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.
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When Scottish scientist Alexander Fleming discovered penicillin nearly a century ago, he sensed he was on to a good thing. Fleming made his discovery in 1928, but despite the promise of limited tests early on, it would take more than a decade for two other scientists, Ernst Boris Chain and Howard Walter Florey, to develop penicillin into an antibiotic drug and prepare it in sufficient quantities for mass distribution. Since the 1940s penicillin has been used around the world to cure a range of dangerous bacterial infections, including pneumonia, and the breakthrough earned all three scientists the Nobel Prize in 1945.
Today, as the world hunts for a vaccine to stop the new brutal disease of COVID-19, a key question everyone is asking is just how quickly a vaccine can be found and distributed.
Over 30 million people have been infected by COVID-19 since it surged in December 2019, and by the time of writing around one million people have died from it. More infections, more deaths, and more disruption to our economies and our societies seem inevitable, that is, unless we find a cure fast.
Just how soon a truly safe and effective vaccine will be made available remains uncertain. And when found, will everyone be able to benefit from it quickly and at an affordable cost?
The good news is that the search for a vaccine gives reason for optimism, with as many as 200 candidates under investigation, and some firms, researchers and governments already claiming that a vaccine is nigh. Still, just how soon a truly safe and effective vaccine will be made available remains uncertain. And when found, will everyone be able to benefit from it quickly and at an affordable cost?
This is an important question for public policy, and the answer depends on a few key considerations.
Check out the OECD Policy Response: Treatments and a vaccine for COVID-19: The need for coordinating policies on R&D, manufacturing and access
The first is indeed the speed of research itself: even if an effective vaccine is developed or a cure discovered over the next year, that would be remarkably fast. Testing any new drug on sufficient numbers of people to demonstrate its safety also takes time.
Second, once a new vaccine is approved, another battle begins, as those involved in penicillin’s development knew too well. For the vaccine would have to be produced in vast quantities at speed. Technology will have to be developed or adapted, all of which will takes time.
Dispensing devices, such as syringes or intranasal sprays, would be needed in huge quantities too, which, considering the shortages of facemasks we have just witnessed during the first wave of COVID-19, will be a tall order. And then there are the logistic, training and other practical challenges of putting in place large-scale vaccination campaigns.
Third, there is the global dimension of the disease, which requires a global strategy backed up by international co-operation. This is vital for beating the pandemic and getting our economies back on their feet. On the scientific side, such co-operation is normal practice, but among firms, competition can be fierce. It is perhaps inevitable, given the serious impact of COVID-19 on so many people and places, that some individual countries will want to be first in line to secure a stock of vaccines for themselves, and it is also understandable that countries with health care giants will “go national”, with sweetheart deals between authorities, developers and producers.
On OECD Podcasts, we speak to Francesca Colombo, Head of the OECD's Health Policy Division on winning the war against COVID-19.
Check out Francesca Colombo's contribution to the Forum Network: Resilient Health Systems: What we are learning from the COVID-19 crisis
However, securing access and cornering the market are not the same thing, and given the international nature of the healthcare industry, taking the latter approach could backfire against the very people that such efforts aim to help. After all, no one can predict where a breakthrough will be made, or whether it will be made by a major firm or a small start-up at home or in some other country.
International co-operation and openness among policymakers is therefore essential both to spread risk and maximise the chances of success.
Co-operation also matters for achieving clarity on costs and payments, so that producers, wherever they are located, can expand capacity and have doses of any treatment getting to the population as quickly as possible after approval. For instance, a clear global commitment to pay for, say, the first five effective vaccines would be sensible in providing market certainty for producers and reducing risk for buyers in case the early ones are ineffective. Co-operation is also necessary for making sure that the doses go to where they will be most effective for ending the pandemic.
Countries could use international Advance Market Commitments (AMC), which aim to make the market for vaccines more attractive by using legal commitments to purchase vaccines on predetermined terms, to provide a global solution. A 3-tier access approach could prove acceptable: national champion country first; then these AMCs; and all accompanied by licensing commitments for local production in low and middle-income countries.
In the absence of such a global mechanism that would ensure sufficient supply through licensing of products at no or low cost, agreement would at least have to be reached on how to handle intellectual property (IP). Much of vaccine R&D effort and the building of manufacturing capacity is currently financed by taxpayers and philanthropists in this crisis, through national funding agencies, such as BARDA and the Department of Defense in the United States, or international mechanisms, such as CEPI and the WHO “ACT” Accelerator.
Also on the Forum Network: The Great Revealer: Emergence of the “Covid-Ready” World by David Nabarro, Special Envoy of the Director-General on COVID-19, World Health Organization, and John Atkinson, Specialist in Systems Change
There is therefore a strong argument for having the intellectual property resulting from these efforts made available widely and at limited cost, otherwise it might be tempting for some countries, even traditionally free trading ones, to use compulsory licensing. This would be legitimate under globally accepted intellectual property rules, in particular the 1995 multilateral agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which was confirmed by the WTO in relation to public health at Doha in 2001. However, compulsory licences are a blunt tool that put national needs first, and their use could deal a serious blow to public confidence in international co-operation for years to come, in health and other challenges besides. Such moves would almost certainly provoke tit-for-tat retaliation in other sectors as well.
There are ways to prevent such a downward spiral. For example, in exchange for funding of R&D and manufacturing capacity, public funders could demand commitments from companies to provide voluntary licences. Companies could also commit to contribute their IP at no cost to international mechanisms for sharing IP, such as the Medicines Patent Pool (MPP) or the COVID-19 technology access pool, established specifically for this crisis by the World Health Organization.
Also on the Forum Network: The only way to beat the COVID-19 crisis is if we come together and commit to science by Jeremy Farrar, Director of the Wellcome Trust
Plenty of lip-service has been paid to such options, but we need to encourage action on the ground, and that means countries working together to ensure issues surrounding intellectual property do not slow world efforts to beat this global pandemic. No country will be immune if this happens.
As the story of penicillin showed, a discovery is the first step. International organisations like the OECD cannot let up on the job of strengthening co-operation if the COVID-19 pandemic is to be stopped once and for all.
Find out more about the OECD’s work on The race to vaccinate
References and further reading
BROWN, K. (2005), Penicillin Man: Alexander Fleming and the Antibiotic Revolution, Sutton.
OECD (2020), “Treatments and a vaccine for COVID-19: The need for coordinating policies on R&D, manufacturing and access”, OECD Publishing, Paris, https://www.oecd.org/coronavirus/policy-responses/treatments-and-a-vaccine-for-covid-19-the-need-for-coordinating-policies-on-r-d-manufacturing-and-access-6e7669a9/.
OECD (2018), Pharmaceutical Innovation and Access to Medicines, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/9789264307391-en.
TOWSE A. and I. FIRTH (2020), “How Should the World Pay for a COVID-19 Vaccine?”, https://www.ohe.org/news/how-should-world-pay-covid-19-vaccine-0.
’t HOEN, E. (2020), “Protect against market exclusivity in the fight against COVID-19”, Natural Medicine 26, 813, https://doi.org/10.1038/s41591-020-0876-6.
BERKLEY S. (2020), “COVAX explained”, Gavi, https://www.gavi.org/vaccineswork/covax-explained.
CHALKIDOU K., H. KETTLER, G. RAMAKRISHNAN, R. SILVERMAN and A. TOWSE (2020), “Leave No One Behind: Using a Benefit-Based Advance Market Commitment to Incentivise Development and Global Supply of COVID-19 Vaccines”, Center for Global Development, https://www.cgdev.org/publication/leave-no-one-behind-using-benefit-based-advance-market-commitment-covid-vaccine.
ACCELERATINGHT (2020), “Accelerating Health Technologies with Incentive Design”, https://www.acceleratinght.org/. Read Alexander Fleming’s speech at the Nobel Banquet in Stockholm, 10 December, 1945 at https://www.nobelprize.org/prizes/medicine/1945/fleming/speech/
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