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“We have about a year to build the necessary infrastructure”

Point of View, 14.05.2020 Forschungsgebiete

For the purpose of developing a coronavirus vaccine, the EU has raised around seven and a half billion euros through its pledging conference. In an interview, global health expert Maike Voss explains why money is not the only thing that counts.

Last week, the EU Commission convened an international pledging conference to secure joint funding for the development of vaccines and drugs to treat coronavirus. The participants pledged €7.4 billion on Monday. Is that enough?

Maike Voss: It is a start. Overall, from the development to the manufacturing and distribution of vaccines, drugs, and other medical products, it will be much more expensive. The virtual pledging conference served as a kick-start for initiating international cooperation in this area. It was therefore an important sign that as many countries as possible were coming together on the same day at the same time.

Money does not seem to be the problem. In Germany alone, the budget allocated for the corona crisis amounts to more than €350 billion.

Maike Voss: It is not solely about money. For instance, the Gates Foundation is one of the largest donors to global health and has now pledged €100 million. Of course, much more could be spent. However, the foundation is making sure that its contribution is in justifiable relation to those of other state donors. It is trying not to push itself to the fore, yet it is heavily involved. Thus, Germany pledging €525 million can be read as a sign that a great deal of support is being given, and that the country is trying to lead the debate with others.

The president of the EU Commission, Ursula von der Leyen, aimed at bringing together all the health organisations in the world under one roof. In the end, heads of state and government from 40 countries, foundations, and companies participated. The United States and Russia were absent…

Maike Voss: … and India. The big pharmaceutical companies are based in the United States, Europe, and India. Two of those big players were not at the pledging conference. This is, of course, devastating for the joint efforts against Covid-19. The absence of the United States is certainly a reflection of its declining commitment to multilateralism. India took part in a meeting of the Non-Aligned Movement prior to the pledging conference. Especially at the beginning of the crisis, the European Commission was criticised for not being able to persuade EU member states to adopt a common policy. At the pledging conference, it was given a leading role.

What does it mean for containing the pandemic?

Maike Voss: I think the pledging conference also made an impression on the countries that did not participate. This is because the participating countries are signalling: We are working together to develop more quickly a vaccine as a global public good that benefits everyone equally. Their intention is not to distribute it exclusively among themselves, but to make it available worldwide. After all, we are only safe from the virus if a large number of people are vaccinated. Consequently, those countries that do not participate would also benefit.

What are the biggest obstacles to the research and development of a vaccine?

Maike Voss: The first question is how to keep the price as close as possible to the cost of production in order to make the vaccine affordable. The granting of patents can make rapid and large-scale production difficult, which therefore delays access to a vaccine. The release of intellectual property rights, information, and data in an international technology pool as well as technology transfers can remedy this situation. At the same time, development and manufacturing costs must, of course, be reimbursed. However, the price of the manufacturer and the purchasing power of the buyer should not decide the level of access to a health good. Moreover, the question of production capacity is still open. The aim is to produce the vaccine in large quantities locally and as close as possible to the population. For all we know at present, the production sites are unequally distributed around the world and are more likely in the Global North. Solutions in the context of development policy are needed, in particular since distribution will face difficulties due to a lack of infrastructure, such as secure cold storage and supply chains.

How can a fair distribution of the vaccine be ensured once it is developed?

Maike Voss: Every euro or dollar that flows into the system must be linked to conditions for equitable access. A review mechanism is needed, ideally at the World Health Organization (WHO). WHO is the organisation that has the legitimacy and experience to do this. However, it must be provided with the necessary resources. Monitoring has to involve civil society as well, for example organisations such as Doctors without Borders. These voices were missing at the pledging conference. In many developing countries, it is local NGOs that keep health care running. We need transparency for all of this. And the pharmaceutical industry is not known for its voluntary transparency. That is why national regulations now need to be adapted – and that will not be easy, given the urgency and dependencies.

What are the priorities to ensure the equal distribution of the vaccine around the world?

Maike Voss: It is important that countries, together with WHO, start now to develop criteria for a fair distribution that is based on ethical considerations. The health workforce, civil servants, and vulnerable groups should be prioritised. In addition to epidemiological indicators, social and economic aspects play a role in global distribution, including the capability to implement and the acceptance of health protection measures, population density, the size of the informal sector, and access to water. The functionality of health systems will also be crucial – for the distribution of goods, but also to maintain health care for all. Well-trained and protected health professionals will be crucial here. We now have about one year to build the necessary infrastructure. Because that is at least how long it will take to develop a vaccine.

The interview was conducted by Çetin Demirci, member of the online editorial team.