Back in 2014, Gary Kobinger was spearheading a groundbreaking treatment for Ebola. It was a cocktail of three antibodies, known as ZMapp, which showed promising results at saving lives amid an outbreak of the deadly virus in West Africa. Kobinger, who was at the time chief of special pathogens at the Public Health Agency of Canada’s microbiology laboratory in Winnipeg, wanted to help as many people as he could. But supply of his drug was low. It was still going through clinical trials on humans and was time-consuming to produce.
Then he got a phone call from China. A representative from a biotech company called Beijing Mabworks wanted to give Kobinger a heads-up that the firm’s researchers had taken information directly from ZMapp’s patent, which was registered online, and used it to clone the active ingredients. They had then produced antibodies on a larger scale by using specialized cells.
“He told me they had produced an impressive amount—hundreds of grams. And five grams was a treatment,” remembers Kobinger. “The guy told me they just wanted to try out their technology and didn’t want to use the drug in a clinic, or undercut us. It was a courtesy call.”
Given the competitive and highly protective world of pharmaceuticals, Beijing Mabworks would soon face accusations of stealing intellectual property: Kobinger’s work at the time belonged to the governments of Canada and the United States. And there were serious geopolitical implications of a Chinese company cribbing information from their patents. But Kobinger himself wasn’t pointing fingers.
The Canadian scientist recalls his Chinese counterpart being surprised at his reply over the phone: “I thanked him,” Kobinger says. “I told him, ‘This is not for money. We’re trying to save lives. Get your stuff out. If it’s clinical grade and approved, you’ll save lives.’”
And indeed they did. Months later, doctors in the United Kingdom credited the Chinese treatment for the recovery of a British Army nurse who had contracted Ebola; by then the Brits’ supply of ZMapp was exhausted.
Now director of the Centre for Research in Infectious Diseases at Laval University, Kobinger lists the handful of vaccines he’s currently working on, in conjunction with teams both domestically and abroad, in pursuit of a vaccine against COVID-19. His desire for collaboration remains as strong as ever. “What I would love to see is 20 vaccines at the start line [of clinical trials]—the more the better—and hopefully we get three to five viable options at the end with solid safety and potency data,” he says. “Let’s save lives and not get bogged down by ‘this is my intellectual property.’”
We’re all in this together, or so the mantra goes. But whichever coronavirus vaccine is first to prove safe and effective, it won’t be available to eight billion people in the first week.
Depending on the manufacturing needs of the vaccine—or vaccines—it could take months, or even years, after it reaches the market until everyone on the planet has access to a dose.
It’s a hard reality that gets overlooked amid announcements like the Trudeau government’s recent commitment to spend $1.1 billion to develop and produce a vaccine for the novel coronavirus—a figurative shot in the arm to this country’s already strong research base in the field. But the irrational optimism is easy to understand, and so is the spending spree among governments on development. With most nations’ economies grounded to prevent the spread of the virus, the first vaccine will become the most highly coveted resource on the planet. So who gets first dibs? And who gets to decide?
On New Year’s Eve, China reported an unknown virus to the World Health Organization. The WHO declared the coronavirus a global emergency. The WHO announced the disease would be called COVID-19. The WHO led a joint mission with China to assess the outbreak in Wuhan. Throughout the pandemic (and through plenty of criticism) this United Nations special agency has been at the forefront of the global response, including the coordination of international collaboration to speed up vaccine development against COVID-19. But that doesn’t mean it will lead the way on vaccine distribution.
“The World Health Organization will try to regulate it, but we’re seeing already that President Trump is not willing to listen to them,” says Volker Gerdts, director of VIDO-InterVac (short for the Vaccine and Infectious Disease Organization—International Vaccine Centre) at the University of Saskatchewan. “If an American company produces a vaccine, Trump will try to ensure that all of it goes to Americans—regardless of what the WHO recommends.”
The U.S. president announced in mid-April his government would halt funding to the WHO, and Trump isn’t the only one criticizing the international body. An open letter signed by academics, activists and politicians—including Irwin Cotler, Canada’s former Liberal justice minister—said the WHO downplayed the pandemic due to influence from the Chinese Communist Party. Japan’s deputy prime minister tartly noted that the WHO has such close ties to China that some have dubbed it the “Chinese Health Organization.”
“The WHO has nothing in place that would give it the authority to tell countries what to do with vaccine supplies,” says David Fidler, a fellow in global health at the Council on Foreign Relations and a former legal consultant to the UN health body.
As for all the spirit of altruism and international cooperation in vaccine research, Fidler advises picturing global health as a human brain. On the one side are the functional issues: science, medicine, public health. “Those tend to work in ways to progress without thinking politically,” he says. “To develop a vaccine that is safe and effective is a monumental task. But it’s primarily one about science. It’s easier to have the optimistic talk of solidarity when you’re focused on functional challenges.”
But on the other side of the global health brain lies politics, which thinks about vaccines much differently, Fidler adds. “The suffering, anxiety, fear and lack of economic opportunity is mounting every day we try to keep social distancing in place.” So if a vaccine came along and the United States had an advanced-purchase contract to buy a lot of it, or if the manufacturer was in U.S. territory, Fidler figures either party—Democrat or Republican—would keep as much as possible for its own citizens, even if another part of the world were in greater need. “That’s a political reality,” he says. “The political pressure will be so strong that the pleas about equity and the health of low-income countries are not going to resonate.”
The Trump Administration has reportedly already tried to get a head start by trying to convince a German biopharmaceutical firm working on a COVID-19 vaccine to move its research operations to the U.S. That raised alarm bells among German officials worrying Trump was trying to make a deal that would get Americans access to the vaccine first. (The German company, CureVac, issued a statement “rejecting current rumours of an acquisition.”)
Most nations don’t have the manufacturing capacity for the global distribution of a vaccine, which is why those funding its research are likely ensuring contracts give them some control over distribution. “If the Bill and Melinda Gates Foundation funds some of it, they have their rules,” Gerdts says. “Or if it is mostly government-funded, like ours, the government will decide. And some countries will say ‘Our citizens first.’”
As vaccine candidates move towards human clinical trials, that’s the time researchers to secure partnerships with manufacturers who can produce millions of doses, Gerdts says, and part of that process will involve securing access to the vaccine for Canadians.
Yet even sharing amongst allies is no sure thing. In April, the U.S. administration held up shipments of N95 masks at the Canada-U.S. border to ensure more supplies for American hospitals. With that as precedent, experts assume that the U.S. government’s recent $456-million commitment to Johnson & Johnson’s pharmaceutical arm to develop a COVID-19 vaccine came on condition that a substantial amount go to the American public first.
Even so, Canada is a lot closer to the front of the line than most other countries. Since high-income nations can fund the development of vaccines—or purchase them—lower- and middle-income countries are in many cases shut out in the free market. Rebecca Weintraub, faculty director of the global health delivery project at Harvard University, points to the rollout in 2009 of the H1N1 vaccine, when wealthier countries negotiated large advance orders, crowding out their less advantaged counterparts. As a result, she says, “we have to talk about how high-income countries cannot monopolize COVID-19 vaccines. Then we have to sort through managing the geopolitics around it.”
There are entities designed to help out developing nations, though they’ve never been tested by a pandemic of this scale. The Global Alliance for Vaccines and Immunisation (GAVI) was founded in 2000—with Melinda and Bill Gates among its first backers—to shorten the time it takes for vaccines to reach developing countries after they go on the market. It does so in part by encouraging manufacturers to lower vaccine costs for the poorest nations. “GAVI is essentially a big fund that purchases vaccines for those countries,” says Kate Elder, a senior vaccines policy advisor with Médecins sans frontières. “But they’re always challenged by raising enough money to buy these vaccines in adequate supply.”
Last year, GAVI stated an ambitious goal of inoculating 300 million children in low- or middle-income countries over the next five years with 18 vaccines—which they estimate would save eight million lives. But accomplishing that task, it told fundraisers, would require US$7.4 billion. And that was before the world needed a coronavirus vaccine.
Closer to the forefront of innovation, the Coalition for Epidemic Preparedness Innovations (CEPI), a global private-public partnership, was launched at the 2017 World Economic Forum with the goal of developing vaccines to stop future epidemics. Major pharmaceutical companies, its founders noted, weren’t always keen to fund research for something that might not bring a return on investment. The Norway-based not-for-profit has since raised US$690 million from national governments—Canada recently pledged $40 million—but is still well short of the $2 billion it says is needed to vanquish COVID-19. CEPI is helping fund eight vaccine candidates in hopes that three make it to the finish line of regulatory approval for general use.
If one proves safe and potent, CEPI’s equitable access policy requires that it is available first to “populations when and where they are needed to end an outbreak or curtail an epidemic, regardless of ability to pay.” But that noble-sounding declaration obscures a problem, notes Weintraub: none of the $2 billion CEPI hopes to raise is earmarked for distribution. Moreover, there are more than 70 other coronavirus vaccine candidates that are not backed by CEPI—and don’t have the same explicit language about equity on their websites.
So if this is deemed a “global race” for the vaccine, is the race against the virus? Or are countries and pharmaceutical companies racing one another?
“My naive, younger self would hope the global race is for the ends of meeting the public’s health,” says Elder. “My more seasoned, global-health side knows it can often be who is first to market, so they have monopolistic control over price and who gets to buy. I’m trying to suspend my experience in global health.”
Elder counts herself as privileged at the moment, despite living in the U.S., where the worst outbreak of COVID-19 is currently happening. “I am able to physically distance myself. I am reading on my computer every day. I still have my salary. Right now, I am the last person who needs a vaccine.”
Many Canadians would count themselves similarly fortunate. But that doesn’t mean they’d be willing to wait it out while the rest of the world gets vaccinated—especially if Ottawa’s money yields results, and Canadians scientists are the ones who find a safe and potent vaccine.
Still, if supply is a problem, couldn’t the researchers who create the first vaccine simply share the recipe online—a grand act of altruism so that manufacturers around the world could ramp up production, ensuring the entire world got vaccinated as soon as possible?
“You can’t,” says Gerdts, the University of Saskatchewan researcher, “because the whole process for developing a vaccine is strictly controlled by the [national] regulatory authorities.” Companies and researchers have to demonstrate how and where they’re making it; what processes and fermenters they’re using; what materials they’re using; where they come from; how it’s formulated; how it’s being deposited into the glass vials; who seals the vials and every stop along the way. Simply making the recipe available to the world would raise issues of quality and accountability, Gerdts adds. “If you have someone who doesn’t follow the quality control and there’s potential contamination, who is responsible for it? Who is liable?”
Even if companies were to ignore intellectual property rights and patents for the highly-coveted substance, as the Chinese company did in the case of ZMapp, there’s still the challenge of finding manufacturers capable of handling orders for the entire planet. “That kind of capacity is not just sitting idle anywhere,” says Luis Berreto, former vice-president of immunisation and science policy for the vaccine unit of Sanofi, the French biopharmaceutical firm. “For those who have it, there are many doing other childhood or adult vaccines.”
Then there are the growing international tensions that the spread of the virus have brought to the fore. In March, a proposed joint statement on COVID-19 by the G7 foreign ministers reportedly fell apart when nations wouldn’t acquiesce to the U.S.’s insistence on it being called the “Wuhan virus.” Meanwhile, China’s state media have spread false stories around the world that the virus was developed in an American biological weapons lab and was brought to Wuhan by U.S. soldiers during a military games event. (The U.S. has no biological weapons program but does have a biological defence lab.)
If China claims to have won the vaccine race, and has the only one available, it will be the gatekeeper for how access is managed globally, says Fidler of the Council on Foreign Relations. “And China could make an argument with a straight face that it will make it accessible to Africa before the United States,” he says. “They could construct an argument that that’s equitable, but there’s a political sting in the tail [for Americans]. That would certainly be interpreted in the U.S. as weaponizing the vaccine. This is what worries me.”