Co-operating on Vaccines: What we must do next

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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. It aims to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge. Opinions expressed do not necessarily represent the views of the OECD.

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The lightning-speed development of the new COVID-19 vaccines could not have happened without an extraordinary level of international co-operation. But it is only the first step and there are many challenges ahead. We can succeed — but only if we continue to work closely together.

“Tackling the COVID-19 pandemic is a marathon, not a sprint.” These words from OECD Secretary-General, Ángel Gurría, underline an important fact: the rapid development of several vaccines is very good news — but it’s not time to uncork the Champagne just yet.

It is against this backdrop that we gathered together several distinguished panellists on 24 November to discuss what we can learn from the extraordinary international co-operation in global public health in 2020. This past year has seen an unprecedented sharing of cross-border research that has led to vaccine development in 10 months rather than 10 years. It has given us reason to be optimistic. It has set a benchmark for what is possible with strong political will and effective collaboration across the board. It has allowed us to dare to hope.

Watch the replay: International Co-operation and Vaccines (OECD Forum virtual series)

Panelists: Ayoade Alakija, Seth Berkley, Jane Halton, Joanne Liu, David Nabarro, Mark Pearson, and Paul Stoffels. Moderator: Anthony Gooch.

Turning hope to reality, however, means not just regulatory approval of the new vaccines, but also their manufacture and worldwide distribution. A mass immunisation programme like this is also unprecedented in scale. The logistical hurdles are immense. It will take time. And policymakers have more hoops to jump through, not least the challenge of overcoming anti-vaxxer doubt and of persuading the vaccine hesitant (explored in our earlier panel on effective public health communications on 19 November).

What did we learn during our discussion? Here are three takeaways:

1. Build cross-border, cross-sector partnerships to overcome market failure and tackle future health crises

2. Bolster co-operation — and beware collective myopia

3. Include lower- and middle-income countries in the conversation

Let’s examine this in more detail.

Multilateral or polylateral? Build cross-sector, cross-border partnerships

Fragmentation makes us all vulnerable, as the OECD’s Mark Pearson underlined from the start. Yet, it is no longer just governments that are being called on to cooperate: foundations, pharmaceutical companies and pioneering multi-stakeholder partnerships have also come to the fore to assume vital roles on the world scene. In this sense, the COVID-19 pandemic represents a case study of a shift to a new form of international cooperation, a move from multilateralism to “polylateralism”. It is demonstrating the need for co-operation across sectors, and highlighting the importance of cross-border partnerships to address public health threats of a global scale.

Gavi, for example, which roles out vaccination programmes for the world’s most vulnerable children, co-led the creation of the COVID-19 Vaccine Global Access Facility (COVAX) and Advance Market Commitment for COVID-19 Vaccines (COVAX AMC). These initiatives are helping to pool demand and resources in order to incentivise the development and manufacturing of vaccines — and ensure that poorer countries are not frozen out of the process. Gavi CEO Seth Berkley underlined the importance of close coordination and financial investment in the development, manufacture and distribution of vaccines.

However, vaccine development is typically a long and expensive process, with a high risk of failure. This erects significant barriers for commercial collaborators, posing a challenge in how we address the most pressing global public health challenges. COVID-19 may prove to be the example of how the pooling of resources and risks ensures that vaccines and other treatments get developed, even where not commercially viable. It should also be noted, said Paul Stoffels from Johnson & Johnson, that COVID-19 vaccine research and development benefited from a deep well of financial resources due to the direct impact the virus had in high-income countries.

Also on the Forum Network: From Vaccines to a Global Cure: Why international co-operation is so important for stopping COVID-19 by Mark Pearson,  Deputy Director of Employment, Labour and Social Affairs, OECD

Bolster co-operation — and beware collective myopia

The work of the Coalition for Epidemic Preparedness Innovations, or CEPI, is an example of how polylateralism can work well. CEPI was set up in 2017 with the mission of addressing market failures through the co-ordination of the type of actors mentioned above. For CEPI Chair, Jane Halton, such partnerships play key roles in bringing together a diverse range of public, private, philanthropic and civil society organisations with a collective goal: to advance, finance, coordinate — and ultimately speed up — the development of new vaccines.  It is further advancing the development of platform technologies that can help us in the fight against unknown future pathogens and emerging infectious diseases before epidemics come to materialise.

We must, however, think about how we can bolster polylateral co-operation to overcome persistent collective myopia. All eyes are now on COVID-19 because it has profoundly disrupted our way of life and inflicted severe costs on our economies and societies. As a result, CEPI  is finding it more difficult to raise funds to fight future — and potentially more lethal — pathogens.

As Seth Berkley put it, we have to learn to invest in “peacetime”. When the 2002–2004 SARS outbreak ended, the search for vaccines abruptly stopped too. It is, according to Jane, high time to stop the “cycle of panic and neglect”.

Include lower- and middle-income countries in the conversation

A further area of concern is that low- and middle-income countries are not being sufficiently consulted, according Joanne Liu and Yodi Alakija. People in developing countries are not as well informed about the development of and access to vaccines.

Yodi also pointed to the widely-held “belief” that infection rates in most African countries are lower than elsewhere, which for some governments could warrant vaccinating no more than 20% of the population. Yet our panelists made clear that we would be much more effective in dealing with COVID-19 by vaccinating the most vulnerable first anywhere in the world, rather than rolling vaccines out in individual countries. And as Joanne Liu noted, bilateral deals between higher income countries and pharmaceutical companies  may well undermine this goal. There thus remains significant room for improvement in how international policymakers co-ordinate — not only across sectors and countries, but also across continents.

The litmus test: better co-operation

Exchanging best practice, sharing know-how and learning from others’ experiences: these are core elements of international co-operation, and are what we should be aiming for. David Nabarro and Mark Pearson pointed to complacency and inadequate preparation as reasons for Europe’s second wave of COVID-19 infections. This left it with no option but to re-introduce strict mobility restrictions in November as the case count started mounting again. Successful vaccines may be coming into view, but their deployment will take time — and they do not obviate the need for sound policy and preparedness.

As populations undergo gradual inoculation in the months ahead, policymakers must also be wary of the risk of opening up a divide between those who have been vaccinated and those who have not, and the effect this may have on exacerbating inequality. We have to work harder to support local actors if we are to become “COVID-ready”, according to David. And looking further ahead, how we pool financing and risk will be critical, as will what we learn from our experiences, and the experiences of others — most notably countries in Asia.

Nonetheless, I came away from the session energised. We have seen what is possible when we work together, when we harness our collective intelligence and ingenuity to pursue a common goal. It has the power to transform the public health agenda for the longer term. And it could be a game changer in better preparing us for other global health challenges, such as cancer and the hidden pandemic of antimicrobial resistance (AMR).

We have seen what is possible when we work together, when we harness our collective intelligence and ingenuity to pursue a common goal.

In sum, we must go beyond the old public and private sector divisions. We have clear objectives and a solid foundation; we must build on this. The COVID-19 pandemic is proving to be a litmus test for international co-operation. Whether or not we pass it depends on what we do next.

Related topics

Tackling COVID-19 International Co-operation Health Vaccines

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