Widespread vaccination against COVID-19 is the most critical component in the fight against the disease, and as countries vie for access to limited initial supplies of a future vaccine, contrasting approaches from governments and vaccine producers have emerged. Without global co-operation and utilization of a comprehensive framework that would address many of the challenges anticipated in the future, vaccine deployment will likely be far from equitable. Despite the call for solidarity, some countries are likely to continue to engage in more explicit acts of vaccine nationalism, driven by domestic political imperatives.
The pace of COVID-19 vaccine development has gathered unprecedented momentum, with 17 vaccines now undergoing clinical testing. Some of these efforts are supported by national government funding, and others by global initiatives.
Given the challenges posed by interconnected supply chains and the global demand for a vaccine, some countries have engaged in activities that have been described as “vaccine nationalism” – a politicized term that has triggered debate around the ongoing efforts to secure access to a vaccine. The various initiatives and deals signed to secure vaccine access are part of a continuum, with vaccine nationalism – marked by efforts to exclude other countries from accessing vaccines or to buy promising foreign vaccine-developers – at one end, and initiatives such as the WHO’s ACT Accelerator, which focuses on sharing limited vaccine supplies globally in an equitable manner, at the other.
Other national and regional activities, such as the European Union ‘s and the African Union’s joint purchasing initiatives, fall between these extremes and typically include a nationalist element – such as advanced market commitments (AMCS ) for vaccines for their populations – that is often balanced by participation in international fund-raising initiatives to provide vaccines for low-income countries. Securing revenues through vaccine AMCs is important for pharmaceutical companies given the considerable risks of research and development failure, as well as the pricing and intellectual property protection pressure that any future COVID-19 vaccine will face. These deals are therefore considered crucially important for accelerating vaccine development.
However, reputational risks for the industry are highly significant. Most pharmaceutical companies will face incredible scrutiny over how and where they launch any successful vaccine. In the current climate, the pharmaceutical industry must follow a strategy that enables it to remain on productive terms with governments worldwide by spreading out vaccine access, while also ensuring that it honors AMCs and advanced purchase agreements.
Outlook and implications
Reputational risks for the industry are highly significant. AMCs provide companies with critical funds to invest in R&D and are therefore crucially important for accelerating vaccine development.
As funding is poured into vaccine development to bring a COVID-19 vaccine to market, it is important to remember that the world is facing major challenges. First, the accelerated timelines may not be sufficient to provide complete data from Phase III trials to show that a vaccine is safe and efficacious. There are also various rate-limiting supplies and raw ingredients, such as glass vials and needles, that are likely to prevent the expansion of manufacturing to meet global demand, at least initially. Furthermore, after securing manufacturing capacity, the deployment of such large quantities of vaccines globally will pose another major hurdle.
IHS Markit assesses that full approval and wide availability of a vaccine – on a global scale and with a meaningful impact on “the return to normal” – is unlikely to be possible until the summer of 2021. There will certainly be a need for several vaccines, which will be adopted both regionally and demographically, each with its own safety and efficacy profile, and its own strength of evidence. Challenges could also arise in vaccine supply further down the line, even for countries that successfully deployed the first batch as vaccines may only provide protection for a short period, potentially requiring periodic boosters. Meanwhile, although it has been relatively stable so far, SARS-CoV-2, an RNA virus, is susceptible to mutations and, there is no guarantee that the vaccines currently in development will retain their efficacy over time.
Without global co-operation and utilization of a comprehensive framework that would address many of these challenges in the coming months and years, vaccine allocation and prioritization will likely be far from equitable. Despite the call for solidarity, some countries are likely to continue to engage in more explicit acts of vaccine nationalism due to domestic political imperatives, particularly in the run-up to internal elections. Others may do so more subtly in the pursuit of economic objectives, fully aware that being the first to successfully use a COVID-19 vaccine could enable them to lift social restrictions and more quickly restart their economies.