Large pharmaceutical companies are multinational organizations with incentives to distribute their vaccines broadly.
This article was originally published at Geopolitical Futures. The original is here.
Nationalism is all the rage these days. Following decades of globalization, the pendulum has begun to swing back the other direction, triggering fears that nationalist policies will lead to a breakdown in international cooperation and a destabilization of the world order. This, in turn, has led to much hand-wringing over “vaccine nationalism,” the notion that governments will take a “me first” approach to vaccines, further exacerbating the health crisis. The crux of the argument was elaborated in Harvard Business Review:
“A [2009 H1N1 influenza] vaccine was developed within seven months, but most high-income countries turned to pharmaceutical companies within their own borders for production. High-income countries directly negotiated large advance orders for the vaccine, crowding out poor countries. Although several of those rich countries, including the United States, agreed to make vaccine donations to low- and middle-income countries, they only carried out these donations after ensuring they could cover their own populations first. As a result, the distribution of the H1N1 vaccine was based on high-income countries’ purchasing power, not the risk of transmission.”
This argument is predicated on an idealized view of nation-state behavior. While it is true that it is preferable from a public health standpoint to provide the vaccine to those individuals, often located in poor countries, who face the highest risk of transmission, it would be politically impossible for a nation that develops a successful vaccine to do anything other than provide it to its own citizens first. Which leader of a rich nation, upon learning of such a vaccine, would declare that the first doses will go to Zimbabwe? When French company Sanofi announced that the U.S. would be the first to receive its vaccine, it had to quickly retract the statement following a tongue-lashing from French President Emmanuel Macron.
Every country in the world has experienced political, social and economic effects brought about by the COVID-19 pandemic. As a result, governments worldwide face extreme pressure on multiple fronts to quickly find a vaccine. In response to this overwhelming demand, dozens of pharmaceutical firms are racing to produce vaccines for as many people as possible. That is why vaccine nationalism is an exaggerated threat.
Currently, there are several vaccines in Phase III clinical trials – which examine efficacy and safety in thousands of human volunteers – that are on the cusp of regulatory approval. Notably, they are being produced by firms located all over the world. The leading candidates are from a British company (AstraZeneca), two U.S. companies (Moderna and Pfizer, the latter collaborating with German firm BioNTech), and two Chinese companies (Sinovac and Sinopharm). For manufacturing or financial reasons, it is common for pharmaceutical companies to collaborate with or license their products to other organizations. AstraZeneca, which intends to provide 400 million doses of its vaccine to the U.S. and the U.K. and another 400 million to Europe, has also licensed 1 billion vaccines to an institute in India for distribution to low- and middle-income countries. The British firm also just announced a deal to produce the vaccine in China.
Additionally, pharmaceutical companies have a strong incentive to provide vaccines to as many people as possible, even if some firms are currently doing so at “no profit.” In an email with Geopolitical Futures, North Carolina State University professor Dr. Julie Swann noted that a pharmaceutical company that delivers a successful vaccine will earn a large boost to its reputation (in a time when “Big Pharma” is muttered as a four-letter word). Further, the companies may anticipate selling the coronavirus vaccine for years to come as well as getting a head start on other related vaccines, such as one for the common cold.
From Russia With Love
A related concern has been that one state or another will be first to develop a vaccine, and then use this advantage as leverage against other states. Much to everyone’s surprise, Russia says that its Gamaleya Institute of Epidemiology and Microbiology in Moscow has developed a COVID-19 vaccine, and that mass production could begin in September and vaccinations in October. The jab was approved on Aug. 11, meaning the world’s first SARS-CoV-2 vaccine approved for public use is Russian. (SARS-CoV-2 is the virus that causes the disease known as COVID-19.) Russia isn’t shy about pointing this out. An article in the UAE’s The National quotes Kirill Dmitriev, head of Russia’s sovereign wealth fund, as saying, “It’s a Sputnik moment for many people who didn’t expect Russia to be the first.” It is certainly true that few expected Russia to be first to produce a vaccine, but this hardly marks a Sputnik moment.
When the Soviets beat the U.S. into space with the launch of their first satellite, Americans feared that they had fallen technologically behind the USSR, prompting the formation of NASA. But the space race is not analogous to the COVID-19 vaccine race for several reasons. First, the U.S. dominates the world in biotechnological and pharmaceutical research. If any country poses a threat to American supremacy in this area, it is China, not Russia. (China, which is the world’s second-largest pharmaceutical drug market, has made significant reforms that very well might lead to a competitive biotech industry.) Second, American and European vaccine candidates are on the cusp of approval themselves. Sputnik showed that American space technology lagged years behind that of the Soviets, but that is not the case here. At worst, the other vaccines will be approved within weeks or months of the Russian vaccine approval. Third, at least one Western competitor dwarfs the scale of manufacturing that Russia envisions. While Russia hopes to produce perhaps 170 million vaccines globally by the end of 2020, AstraZeneca has been able to promise hundreds of millions of vaccine doses as a result of its efforts to develop multiple supply chains and to increase manufacturing capacity. The Russian vaccine will be one of many available options.
Can a foreign vaccine be trusted to be safe and effective? It depends. A British one certainly will be because the U.K. has an advanced biotech industry and solid regulatory standards. In the case of Russia, the vaccine was produced by the Gamaleya Institute, which is reputable. The institute has ongoing clinical trials, including ones for its COVID-19 vaccine, registeredwith the U.S. government. Some virology experts say that the vaccine should be safe because it’s based on a proven technology known as an adenoviral vector. But others fear that the vaccine was rushed, especially since there is no published data for other scientists to examine.
Regardless of its country of origin, when it comes to foreign drugs, the U.S. Food and Drug Administration takes a “trust, but verify” approach, meaning the U.S. government will need to examine the data prior to issuing approval – assuming that foreign companies and their governments intend on selling their vaccines in the U.S. For a COVID-19 vaccine to receive approval, it must demonstrate safety and be at least 50 percent more effective than a placebo at preventing disease.
How Vaccine Nationalism Might Play a Role
Russia says that countries all over the world – and even some U.S. companies – are interested in its vaccine. This is to be expected. Every country is interested in every potentially successful vaccine. Most likely, there will be several vaccines that get approved, and scientists will then monitor populations to determine which vaccines are most successful. But from a global public health standpoint, it makes little difference which country can claim bragging rights to be the first to market.
But it does make a geopolitical difference. Safety questions aside, long-standing distrust between the U.S. and Russia may make the U.S. hesitant to embrace a Russian vaccine, particularly with an administration that has been accused of being too cozy with the Kremlin and an election that is just over 80 days away. Besides, for its own strategic reasons, perhaps Russia wouldn’t want to provide Americans with a vaccine. Similar political pressures, in addition to a long track record of shoddy products and poor safety standards, render the chances of a Chinese vaccine being available in the U.S. also small. Additionally, Chinese companies were cut out of Operation Warp Speed, America’s program to quickly finance and develop multiple vaccine candidates.
For Russian President Vladimir Putin, the geopolitical consequences of a vaccine could be substantial. Confidence in his regime is sagging, and a vaccine that saves not only Russians but millions of others will enable Putin to portray himself as an international hero. Ironically, the coronavirus could be the lucky break Putin needs to restore the confidence of his compatriots. For the rest of us, we just want something that works so that our lives and economies can return to normal.
© 2020 Geopolitical Futures. Republished with permission.