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Governments are pouring massive resources into coronavirus vaccine and treatment development, and pressure is mounting to make sure results will reach the most vulnerable in the global South.

Academics, lawyers, non-profits and the leaders of some biotech firms have written to the World Health Organization arguing that “the broadest sharing of technology could save the most lives”. Last week Costa Rica’s President Carlos Alvarado Quesada urged the WHO to set up a “pool” of patents and data.

Fears were heightened after the United States’ President Donald Trump apparently tried to buy the rights to intellectual property arising from a coronavirus vaccine project at a German company, whose work is partially funded by public, private and philanthropic money channelled through CEPI, the Coalition for Epidemic Preparedness Innovations.

“Asking the question of access as early as possible is really critical. If you wait until the last moment … the pressure to just go and ‘do’ will be so large that these kinds of questions will be skipped.”

Manuel Martin, adviser, Medécins Sans Frontières’ Access Campaign

Ali Salanti, an immunologist at the University of Copenhagen, who is developing a vaccine as part of a consortium receiving USD$3 million from the European Union, tells SciDev.Net he has been approached by several companies wanting to buy rights to his research.

“There have been some offers that were difficult to say no to from a financial point of view,” he says.

Thirty members of the European Parliament have complained that, despite the European Commission’s investment in COVID-19 research, “no legal provisions or requirements appear to have been put in place to ensure research outcomes will remain in the public domain and end products will be made accessible, affordable and available”.

Meanwhile, fearing they could be denied access, Ecuador and Chile have made preparations to issue compulsory licences, in order to sidestep patents to enable the generic manufacture of emerging vaccines and therapeutics.

Since the seriousness of the COVID-19 pandemic became apparent, governments and philanthropic organisations have been investing large sums in research and development for therapeutics and vaccines.

The European Commission has allotted USD$55 million to research projects, on top of existing funding for many projects relating to pandemic vaccines. Meanwhile, many donors are channelling money through CEPI, which is a new partnership of public, private, civil and philanthropic organisations, which is trying to raise US$2 billion to develop three vaccines so they are ready for production. It has already funded eight research projects.

The UK’s Department for International Development currently leads CEPI’s national donors with USD$309 million in funding, and Germany has given USD$153 million.

Campaigners say action to ensure the world’s most vulnerable will not be left behind is crucial now, rather than when the vaccine is ready.

“Asking the question of access as early as possible is really critical,” says Manuel Martin, an adviser with the humanitarian organisation Medécins Sans Frontières’ (MSF) Access Campaign.

“If you wait until the last moment … the pressure to just go and ‘do’ will be so large that these kinds of questions will be skipped.”

CEPI says it is now trying to establish coronavirus vaccine manufacturing capacity in multiple jurisdictions “to mitigate the risk that any one local government could seize all output of vaccines for domestic use”.

“This approach would also enable increased production volume and reduced cost of goods,” a CEPI spokesperson tells SciDev.Net.

Even with a strong negotiating position, however, Martin believes it would be hard for CEPI to withstand a bilaterally negotiated contract between a country and a vaccine manufacturer.

“That isn’t the fault of CEPI. The response really needs to be a global one, it cannot be a national one,” he says.

This is why the global vaccine alliance Gavi, the WHO, national governments, regulators, civil society, and philanthropic organisations are holding urgent discussions about creating an allocation system to ensure that those who most need the vaccine get priority access. This is essential not just for reasons of fairness, says the CEPI spokesperson, but also because “if a COVID-19 vaccine is to be used effectively to end the pandemic, we’re going to need to ensure that vaccine can be deployed globally”.

“Currently, there is no global entity that has that responsibility, so that is something that the world will need to start thinking about now and quickly. One idea would be to establish a globally fair allocation system for any vaccines produced.” The world may agree to set up a global purchasing agent, for example.

CEPI was accused last year of watering down its equitable access policy after large vaccine manufacturers argued the policy was not consistent with a competitive business model. MSF says the new policy is vague and not tough enough on drug companies or states, but CEPI says the former “rules-based approach mandated specific access requirements that were unworkable” and had been altered to a “principles-based approach”.

MSF’s Martin, however, praised other measures CEPI has taken, such as enshrining the principle of equitable access into its core mission and inviting the WHO and MSF to take part in “stage gate reviews” at critical moments in the research and development process.