COVID-19 Vaccines A Global Common Good

To date, over 3000 people, including 115 international personalities and 19 Nobel Laureates, have issued a joint appeal to global leaders, international organisations, pharmaceutical companies, and governments to adopt legal measures ensuring the availability of 2019 novel coronavirus disease (COVID-19) vaccines for all and free of charge.¹

We present the case behind not only the declaration of COVID-19 Vaccine a Global Common Good, but also how this can be operationalised.

The need for such a declaration has been illustrated by the US Government's announcement that it has allocated US$1·6 billion to US biotech Novavax for its COVID-19 vaccine project, guaranteeing priority access to the first 100 million doses in case of proven effectiveness; all part of Operation Warp Speed to produce enough to vaccinate all Americans by January, 2021.

This announcement is not limited to the USA as vaccine developers report that they are being approached by an increasing number of countries seeking to establish advance-purchase arrangements. The UK Government also recently signed a deal for access to a further 90 million vaccines on top of the 100 million doses of the Oxford University vaccine being developed with AstraZeneca. This, along with the need to recover research and development costs and meet the demands of shareholders is driving up prices, which, without an alternative arrangement for funding and provision, will exclude many (likely most) global citizens from access to the vaccines. Such a development would be to everyone's health, social, and economic detriment, irrespective of our nationality.

Scientific consensus is that the only way this pandemic will be eradicated is through the vaccination of all people worldwide. It is, therefore, important to recognise this in our policy actions to avoid the tragedy of the commons, in which selfish behaviour leads to adverse communal outcomes.

Globally, people are acting to eradicate COVID-19 within countries through actions such as handwashing, distancing, and using face masks and other personal protective equipment. These things are done to protect our own health and that of others. Without such unselfish acts, our abilities to undertake all other actions—economic, social, self-interested, or altruistic—would be seriously impaired. The same applies internationally: as the virus knowns no geographic boundaries, we have to act to help each other. Otherwise, we might never be able to return to the previous extent of cross-border collaborations for economic and social progress towards the Sustainable Development Goals. Avoiding a tragedy of the commons on an international scale requires equitable access to vaccines for all people, irrespective of age, gender, ethnicity, country, and other social and economic factors; thus rendering vaccines a global common good.

If a vaccine is developed in less than 18 months, immense economic investments will have been involved. Many private sector research laboratories that were part of the vaccine research will be expecting a return on their investments.

Nevertheless, much of the investments are also of public monies. This, along with the case for COVID-19 vaccines as a global common good, also require recognition in developing a pricing structure that allows for a fair level of return in exchange for putting the vaccine in the public domain. As part of this, too, it should be recognised that a vaccine represents a common good for the pharmaceutical industry because it will enable them to practice in a world unencumbered by COVID-19.

For these reasons, information issued by the private sector, scientists, and authorities, needs to be timely, accurate, clear, complete, and transparent. The research results should be in the public domain, making it available to any production facility that pledges to operate under strict international regulatory supervision and only to such facilities.

Three key pillars would be required to make COVID-19 vaccines a global common good. First, would be a set of clear principles (panel ).

Panel. Proposed principles for declaring COVID-19 Vaccine a Global Common Good.

• •Vaccines approved by regulatory authorities to be treated as essential generic medicines.
• •Patents to be placed in the public domain against cost-based compensation for laboratories.
• •The production and distribution of vaccines to be accessible to all countries, without priority nor exclusivity, and thus regarded as a global common good.
• •Allocation rules and pricing policies to be transparent, under the watch and reporting of an arbitrator whose decisions are final.

WHO has the capacity to forge a consensus between member countries. Each country would then be responsible to endorse the principles and commitments and translate them into their own legislation. The G20 could also contribute to the achievement of this political consensus.

WHO has already started to move in this direction, as they hosted the launch of the Access to COVID-19 Tools Accelerator,² a new global collaboration to accelerate development, production, and equitable access to COVID-19 diagnostics, therapeutics, and vaccines.

The second pillar is an operator to establish and enforce allocation and pricing rules. WHO has neither operational nor financial capacity to participate in this role. This requires a not-for-profit operator with such capacity to interface between the international community, the health systems of the different countries for implementing mass vaccination, and the pharmaceutical industry for manufacturing vaccines at a given price. This entity would also be required to mobilise contributions from WHO member states, multilateral organisations (eg, World Bank and European Investment Bank) and major foundations.

The Global Alliance for Vaccination and Immunization (GAVI) presents a ready-made model. The organisation was created 20 years ago to accelerate vaccination against childhood diseases in developing countries. It has helped vaccinate more than 760 million children in the world's poorest countries, preventing more than 13 million deaths and has mobilised over $20 billion from donor countries, international organisations, and philanthropic foundations such as the Gates Foundation. Similarly, it has raised over $500 million funding towards COVID-19 vaccines from donor governments, multilateral organisations, major foundations and high-net-worth Individuals; and launched the COVAX Facility aimed at providing governments with the opportunity to benefit from a larger portfolio of candidate vaccines, and secure 2 billion doses of vaccines, in cooperation with the Coalition for Epidemic Preparedness Innovations. GAVI has created an innovative financial instrument called vaccine bonds, which could serve as a model for COVID-19.³ The aim of such bonds is to accelerate the funding promised by governments. GAVI issues vaccine bonds on the capital markets, which are repaid by long-term donor pledges. This instrument would be particularly relevant in the case of COVID-19 because funding is required now for a global campaign of vaccination, which governments, for budgetary reasons, could pay back over a set period of time (eg, 10 or 20 years).

The third pillar is an industrial force. The pharmaceutical industry is needed for mass producing the vaccines. The prospect of abandoning the exploitation of patents in favour of a global common good, available in open source, and of obtaining compensation at cost for the investments made for the development of these vaccines, to the exclusion of a net profit, can seem unattractive. This objective will only be achieved through global political pressure and the appointment of a single interlocutor to negotiate. But the pharmaceutical industry will recognise the benefits to them from the global common good attributes of a global vaccination programme, the economic efficiency of very large-scale distribution, a factor in lowering costs, and also the image and reputation benefits it can derive. The reward for laboratories and researchers who contribute to the development of COVID-19 vaccines could even be a Nobel Prize in Medicine, and perhaps in Peace. The reward for the world will be continued progress towards health longevity.

The funds required to mobilise around COVID-19 Vaccines as a global common good are likely to pale into insignificance relative to what will be required to address on ongoing economic recession consequent on non-eradication. But despite this financial case, such mobilisation requires a breakthrough in the conventional way of thinking about the economy and of doing business.

Therefore, we call for the response to COVID-19 to be global in deeds as well as words, and based on principles of equal and universal access to the treatments and vaccines. The mission, and driver, should not be one of profit but, rather achievement of the widest health benefit possible. In that vein, we invite all social, economic, political, and health entities not only to declare, but also act upon, COVID-19 Vaccines as a Global Common Good.