Financial differences, legal hurdles and supplies limit efforts to immunize the world – 17/05/2021 – World

By delivering vaccines, pharmaceutical companies, with the help of monumental investments from governments, have given mankind the miraculous possibility of ridding itself of the worst pandemic in a century.
But the rich countries took a huge share of the profits. Only 0.3% of vaccine doses administered globally went to the 29 poorest countries, where about 9% of the world’s population live.

Vaccine makers say a solution is at hand, as they aggressively expand production lines and contract with companies around the world to produce billions more doses.

Every month, 400 to 500 million doses of vaccine are produced at Moderna, Pfizer and Johnson & Johnson laboratories, according to a US official briefed on global supply.

But the world is far from having enough. About 11 billion doses are needed to immunize 70% of the world’s population, the minimum amount to achieve herd immunity, according to an estimate by researchers at Duke University. But so far only a fraction of it has been produced. While global production is difficult to measure, analytics firm Airfinity estimates the total so far at 1.7 billion doses.

The problem is that many key raw materials and equipment are still scarce. And the global need for vaccines could be much greater than is estimated today, as the coronavirus represents a moving target: if dangerous new varieties emerge – requiring booster doses and reformulated vaccines – the demand could. increase considerably, intensifying the need for each country to ensure the supply of its population.

The only way to get around the competition is to dramatically increase the global supply of vaccines. On this point, almost everyone agrees. But what’s the fastest way to do this? There, divisions remain firm, undermining collective efforts to end the pandemic.

Some health experts say the only way to avoid disaster is to force the drug giants to loosen control of their secrets and involve many other manufacturers in vaccine production. Instead of the existing deal – in which pharmaceutical companies form partnerships on their terms and set vaccine prices – world leaders could coerce or convince industry to cooperate with more companies to produce more doses at lower prices. affordable prices.

Those advocating this intervention focus on two basic approaches: ditching patents to allow more manufacturers to copy existing vaccines, and requiring labs to transfer their technology – that is, teaching others manufacturers to copy their products.

The World Trade Organization (WTO), arbiter of international trade disputes, is the venue for negotiations on how to proceed. But the institution operates by consensus, and so far there is none.

The Biden government recently joined more than 100 countries in asking the WTO to partially set aside vaccine patents. But the European Union has indicated its intention to oppose the granting of patents and to support only voluntary technology transfers, basically assuming the same position as the pharmaceutical industry, whose aggressive lobbying has shaped much of the process. rules in its favor.

Some experts warn that repealing intellectual property rules could dramatically disrupt the industry, slowing its vaccine delivery efforts – it would be like reorganizing firefighters in the middle of a big fire.

“We need it to increase production and deliver,” said Simon Evenett, trade and economic development specialist at the University of St. Gallen in Switzerland. “We have this huge increase in production. Nothing should stop it from threatening it.”

Others say relying on the pharmaceutical industry to deliver vaccines to the world has helped create the current divide between those who have and don’t have vaccines.

The world should not put poor countries “in this position of having to essentially beg or wait for donations of small amounts of vaccines,” said Chris Beyrer, senior scientific liaison at the Covid-19 Prevention Network. “The model of charity is unacceptable, I believe.”

In this climate of fracture, WTO leaders are shaping their procedures less as an effort to formally change the rules and more as a negotiation that will convince national governments and the global pharmaceutical industry to agree to a unified plan – ideally within months. to come up.

Europeans are betting on the idea that vaccine makers, fearing patent breaches, will end up accepting transfers, especially if richer countries give them money to make sharing more acceptable.

Many public health experts say that patent waivers will have no significant effect unless manufacturers also share their manufacturing methods. Opening patents is like publishing a complex recipe; technology transfer is like sending a chef to teach you how to cook a dish.

“For you to be able to manufacture vaccines, you have to make several things work at the same time,” WTO Director-General Ngozi Okonjo-Iweala recently said. “If there is no technology transfer, it will not work.”

Even with the waivers, technology transfer and increased access to raw materials, experts say it would take around six months for more manufacturers to start shipping vaccines.

The details of any plan to increase immunization globally may be less important than the overhaul of the incentives that caused the current situation. Rich countries, especially in the West, have monopolized most of the vaccine supply not by chance, but because of economic and political realities.

Companies like Pfizer and Moderna have made billions of dollars in revenue selling most of their doses to wealthy governments in North America and Europe. The agreements left very few doses available for Covax, a multilateral partnership created to get vaccines to low- and middle-income countries at relatively low prices.

Changing that calculation may depend on convincing rich countries that allowing the pandemic to follow its onslaught across much of the world poses universal risk, by allowing variants to take hold, forcing the world into an endless cycle of upgrading. pharmaceutical day.

“World leaders must act together, affirming that the vaccine is a form of global security,” said Rebecca Weintraub, a global health specialist at Harvard Medical School. She suggested that the Group of the Seven Richest Countries lead the campaign and fund it when members meet in Britain next month.

Whether the world has a sufficient number of underutilized and adequate factories to rapidly increase production and overcome inequalities is a hotly debated question. At a WTO vaccine summit last month, the body heard testimony that factories in Pakistan, Bangladesh, South Africa, Senegal and Indonesia have the capacity that could be quickly mobilized to produce vaccines for Covid.

Canadian company Biolyse Pharma, which focuses on anti-cancer drugs, has already agreed to supply 15 million doses of the Johnson & Johnson vaccine to Bolivia – if it obtains legal clearance and technological expertise from Johnson & Johnson.

But even big companies like AstraZeneca and Johnson & Johnson have stumbled, falling short of production targets. And the production of the new type of mRNA vaccines, such as those from Pfizer-BioNTech and Moderna, is complicated. Where pharmaceutical companies have made deals with partners, the pace of production has often disappointed.

“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Krishna Udayakumar, director of Duke’s Center for Global Health Innovation. Much of the vaccine manufacturing capacity is already being used to produce other vital vaccines, he added.

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