The following article was first published here by the RUSI (Royal United Services Institute) on Monday 19 May 2020.
A scientific gold rush is underway for the first Covid-19 vaccine but, as the world is anxious and impatient for its arrival, medical protectionism and vaccine nationalism could rise considerably if unchecked.
Outwardly, most governments recognise the need for a global response to this worldwide emergency. No one state alone can solve its epidemiological, economic and political complexities. Yet a new study shows that 85 jurisdictions have placed bans or export restrictions on medical supplies and medicines since January. The worldwide hunt for face masks has led to accusations of modern-day piracy. The availability of ventilators has been a revealing index of preparedness and, when push comes to shove, it has been a scramble for the national interest.
The shuttering of factories in lockdown has exposed supply chain vulnerabilities, and border closures worldwide have further disrupted the flow of supplies. There have been calls for less dependence on imports that cannot get through, and an aspirational surge for revamped industries to inject life into sickening economies. But beyond sensible measures to hold sufficient stockpiles and rebalance lopsided economies, longer-term pandemic protectionism seems retrograde. International interdependence on medical treatments and supplies prevents one state having hegemony. Arguably, the imperative to cooperate and collaborate creates healthier conditions for international relations under stress.
Over 100 candidate vaccines are trying to defeat 29 microscopic proteins. The scale of the retaliatory effort sounds encouraging. But only about 10% of candidates make it over the finishing line, and there are good reasons why vaccines normally take many years. Novartis CEO, Vas Narasimhan, who spearheaded vaccine development during the H1N1 pandemic, estimates roughly one and a half to two years for a coronavirus vaccine to allow time for the appropriate clinical studies.
The analogy of a vaccine race is not helpful, for it implies that who gets there first is also the best. In this field of human endeavour, the contrary may be true: speed may come at the expense of safety, efficacy and immunogenicity. Nevertheless, the reality is that we are facing a race – a highly politicised one, as governments around the world are desperate to find an answer to the pandemic in order to kickstart their damaged economies and showcase their technological prowess.
While representatives from the scientific community have pledged to collaborate, countries are pumping most money into their home teams. US biotech company Moderna, which is now attracting media headlines, can draw on up to $483 million from the US Biomedical Advanced Research and Development Authority to accelerate its prime candidate, mRNA-1273. The US launched Operation Warp Speed to coordinate all its vaccine efforts for Americans. The UK government pledged £84 million to boost work on Oxford University’s ChAdOx1 nCoV-19 and Imperial College London’s RNA vaccine, too. Oxford University agreed a deal with UK-based AstraZeneca whereby, if the vaccine works, the UK gets first access to 30 million of the 100 million doses AstraZeneca produces.
Experience suggests that eventually nationalism predisposes groups to exclude or mistrust others, leading to competition or conflict, and vaccine nationalism does not look exempt from this tendency. For instance, Chinese President Xi Jinping told his country’s ruling elite in February to share relevant data ‘with the scientific and technological circles of China’. To note: ‘of China’. In March, Beijing’s mouthpiece, Global Times, reported ‘there is no way for China to rely on Europe or the US in vaccine development. China has to be by itself in this crucial field’.
Meanwhile, Germany’s Welt Am Sonntag suggested that President Trump offered $1 billion for exclusive US access to vaccine research at CureVac, a biopharma company located in Tübingen, Germany, which mushroomed into a question of national security before CureVac issued a statement denying rumours of an offer. And in France, President Macron was reported to be angry with the British-born CEO of Sanofi, Paul Hudson, over an emailed statement suggesting the US market could be prioritised for the French pharmaceutical company’s vaccine.
And the competition has its own more subterranean implications. Cyber attacks are escalating. The US is warning of Chinese espionage, while UK experts report evidence that government-funded hacking groups from China, Iran, Russia, North Korea and Vietnam have been actively targeting frontline coronavirus research organisations.
Clearly, symptoms are emerging of vaccine nationalism infecting international relations. If allowed to spread throughout the international body politic, it will be a lot harder to treat. Yet the reality is the world needs multiple teams striving to cross the finishing line in quick succession as Moderna CEO Stéphane Bancel makes clear: ‘We at the global level are not going to have enough supply … I really hope that we have three, four, five vaccines because no manufacturers can make enough doses for the planet’.
Once a vaccine has passed the first three phases of clinical trials for safety and efficacy, it needs to be approved for phase-four use in the general population. At this point, information transparency over an adverse event following immunisation – however minor it may appear – can become critical to understanding the long-term safety and efficacy of the vaccine. In the UK, this is monitored by the Medicines & Healthcare Products Regulatory Agency. In the US, the Vaccine Adverse Event Reporting System. For EU member states, the European Medicines Agency.
As well as trust that the vaccine has been manufactured in accordance with good manufacturing practice, trust that information about adverse effects will be shared openly will be a thorny aspect of vaccine diplomacy. For, at present, most of the international community does not believe China’s figures on something as binary as whether or not a person died. The same international community is not likely to trust China’s figures on much more subtle, often slow and chronic, adverse effects.
UK VACCINE DIPLOMACY
The UK has three strong cards to play. First, it is a serious vaccine contender thanks to the world-class scientific research and development capabilities it has honed over decades. If not the first vaccine, the UK can still potentially produce the best and – who knows? – may actually achieve both.
Second, the UK is consistently rated high on global ‘soft power’ rankings where ‘trust’ is a key metric.
Third, the UK could commandeer leadership roles in the emerging constellation of public, private and philanthropic individuals, initiatives and organisations on funding, developing, manufacturing, distributing and administering new vaccines and treatments. ‘Global Britain’ could aim to be a ‘global health superpower’.
The UK government has one shot to get this right; the British public will have no appetite for a second attempt at national immunisation if the first turns out to be a quick and dirty vaccine. It would be a disaster to achieve a molecular masterpiece but have a shortage of vaccine ingredients to make it; not enough sand for glass vials to contain it; insufficient cold-chain storage to transport it; too few syringes to administer it.
Practical aspects are laden with challenges, but there are some opportunities for ‘global Britain’, as well as a genuine silver lining to the pain the UK is experiencing and the hammering the British government may yet receive over its handling of the crisis. The UK’s reputation in terms of competence and effectiveness can be given a real boost through skilful vaccine diplomacy. There is a lot to play for.