Vaccine Nationalism Puts Global Advocate on Covid Front Line

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As the coronavirus spreads around the world and the death toll tops 300,000, it’s sparking a race for a vaccine that could leave poorer nations behind. Seth Berkley saw it coming.

“The natural instinct of political leaders is to protect their own populations,” said Berkley, chief executive officer of Gavi, the Vaccine Alliance, an international organization that aims to improve access to inoculations against deadly diseases. “Of course that’s what they should do, but they need to understand part of that is making sure the world is protected.”

Covid-19 has sparked an unprecedented research mobilization, with developers globally working on as many as 100 experimental vaccines. As nations rush to ease lockdowns and restart economies, concerns are growing that some will try to secure early supplies of a vaccine, the strongest bulwark against the spread of disease, for themselves.

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AstraZeneca Plc CEO Pascal Soriot said the U.K. will takepriority for the University of Oxford’s fast-moving effort to develop a shot. French drugmaker Sanofi’svaccine that received funding from the U.S. will likely be used there initially, CEO Paul Hudson said last week. Sanofi said later that its vaccine would be available to everyone.

Two-Tiered World

The prospect of a two-tiered world has sparked outrage. French officials said the idea of the U.S. being first is“unacceptable.” More than 140 world leaders and experts called for a free, swiftly available “people’s vaccine.”

Berkley is at the center of a high-stakes bid to ensure equitable distribution. The European Commission has raised 7.4 billion euros ($8 billion) for global vaccine access, and governments and charities have contributed to theCoalition for Epidemic Preparedness Innovations, an Oslo-based nonprofit that’s funding a number of Covid projects. But the effort will still require countries and drug companies to put global interests ahead of their own.

Holes in the immunization shield create risks. Despite decades of progress against measles following the introduction of a shot in the 1960s, theWorld Health Organizationflagged a potential resurgence after 800,000 cases last year, largely due to unvaccinated pockets. The coronavirus could do the same.

“If you have perfect control, but the countries around you don’t, the virus will move,” Berkley said in an interview. “We’ve proven that now, time and time again.”

Universalizing immunizations is Gavi’s business. The organization has supported the vaccination of more than 760 million children and accounts for about half ofglobal childhood shots for measles, polio, whooping cough and other illnesses. Berkley is proposing a proven financing measure, called an advance market commitment, designed to push vaccine makers to invest in production capacity, speed up global deployment and provide shots at affordable prices.

‘Uphill Climb’

A decade ago, Gavi entered such an arrangement withPfizer Inc. and GlaxoSmithKline Plc to provide pneumonia vaccines. A 2016agreement withMerck & Co. helped create a stockpile of Ebola vaccine later used in the Democratic Republic of Congo.

Gavi and its partners face an “uphill climb” in any negotiations with drug companies over Covid-19 shots, said Kate Elder, a policy adviser at Doctors Without Borders. In markets with only one or two suppliers, prices tend to stay relatively high, she said.

While Elder said she’s “cautiously optimistic” about the campaign to widely distribute potential Covid shots, it’s “very hard to believe that there isn’t going to be some of the usual dynamics at play in terms of the highest bidder getting first access.”

Berkley estimates it will cost about $2 billion to vaccinate his first target -- 20 million nurses, doctors and other health workers -- and create a stockpile for the neediest regions. Immunizing the world could cost tens of billions of dollars, he said.

“One of the challenges is going to be trying to get a universal agreement on this, and that may be tough, but you want as many groups who agree with this as possible,” Berkley said.

The ability to bring government, industry and nonprofit officials together will be crucial when -- and if -- scientists deliver a vaccine. Government funding efforts and commitments to impartial distribution have encouragedTore Godal, the founding director of Gavi. But he doesn’t want to repeat the panic of the 2009 H1N1 flu pandemic, when wealthier countries rushed to secure supplies, leavingpoorer regions behind.

“Finding mechanisms to prevent that from happening is very important,” said Godal, who recommended Berkley for Gavi’s top spot nine years ago. “But you also have to be realistic. Each leader of a country obviously has a responsibility first and foremost to one’s own population.”

Tough Odds

Berkley, 63, has faced daunting odds before. After serving in the U.S. Centers for Disease Control and Prevention and later seeing the devastation of AIDS as an epidemiologist in Uganda, he launched an international effort in 1996 to bring an HIV vaccine to the developing world. That goal continues to elude scientists.

The world will need something like a “Marshall Plan” for Covid vaccines to figure out how to introduce doses to the public, and who should get them initially if supplies are limited, said Wayne Koff, CEO of the Human Vaccines Project, who worked with Berkley on the HIV push.

There’s been progress since Bill Gates and Gavi’s CEO warned at aconference five years ago that infectious diseases posed a rising threat to the world. The 2017 establishment of CEPI, the nonprofit working with companies and universities to speed up vaccines, is a prime example, Berkley said.

Even as countries and companies wrestle over their response to the current outbreak, Berkley is looking ahead. The world should consider an early-warning system and increase capacity to scale up vaccine production to brace for the next emergency, he said.

“This is not the last time this is going to happen,” he said. “We’ve had a few dress rehearsals. Each time we’ve gotten a bit better, but not as much as we’d like. The critical issue is whether this is going to be the wake-up moment.”

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