Mobilize Political Interest for the ACT Accelerator, but Finer Details Around Distribution Are Still Unclear

South Africa and Norway co-chaired the meeting, pledging to both galvanize political leadership to support the Accelerator and motivate countries to mobilize funds. However, details such as the governance structure of the COVAX Facility, or the exact distribution plan of a successful vaccine candidate, have not yet been hammered out.

The deadline for countries to make a binding financial commitment to the COVAX Facility is fast approaching on September 18th. So far, some 170 countries have expressed interest in joining the facility, including 92 lower-income countries that qualify for development assistance. Some large traditional global health donors, including the European Union, Germany, and Japan, have also made commitments to the COVAX Facility to help fund procurement of vaccine doses for poorer countries.

However, the United States, historically the world’s largest global health donor, has said that it will not join the COVAX Facility because it it is in part led by the World Health Organization. The Trump Administration in March began criticising the agency for allegedly bowing to pressure from China and moving slowly in the early days of the pandemic. Since then, Trump has suspended funding to the Organization, and has notified Congress and the United Nations of the US’ intent to withdraw from the WHO by July 2021. The US currently has the world’s highest coronavirus caseload, and the highest number of coronavirus deaths.

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