On 15 October 2020, Baroness Sheehan will ask the Government about equal access for low and middle income countries to any future vaccine for Covid-19.

Covid-19 vaccine: where are we?

As of 2 October 2020, 42 vaccine candidates are in the clinical evaluation stage of development. Of these, 10 are in phase 3 trials. Phase 3 involves large-scale clinical trials involving tens of thousands of people, designed to test the safety and effectiveness of a vaccine candidate.

Candidates that have reached this stage include the University of Oxford/Astrazeneca’s candidate, which is undergoing phase 3 trials in the United States, and the Moderna/National Institute of Allergy and Infectious Diseases (NAID) candidate, which uses a new synthetic mRNA technology that some scientists say is faster and cheaper than traditional vaccination methods.

Scientists are divided over when a vaccine will be ready for distribution. Some predict results from phase 3 could be available in late October, while others state that mid-2021 is a more realistic expectation. Once results from phase 3 are available, regulatory approval could be granted within a month (although this may differ between countries), with a subsequent six-month period before a vaccine is ready for public distribution. Planning has already started on how to distribute the vaccine in many countries, with the World Health Organisation (WHO) publishing guidance on how vaccines should be allocated and prioritised.

Why are low and middle income countries at risk?

Mass pre-ordering amongst richer countries has led to concern about ‘vaccine nationalism’. This could lead to the initial supply of a successful vaccine quickly becoming unaffordable and inaccessible to those in low and middle income countries. The UK has pre-ordered around 380 million doses from a variety of global manufacturers.

Although almost 200 vaccine candidates are currently in development, the chances of an individual candidate succeeding and entering mass manufacture and distribution remain very low. Competition among states for supplies of a successful candidate is already fierce. Countries with greater economic resources have already pre-ordered hundreds of millions of doses of multiple candidates, before regulatory approval has been granted on any one vaccine. According to research conducted by Oxfam, higher-income states covering 13% of the population have already bought around 51% of the potential vaccine supply.

Sheuli Porkess, director at the Association of the British Pharmaceutical Industry, told the British Medical Journal (BMJ) that:

once a vaccine is discovered, demand will outstrip initial supply. […] We need highly coordinated and collaborative action by the public and private sectors […] to ensure equitable access for Covid-19 vaccines at global and national levels.

How will low and middle income countries receive a Covid-19 vaccine?

In April 2020, the WHO launched the Access to Covid-19 Tools (ACT) Accelerator, a “global collaboration to accelerate development, production, and equitable access to Covid-19 tests, treatments, and vaccines”.

The third pillar of this collaboration, the Covid-19 Global Vaccine Access Facility (COVAX), “pools resources and manages risk” for countries in delivering a Covid-19 vaccine to their populations. Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, has stated of COVAX:

it is the only effort to ensure that people in all corners of the world will get access to Covid-19 vaccines once they are available, regardless of their wealth.

COVAX is a self-funding mechanism, where higher-income countries contribute funding. Berkley has stated:

doses will be distributed equitably as they become available between the self-financing countries that will pay for their doses and developing countries that would otherwise be unable to afford to pay for the vaccine.

Some funding has also been secured from the private sector. For higher-income countries, Berkley has called COVAX a “classic insurance policy”, increasing likelihood of obtaining more doses of a successful vaccine, as well as pooling the licensing process.

The COVAX facility has so far spent $895m on securing nine different vaccine candidates that will be distributed through the programme. Its aim is to deliver 2 billion doses to its members by the end of 2021.

As of 21 September, 64 higher-income countries have joined COVAX, including Germany, Japan and countries represented by the European Commission. At the same time, 92 middle and lower income countries are eligible for financial support in accessing a vaccine, through the Gavi Advance Market Commitment for Covid-19 Vaccines (COVAX AMC). Combined, this spread of 156 countries covers around 64% of the global population.

Have concerns been raised about COVAX

While many have praised COVAX for its attempts to limit vaccine nationalism and to ensure more equitable distribution of vaccines, others have raised concerns. These include:

  • COVAX does not prevent countries signing their own bilateral deals with manufacturers, which states including the UK continue to do; and
  • it does not go far enough in its aim of 2 billion doses by the end of 2021, particularly as two to three doses of a vaccine may be needed to provide immunity.

Additionally, not all higher-income countries have signed-up to COVAX. The United States has declined to join, citing a desire not to be “constrained by multilateral organisations influenced by the corrupt World Health Organization and China”. Russia has also declined to join. China, while publicly supporting the aims of COVAX, is yet to fully commit.

What is the UK Government doing?

The UK Government has signed-up to the COVAX facility. In a speech on 30 September, the Foreign Secretary, Dominic Raab, stated:

We want to be able to ensure large-scale manufacturing, rapid delivery of the future vaccines globally and on an equitable basis. I’m very proud that the Prime Minister has announced the UK’s participation in the COVAX facility, which demonstrates our commitment to multilateral solutions to the global challenges that we all face.

The Foreign Secretary went on to state that the UK has committed £250m to COVAX, and will add an extra £1 for every $4 committed by others, up to an additional £250 million.

The Shadow Secretary of State for International Development, Preet Kaur Gill, has written to the Foreign Secretary, welcoming the Government’s decision to join the COVAX facility. However, she also highlighted several concerns, and called for the Government to:

  • push for transparency in any agreement Gavi (on behalf of COVAX) reaches with pharmaceutical companies;
  • ensure that companies the COVAX facility buys from make the vaccines available at a fair price; and
  • ensure the funding arrangement inherent in the COVAX AMC doesn’t require low and middle income countries to direct their resources away from other routine immunisation programmes.

What has happened in the Lords?

On 24 July, Baroness Sheehan asked the Government what plans they have to ensure that a Covid-19 vaccine is available to, and affordable for, low and middle income countries. Baroness Sugg, answering for the Government, stated:

My Lords, our best chance of defeating this virus is by working together globally to develop a mass-produced vaccine that is accessible and affordable to all. The UK absolutely supports a global approach to the rapid development and scaled-up manufacture of vaccines, with equitable access to all who need them.

In her response, Baroness Sheehan stated:

Gavi has taken no action to tackle intellectual property barriers to ensure access for all. The Government cannot assume that access, supply and affordability will simply be dealt with by others through the WHO ACT-Accelerator.

Photo by Giacomo Carra on Unsplash.