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We cannot afford not to vaccinate the world

In Soweto, South Africa, 20 years ago, the roadsides were lined with advertising boards for funeral companies: “Motaung Funeral Directors – We Salute the Spirit of Ubuntu!” You could choose 21st Century Funeral Brokers or give your loved one a “Rasta” burial. Drugs to save people with HIV already existed at the time; unfortunately, poorer countries couldn’t afford them, and millions kept dying.

Only years later did cheap generic medicines, manufactured by Indian companies, reach most African people with HIV. President George W Bush, who helped make the treatments available, ended up saving many lives in Africa – something that should go on his record as much as the lives he destroyed in Iraq and Afghanistan. The messy, belated compromise on HIV is the model for what must happen much faster for Covid-19. We need to help poorer countries produce vaccines.

The world is in the same bind now as 20 years ago: the medicines work but poorer countries can’t get them, even if the main obstacle today is supply rather than price. The problem is that every adult human needs the jab simultaneously. High- and upper-income countries have procured more than six billion of the 8.6 billion vaccines ordered so far. Fewer than 600 million have been administered.

Given that there are about 5.8 billion people on earth aged 15 and up, most of whom will require two doses, we need more than 11 billion vaccines quickly. The mantra “Nobody is safe until everyone is safe” sounds trite but is true. Yet even if we made 11 billion doses, the virus would almost certainly keep circulating, so we’ll need billions of booster shots every year to zap mutations.

The global economic cost of vaccine nationalism would be between $1.8tn and $3.8tn, says the International Chamber of Commerce. By contrast, vaccinating the world’s poorest people should only cost tens of billions. So how are we going to do it?

Getting rich countries to share their scarce supplies won’t happen. If governments have to choose between jabbing their own voters first or doing the right thing by the world, we know what choice they’ll make. That’s why we shouldn’t push them to make it. Instead, they can help lower-income countries produce Covid-19 vaccines.

This is already happening on an insufficient scale in India, Brazil, South Africa and elsewhere, but we need much more global vaccine-making capacity, permanently: first, to handle endemic Covid-19, and then the next pandemic. We’ll have to build factories worldwide so that poorer regions can supply themselves, now that they know they can’t rely on rich countries.

There’s a fight on to have vaccine-making companies waive their patents for lower-income countries. The companies – backed by most rich countries – are resisting. Albert Bourla, Pfizer’s chief executive, mocked the proposals as “nonsense” and “dangerous”.

But the White House is discussing suspending patent protections, and quite right too. Many pharma companies took billions from governments to develop their vaccines. Moreover, US government scientists at the National Institutes of Health helped make the crucial discovery of how to stabilise spike proteins.

Even so, patents are a bit of a sideshow. Countries are allowed to issue compulsory licences to override them, as long as production is mainly for domestic use. The least developed countries get broader exceptions. And Moderna has said it won’t enforce patents during the pandemic.

The bigger issue, explains Mark Dybul, former executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria, is that pharma companies need to transfer their vaccine-making technology. That means scientists and technicians flying to lower-income countries to train locals.

The pharma companies must also allow vaccines made in poorer countries to be branded with their names, as that will hasten regulatory approval. But tech transfer isn’t happening yet, partly because the pharma companies are overwhelmed just trying to supply rich countries.

Building one factory in Africa that could make one billion doses of vaccine could be done for as little as $200m, says Dybul. He reckons that as technology improves, the price of a jab could eventually drop from $20 or $30 to $5. Whenever the virus mutated locally, the factory could produce booster shots fast.

Taming pandemics would be transformative. But the potential of global vaccine factories goes beyond that. The Pfizer and Moderna vaccines are the first human uses of a thrilling technology: messenger RNA. Vaccines made with mRNA teach our cells how to make a protein, or a piece of a protein, which creates an immune response.

One day we could have mRNA-based vaccines for HIV, tuberculosis and cancer, says Ugur Sahin, co-founder of BioNTech and developer of Pfizer’s vaccine. RNA solutions could be used in agriculture instead of chemical pesticides, says GreenLight Biosciences. In fact, the potential of RNA is one reason why pharma companies are clinging to patents. They aren’t interested in making money from vaccinating Africa against Covid-19. They are playing a longer, bigger game.

With HIV drugs, we wasted a fatal decade. Doing the right thing this time could spur global medicine into a new era. It wouldn’t even be particularly expensive.

Follow Simon on Twitter @KuperSimon and email him at [email protected]

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