Wanted: global co-ordination to make a COVID vaccine accessible to all

The race to get to the COVID vaccine first is well under way. It pits not just pharmaceutical companies against each other, but also country against country, as each government finances its own champion in the hope of securing preferential access to the treatment for its citizens.

The AstraZeneca-Oxford team has committed to allocate 30m doses of its hypothetical first batch of a vaccine to the UK. Last week, French firm Sanofi said its vaccines would go the US first as a payback for funding Washington provided.

This race is at odds with the oft repeated call for the coronavirus vaccine to be made available first not to those who pay the most, but to those who need it the most. This worthy principle could become a reality, but only through the creation of a global coronavirus fund vastly more ambitious than existing initiatives, and the commitment of all countries to international cooperation.

Two principles of action should guide our global efforts to develop, produce and allocate the vaccine.

First, diversifying the portfolio of research avenues is crucial. The World Health Organization lists a hundred initiatives aiming to develop a vaccine. They use a wide range of scientific methods; it is impossible to predict which will prevail. This diversity is a strength because it maximises the probability of getting a vaccine faster. But since most attempts will not be successful, it is essential that each country has access to the potential discoveries of many different initiatives. That will only happen if nations commit to sharing vaccines produced by any successful methods. Without it, luck may determine who gets treated: if the AstraZeneca-Oxford project fails but a US-backed effort is successful, should UK citizens be vaccinated months (or years!) after the US? In the absence of a multilateral architecture coordinating vaccine access globally, price wars may also ensue, with countries out-bidding each other to get the vaccine first.

The second principle is to invest today to speed up the distribution of vaccines tomorrow. The vaccines currently under study require very different production methods and substantial investments that private actors will not undertake if the returns on their investment is very uncertain. It is essential to subsidize these investments so that production and distribution networks are operational as quickly as possible. Such investments must begin today, without waiting for the end of clinical trials and including for vaccines whose viability remains uncertain. It is worth the effort: based on data from the WHO and the IMF, a team led by Michael Kremer (Economics Nobel Prize winner in 2019) estimates that speeding up the distribution of a vaccine on a large scale by just a month would save 200,000 human lives and $375bn worldwide.

How could these principles be put in practice? Previous successes in financing vaccines suggests a global fund is the best solution. This fund would commit to purchasing a large number of vaccines from manufacturers to meet the needs of vulnerable populations in all member states on the basis of a pre-established purchase price. It would also subsidize the development of manufacturing capacity in parallel with clinical trials. To ensure its diversification, the fund would support the development of around twenty vaccines in parallel. This mechanism would thus provide adequate financial incentives to private actors while ensuring participating countries benefit from the outcomes of multiple research efforts.

Estimates of the cost of such an approach can be obtained by using comparable recent vaccination campaigns. It is estimated that around 140 bn euros would be needed to meet global needs, or 0.17% of world GDP. 45 bn would be spent on the purchase of vaccines at a predetermined price of 35 euros for the first billion vaccines produced and 5 euros for the following. To encourage rapid progress, this price would be guaranteed only for vaccines produced within 18 months. In parallel, 95 bn would be dedicated to the co-financing of production capacity. In return, participating manufacturers and research centers would have an obligation to share progress and data, notably the results of clinical trials. This system would work like a gigantic insurance fund by diversifying risks for all, benefiting everyone.

This fund would be funded by an entry fee which each state would pay based on its wealth and population. Developing countries could pay this amount through loans obtained from the World Bank, or with the support of public or private donors. Each nation would have an incentive to join to guarantee access to the first batch of the future vaccine, which will be distributed based on a collectively agreed allocation rule. This rule should be based on at least three factors: the size of the population at risk, the number of front-line health staff, and the tally of confirmed COVID-19 cases.

This ambitious approach is within our reach - if we act now. The Global Vaccine Summit, hosted by the UK last week, raised 500 milion euros to provide access to COVID-19 Vaccines for low- and middle-income countries. This is a start, but this amount is small compared to the amounts governments in rich countries have bilaterally agreed to pay individual pharmaceutical companies for privileged access to their hypothetical vaccines. The number of human lives on the line, and the economic cost of an uncoordinated ‘race to the vaccine’ between competing countries, mean we should do better, and do it fast.

Lucie Gadenne, Associate Professor of Economics, University of Warwick and CAGE Deputy Theme Leader, Culture and Development

Xavier Jaravel, Associate Professor of Economics, LSE