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Slow Views • The Tortoise Take

Prick of conscience

Friday 4 June 2021

The G7 summit must make global vaccine roll-out its highest priority. Covid respects no border, and will continue to mutate until the citizens of all nations – rich and poor – are vaccinated in high numbers


Next Friday, the leaders of the G7 nations, joined by their counterparts from Australia, South Korea and South Africa, will gather in Carbis Bay, Cornwall, for the keynote summit of the UK’s year-long presidency.

India’s prime minister, Narendra Modi, is expected to join the gathering remotely, while Ursula von der Leyen and Charles Michel – respectively, presidents of the European Commission and Council – are set to attend in person. The broader range of participants reflects the shared interest of Joe Biden and Boris Johnson in piloting an organisation of democratic nations – a “D10” or “D11”.

Though climate change and “building back better” will naturally occupy some of the delegations’ time, their focus should be sharp, practical and remorseless: how to ensure that the Covid vaccine is rolled out throughout the world, in the shortest possible time, with the maximum possible efficiency.

Though the daily news from India, Malaysia, Peru and elsewhere makes an unequivocal humanitarian case for massive global intervention, this is not simply a matter of charity or philanthropy. Enlightened self-interest should also spur the richer nations of the world to take radical, aggressively orchestrated action, and do so now.

On Monday, the UK reported no new deaths within 28 days of a positive coronavirus test for the first time since July 2020. The roll-out of the jab in this country continues to exceed all expectations. But the cliché “nobody is safe until everybody is safe” is a cliché for the simple reason that it is unquestionably true.

As long as the virus continues to rampage through unvaccinated countries, its relative decline in the UK – and other developed nations – will be entirely provisional. Pathogens that are left to their own devices mutate furiously, as we have already seen with the Kent, South African, Brazilian, Indian and now Nepalese variants.

Unless the whole world is given access to the jab, there will be a clear and present danger of “vaccine escape”: the point where the virus, driven by the pressures of natural selection, evolves sufficiently to outpace medical science, and breaks through the immunity conferred by the first generation of preventive anti-Covid technology.

The urgency of the challenge could scarcely be more acute: according to World Health Organisation data, only 0.3 per cent of 1.1 billion doses administered by 5 May had gone to low-income countries, compared to the 80 percent of the total jabbed into the arms of those fortunate enough to live in high and upper middle income nations. In Africa, only 28 million doses have been delivered – accounting for less than 2 per cent of the continent’s population. 

Here are the key measures that Biden, Johnson, Angela Merkel and their colleagues should (and should not) initiate in Cornwall next week:

  • Leadership: COVAX – the global initiative established in April 2020 under the joint auspices of the WHO, the Coalition for Epidemic Preparedness Innovations, and Gavi (formerly the Global Alliance for Vaccines and Immunization) – is well-meaning, staffed by hard-working professionals, and totally unequal to the mission with which it has been tasked.

    As Professor Sophie Harman of Queen Mary University London said at a Tortoise Sensemaker Live on 14 May, COVAX is based on a “really outdated charitable model”; more Live Aid than 21st century pathogen-smasher.

    If it is to stand a chance, the COVAX operation needs to be turned over lock, stock and barrel to a new UN High Commissioner for Vaccine Emergency – a person with the stature and convening power of a Barack Obama, a George W Bush, or a Tony Blair. At this rate, COVAX will miss even its modest target to have 20 per cent of the population of 92 poorer countries vaccinated by the end of 2021. 

    A figure of global authority is required without delay to animate the listless limbs of the WHO, the World Trade Organization, and associated NGOs – the middle-order bodies of global multilateralism, in other words – and to hit the phones, twist arms and (if necessary) take to the airwaves to name and shame recalcitrant institutions and individuals. The stakes are simply too high for business-as-usual inertia or diplomatic ambiguity.
  • Resources: It should be a matter of global shame that there is a $2.6 billion hole in COVAX’s financial plan for 2021 – a rounding error compared to the national rescue packages that individual governments have implemented during the pandemic. 

    The Vaccinate Our World campaign is right: an injection of at least $100 billion is needed immediately, and ought to feature in the first paragraph of the communiqué issued by next week’s G7 summit.
  • Patent waive: President Biden has become an unexpected convert to the idea that pharmaceutical companies should waive their patent rights to Covid vaccines, a measure that can, in theory, be forced upon them by the WTO. In practice, for all its virtue-signalling appeal, this proposal is an almighty red herring.

    Even if the major industrialised nations were to unite behind the US and insist upon open-source access to all the core intellectual property associated with the major vaccines, the practical impact upon global roll-out would be minimal.

    The manufacture of all these products is extremely complex, especially so in the case of mRNA technology (the key to the Pfizer and Moderna jabs), and the chance of the worst-hit nations developing their own manufacturing infrastructure in time to prevent public health catastrophe is zero.

    Furthermore: the future of global public health resilience requires Big Pharma to retain an incentive to keep experimenting and the markets to keep investing in vaccine research. It is no accident that vaccine tech developed so quickly when Covid surged – a reflection of years of massive R&D and capital investment. The G7 should not be tempted down this blind alley.
  • Hoarding: Many of the richer nations – the UK included – have massively over-ordered vaccine supply, for reasons that are entirely understandable (what if one of the main jabs had turned out to be a dud, in spite of regulatory approval?). There are billions of doses already stockpiled – 73 million in the case of the US – or, no less importantly, in the process of being manufactured, that should now be diverted to places that actually need them.

    Canada has ordered enough doses to vaccinate all its citizens ten times over. The UK has procured sufficient supply to give the double-dose jab to every Briton eight times. It was absolutely right to err on the side of excess provision, but now it is time to share.
  • Production: No less important is the need to drive 24/7 production at all conceivable facilities and for the key pharmaceutical companies to ramp up joint-venture production around the world. At present, the pace of manufacture, at least to supply poorer nations, is woefully inadequate.

    Moderna, for instance, has agreed to supply COVAX with 500 million doses at its “lowest-tiered price” – yet most of these jabs will not be available until next year. The absence of urgency in the system, as presently configured, is deeply alarming.

    The corollary of dramatically increased production is that local jurisdictions – notably the EU – work equally fast to cut through all red tape associated with licensing, and to abide by a new global agreement (temporary, if necessary) to ditch all barriers to the export of vaccine ingredients and manufacturing tech.

    If India, for instance, is to make it through its own present agonies, it will have to drop populist measures such as the current ban on exports from the Serum Institute in Pune, Maharashtra, the world’s largest vaccine manufacturing facility. Antagonistic vaccine nationalism is no substitute for the global collaboration that Modi badly needs to embrace.
  • and a longer-term strategy: The next, slower phase of global vaccine planning will be to assist developing countries in the building of new infrastructure of their own and the development of local expertise in readiness for the next pandemic. New jurisprudence will also be needed to remove the legal obstacles to rapid-turnaround licensing of new vaccine products as they go to market.

But that is not the priority in June 2021: at present rates, much of the world will still not be vaccinated even at the end of 2023 – a recipe for appalling death tolls, and (for vaccinated nations) a huge epidemiological gamble against virus variants emerging that outpace even the second iteration of the jab.

The G7 has not had a good pandemic. Precisely when there was the greatest and clearest need for international leadership on supply chains, travel rules, food safety and health information, the world’s most powerful nations scarcely seemed able to organise a Zoom call. 

Since the departure of Donald Trump from the geo-political scene, there has been much talk of a “new multilateralism”, geared to the needs of the 2020s and beyond. 

In Cornwall next week, the leaders of the free world have a chance to turn that aspiration into a detailed action-plan to address an emergency of immense scale and moral clarity. If they leave without issuing such a plan, posterity will not judge them kindly. 

Photograph by Brian Ongoro/AFP via Getty Images