Blog written by Jean-Hervé Bradol, director of studies at the Crash. 

Today, in order to obtain supplies of vaccines against Covid-19, there is neither a major difficulty related to price, nor a major obstacle related to intellectual property rules, nor a deficit in bio-medical research. However, these three topics are generally at the heart of MSF's communication in the area of access to medical care for those in most need. Our discourse must therefore evolve.

With the emergence of worrying variants of the virus present in the early stages of the pandemic and, as a consequence, the need to vaccinate on a global scale as quickly as possible, the world is facing a double challenge: biological engineering and ultra-industrial production – “ultra” echoing the need to produce on a global scale in a short period of time.

Two false problems

In the face of a public safety crisis, leaders may decide to activate intellectual property exemptions for vaccine procurement. Indeed, States possess all the legal tools at the national and international levels to take the initiatives they deem necessary to ensure collective security; they do not deprive themselves of these tools, judging by the current state of our individual liberties.

If patents are not a barrier to access to vaccines, neither are price levels. Vaccines against Covid-19 are not expensive, and the share of vaccines in the "cost of the pandemic" is of little importance - the denominator is so high that the numerator is relatively low. For example, the total amount pledged by France for its 67 million inhabitants for the Covid-19 response is 86 billion euros. If one bought 180 million doses at 10 euros for France, one would spend 1.8 billion, or 1.8 out of 86, or 2% of the total public expenditure for Covid-19. Not an excessive amount to prevent the economy from continuing to plummet. And even if the State had to commit this expenditure every year, it would remain feasible and economically interesting.

Biomedical uncertainty

A few weeks ago, hopes were expressed as follows: limiting and protecting human-to-human contacts; treating severe forms of Covid-19 in hospital and in intensive care units if needed and possible; detecting and isolating positive cases as well as contact cases; prioritizing vaccination of most-at-risk groups; and in parallel waiting for the arrival of herd immunity to ensure a return to an acceptable level of economic and social activity. The cards have been reshuffled with the arrival of variants on all continents, threatening to accelerate the transmission of the virus and render certain diagnostic tests, antibody treatments and vaccines obsolete. Today, the main uncertainty is therefore biological. No one can say whether researchers will be skilled enough to follow the evolution of the viral genome at the pace it imposes.

A supply problem

Biological uncertainty complicates the difficulty of producing and distributing supplies on a global scale. It is likely that in order to obtain such volumes in such a short period of time (several billion in less than a year), States must become involved in industrial activities one way or another. However, MSF has little knowledge on this subject and therefore cannot express any opinions. We could also learn from Sanofi; this company is well placed to teach us about the constraints of providing industrial support for the production of a vaccine developed by others. Pfizer's vaccine, produced in part with Sanofi's participation, is scheduled for distribution in July 2021.

What is the current status in different countries?

While the national and continental situations are diverse, the short-term trend is towards vaccination on all continents. Some (UK, Israel, USA...) have understood the strategic dimension of vaccine supply and have agreed to spend further by buying more expensive vaccines earlier in order to ensure that they can launch their national pandemic project. Other countries, such as Russia and China, had already made significant investments to guaranty their autonomy of action within their national framework and to ensure international outreach with their Covid-19 vaccines. About 100 countries, including Japan, have not started vaccinating. The African Union is working to secure its access to 300 million doses. The WHO is trying to activate a mechanism adapted to low-income countries. Algeria and Chile have started vaccination.

Too early to judge?

In this general picture, where information on the commercial and industrial dimension is evolving daily, one cannot judge the consequences that the problems of access to vaccines encountered by EU members in the first quarter of 2021 will have at the end of the year. It is also difficult to assess the effectiveness and efficiency of early vaccination campaigns, given that the time frame envisioned for their implementation is approximately 6 to 9 months for countries with significant resources. However, in order to appreciate the speed of this unprecedented attempt to carry out emergency vaccinations on all continents, and with antigens that were still unknown a few months earlier, one has to remember very different situations. At the end of the 1990s, it took 5 years (1996-2001) for countries with limited resources to prescribe HIV triple therapies. 

An operational subject

Given the context, we should avoid intervening in the public debate to recommend general solutions such as intellectual property reform, instead focusing on concrete, local vaccination actions. For example, vaccinating caregivers and at-risk groups, within a reasonable timeframe, in a country like Malawi where we are already treating cases! This would ground our discourse on barriers to vaccine supply into reality, based on experience that matches our skills and capacities.    

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Faced with the emergence, or resurgence, of the Covid-19 epidemic, many countries where MSF works, particularly in sub-Saharan Africa, do not yet have access to the vaccines they need to protect the populations most at risk. Isabelle Defourny, director of operations at MSF, and Jean-Hervé Bradol, director of studies at the CRASH, give their analysis of the inequalities in access to Covid-19 vaccines and the main areas of intervention for MSF in this field. This video is a shorter version of the original interview, which is currently only available in French. 

THIS BIOMEDICAL INSTABILITY IS COUPLED WITH AN INDUSTRIAL UNKNOWN AND THEN A LACK OF POLITICAL CLARITY, I.E. WHICH GROUPS SHOULD BE CONSIDERED AS PRIORITIES? WE SAY THE CAREGIVERS BUT ALSO SOME COHORTS OF CHRONIC PATIENTS WHO ARE AT RISK. WHAT WE DON'T WANT IS TO SACRIFICE HEALTH CARE PERSONNEL IN THE LEAST AFFLUENT COUNTRIES AND A FEW COHORTS OF CHRONIC PATIENTS FOR A HYPOTHETICAL COLLECTIVE IMMUNITY IN COUNTRIES THAT ARE MUCH MORE AFFLUENT.