As wealthy nations ensure themselves a sufficient supply of vaccines, there are concerns the hoarding could lead to vaccine nationalism and a shortage for others.
Health experts have for months voiced concern that countries boasting financial horsepower, might stockpile coronavirus vaccines for their own use before they are spared for people in low and middle income nations. Fears have now become reality.
In the last few days, the United States, the United Kingdom, and others have signed agreements with pharmaceutical companies that are in the advanced stages of vaccine testing.
The biotech firm, Moderna, is in talks with the US government, while AstraZeneca has deals with Germany, France, Netherlands and Italy. The UK government has secured 60 million doses from Glaxosmithkline and Sanofi, in addition to millions of shots of vaccines being developed by Pfizer and BioNTech.
“There is a bit of a global bidding war going on where the companies are making a nice chunk of money selling vaccines - that actually don't exist yet - to wealthy countries,” says Ellen 't Hoen, director at Medicine Law and Policy, an NGO which advocates for affordable drugs.
Even in cases where a pharmaceutical company has sub-licensed a patent to a producer in a developing country, “vaccine nationalism” is taking priority when it comes to distribution.
AstraZeneca has licensed the Serum Institute of India to produce a billion doses of its vaccines to be sold to other developing countries. But Serum’s CEO, Adar Poonawalla, has already said whatever is made at the Pune-based producer will first go to meeting the domestic needs of India’s billion-plus population.
Governments choosing to prioritise their own people could lead to disruptions in global supply chains, as seen when countries started to hoard face masks and medical protective gear at the start of the pandemic.
Vaccines, which work by enhancing the immune response to the virus, generally take years to be developed. The urgency to deal with coronavirus, which has already killed more than 673,000 people worldwide, has forced developers to compress the process into months.
That has partly been made possible by the billions of dollars in funding that vaccine-developers have received from tax-payers in rich countries. For instance, Washington has invested around $1bn in Moderna’s vaccine.
Moderna, Pfizer, and Merck have already told a US congressional hearing that they intend to make a profit on their vaccines.
They have refused to sell the drug at cost despite warnings by public health experts that this will not help permanently beat the coronavirus.
However, even in cases where companies such as AstraZeneca and Johnson & Johnson have said they do not intend to seek profit in exchange, a lack of transparency in the deals has left questions about the eventual impact on low and middle income countries.
Is $20 per dose a lot?
The exact financial details of the agreements so far signed between pharmaceutical companies and rich countries have not been made public.
According to a Financial Times report, the price of some of the trial vaccines could range between $3 to $30 per dose. Pfizer and BioNTech are looking to sell to the US government at $19.50 per dose.
The question is, could a price tag of $20 per dose, which translates roughly as 7,650 Nigerian naira or 3,300 Pakistani rupees, too much to ask?
“Yes,” says Hoen. “Especially as we don't know if it is a one-shot vaccine or it has to be repeated or how often it has to be repeated.”
“A $20 vaccine for a lot of low and even middle-income countries, considering that you have to vaccinate your entire population, can amount to an enormously hefty bill.”
Another problem that could emerge from the way this is handled is that middle-income countries, such as Pakistan and South Africa, might stand to be the biggest losers since they qualify for donations.
A World Health Organisation-led initiative calling on pharmaceutical companies to publicly share patents, does not seem to be going anywhere. Big pharma has refused to share its intellectual property with governments and companies in developing countries - it wants to make money.
Hoen, who helped set up the United Nations-backed Medicine Patent Pool (MPP) ten years ago, says the initiative can help save millions of lives, as in the case of HIV-AIDS drugs, which saw a drastic drop in their prices when patents were shared and production increased subsequently.
“We know that such a model can work and we know what it can deliver,” she says.