Despite thousands of experts working faster than ever before, it is still going to be at least a year before any licensed and widely distributed COVID-19 vaccines become available, if we’re lucky to have some of the first ones work. Although there are more than 200 in development, there’s normally only about a 7% chance that a candidate vaccine in preclinical development will ultimately prove to be both safe and effective, so the majority are likely to fail. In vaccine development, that is to be expected. But given the urgency in the context of the current pandemic, the uncertainty it brings creates the potential for a deadly zero-sum game.
We desperately need COVID-19 vaccines to end this crisis, and with so many in development we can be optimistic about getting at least one. But if governments end up competing for them, backing individual vaccines in the hope that they have picked a winner, then one country’s gain will mean many more countries missing out. Moreover, regardless of which vaccines succeed, if we don’t also take a more global and multilateral approach, one involving unprecedented collaboration, where countries work together with global health agencies toward COVID-19 vaccines and where the rewards are shared, then ultimately we all stand to lose. Because with infectious disease, no one is safe until everyone is safe.
Given that many governments are now in bilateral negotiations with manufacturers to secure the doses they need, even before it is known whether the vaccine will succeed, we are now at a critical juncture. Governments have a duty to make the protection of their citizens their first priority, but with infectious diseases like COVID-19 that can only be achieved by protecting others too. By taking a purely “me-first,” bilateral approach, not only do those governments risk ending up with no vaccines at all, but they also expose their citizens to the risk of resurgence by leaving the majority of the world to go without.
There is, however, a way for governments to have their cake and eat it too. The COVAX Facility, which Gavi launched in early June, is a financing instrument designed to make that possible for all countries. The facility effectively serves as an insurance policy that will increase their chances of getting successful COVID-19 vaccine doses, even if the one they backed fails. It also assures that there will be enough doses to go around, initially to protect some of the highest-risk groups, so that other countries get access too, including those that would otherwise be unable to afford it—particularly low- and lower-middle-income countries. It is a win-win solution.
The COVAX Facility will achieve this by pooling resources to simultaneously back the development and manufacture of a larger and more diverse range of COVID-19 vaccines than could otherwise be achieved by any individual or group of governments. This includes nine vaccine candidates that have been supported so far by Gavi’s partner, the Coalition for Epidemic Preparedness Innovations (CEPI), but the facility will also be extended to other manufacturers not currently working with CEPI. By having such a large portfolio, the facility greatly increases the chances of getting a successful candidate. And by investing in the scaling up of manufacturing capacity in advance, the facility at the same time will ensure that more doses of a successful vaccine can be made immediately available. This element of the strategy acknowledges the absolute truth that there is no scenario where there will be enough doses for everyone in the next 18 months, so we need to be sure we use these doses as strategically as possible to help mitigate the pandemic and make access more equitable.
This last point is absolutely critical. The COVAX Facility is part of a wider effort to accelerate the development of much needed diagnostics, therapeutics, and vaccines for this novel coronavirus, with a particular emphasis on equitable access. For the small number of countries that pay into it that have already secured deals with manufacturers, the COVAX Facility is an insurance policy, a backup in case their Plan A fails. But for those that have been unable to secure bilateral deals—that is, for the vast majority of countries in the world—and for those that cannot afford to do so, which together represent roughly half the world’s population, it is the only way to ensure that they will get access to COVID-19 vaccines.
Timing is crucial. The effort can only work if governments get on board now. It takes time and money to scale up manufacturing. In order to have doses available when vaccines get licensed, we need to start investing immediately. Normally vaccine manufacturers are reluctant to risk making such investments until they know they have a licensed product. After all, it can cost around half a billion dollars and considerable time to build and get regulatory approval for just one vaccine manufacturing plant.
The COVAX Facility will avoid such delays, by encouraging manufacturers to scale up in advance through “push” and “pull” financial mechanisms. “Push” financing comes in the form of direct catalytic investment in research and development, and in production, while “pull” mechanisms will provide manufacturers additional incentives to scale up, through advance commitments to purchase substantial volumes of a successful vaccine.
Given that the majority of the vaccine candidates in development won’t succeed, there are obvious risks here. But by pooling resources and sharing the risks, we increase our collective chances of succeeding, and stand to share the rewards if we do. When governments pay into the COVAX Facility, with Gavi and CEPI at the helm, they not only get access to the largest portfolio of COVID-19 vaccines that exists, but they also get to be part of the global solution to this pandemic.
For that reason, this is an insurance policy like no other, because it is one we will want and need to redeem. With more than 10 million cases and over half a million deaths already, this pandemic is showing no signs of abating. What’s more, given that the disease’s cost to global GDP has been estimated by the International Monetary Fund to reach $375 billion per month, moving the availability of a vaccine forward by just five days will pay for the entire global effort—and we are trying to move it forward by six to eight months.
There’s still no guarantee that any of these vaccines will work, but if we want to end this crisis and the suffering, and get global economies back online any day soon, then they are our best hope. That means pooling our resources to invest in as many vaccines as possible, and if successful, ensuring that we have enough doses to secure global impact. Ultimately, this is a global problem that needs a global solution.
Dr. Seth Berkley is CEO of Gavi, the Vaccine Alliance.
