With pharmaceutical companies now rolling out effective vaccines for Covid-19, how do we ensure these are distributed fairly? In our previous article in this series we touched on how combatting Covid-19 will rely on ensuring equitable access to medicines, with multi-stakeholder partnerships a successful model for addressing global health challenges. In this article, we explore how inequitable access to Covid-19 vaccines will only prolong the pandemic, and outline our expectations for pharmaceutical companies.
Covid-19 has exposed inequalities both within and between countries. Disparities in access to quality healthcare and the ability to adapt to social distancing heightened the impact on marginalised groups. For example, in the US people of colour suffered higher rates of Covid-19 cases, hospitalisations and deaths, while as of 30 November black and Hispanic or Latinx people were 2.8 times more likely to die from Covid-19 than white people. On a global scale, lower-income countries are vulnerable due to a lack of resources and weaker health systems.
The recent advances in Covid-19 vaccine development have increased the focus on vaccine distribution. In this pandemic a global solution is needed because without one, people will be left unprotected, allowing the virus to continue to thrive. However, lower-income countries may not be able to secure enough vaccines as they are competing with higher-income countries for a limited supply.
Before any vaccines were approved for use, countries had already entered into purchasing agreements with pharmaceutical companies for successful vaccines. A global assessment of these agreements conducted by Duke Global Health Innovation Center published in early November revealed that 3.8 billion doses had been purchased by higher- and middle-income countries. For example, Canada, Australia and Britain have each purchased enough vaccines for five or more doses per person, and the United States could eventually control 1.8 billion doses or a quarter of the world’s near-term supply. This advanced purchasing, driven by manufacturing capacity, wealth disparities, self-interest and politics, threatens equitable vaccine access, which can delay Covid-19 protection for everyone.
Low-income countries may also lack the necessary infrastructure, capacity and technologies to store and distribute vaccines, especially if they require extreme cold storage such as the vaccine developed by Pfizer. Therefore, only certain vaccines may be suitable for these countries.
To provide equitable access to Covid-19 vaccines and end the acute phase of the pandemic, the World Health Organization (WHO), Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI) launched COVAX, an end-to-end solution for vaccine development, manufacture and supply. Two-thirds of the world is engaged in COVAX, which aims to have two billion vaccine doses available by the end of 2021. This is enough to cover high-risk people and frontline healthcare workers, to distribute to participating countries who will all have equal access. While COVAX may be the only way that lower-income countries can afford Covid-19 vaccines, the Duke assessment found that several COVAX signatories were entering purchase agreements for vaccines as side deals, undermining the intentions of the pact.
Our engagement expectations
We expect pharmaceutical companies, both those involved in developing a vaccine and those that are not, to develop and implement an effective access to medicines strategy. The strategy should be integrated into a company’s core business operations and include elements such as pricing, and research and development. Our engagement on access to medicines supports the UN Sustainable Development Goal (SDG) 3, focused on Good Health and Well-Being.
In relation to Covid-19, a pharmaceutical company with an effective access to medicines strategy would be better positioned to provide more equitable access to its vaccine than one without such a strategy. As stressed in our previous article in this series, multi-stakeholder partnerships are a successful model for addressing global health challenges. Additionally, given the large demand for Covid-19 vaccines, pharmaceutical companies need strong product governance to ensure both sufficient quantity and quality.
As we continue to engage, we face challenges around government involvement. As we noted earlier, countries have already entered into purchase agreements with vaccine manufacturers. Beyond the pandemic, companies engage with governments through their public policy, lobbying efforts, and trade association memberships. We urge companies to improve their disclosure on these activities and demonstrate how the public policy positions of the associations of which they are members align with their own stated positions. The public will also need to be educated on the safety and efficacy of Covid-19 vaccinations to ensure a strong take-up rate, and companies - including those in the technology industry - have a role to play in dispelling disinformation campaigns.