Affordable vaccines — is it really too much to ask for when we paid for the research?
Why CEPI* needs to get tougher with its industry partners to ensure equitable access to vaccines.
Manuel Martin, Medical Innovation & Access Policy Adviser, MSF Access Campaign
In medical school we are given the impression that infectious diseases, while scary, are something we can handle with the right tools. The thought of facing them without treatments or vaccines available never crossed my mind, but if it had, it would have been terrifying.
Yet, this was exactly what our teams faced when we responded to the 2014–16 Ebola virus outbreak in West Africa which killed more than 11 000 people.
One health worker responding to the outbreak called it “fighting a forest fire with spray bottles”.
Today we are back, fighting another Ebola outbreak in the Democratic Republic of Congo but this time there are two vaccines and two promising treatments available to us. It’s not going to rid the world of Ebola, but it is a crucial piece of the puzzle when combatting outbreaks.
So why weren’t there vaccines or drugs available to us and other caregivers the first time? The simple and chilling answer is that pharmaceutical companies were unwilling to develop vaccines against Ebola because, as they saw it, the expected profits did not warrant the risk of funding research and development (R&D) in to these urgently needed, lifesaving medical tools.
The same commercial rationale explains why we don’t have vaccines and other medical tools to fight Lassa fever, Nipah virus, Zika and other infections which primarily affect the poorest people on the planet and have epidemic potential. This is what economists call a ‘market failure’ — something the public desperately needs and that traditional market ‘actors’ will not provide.
This ‘market failure’ is symptomatic of a much wider problem with the way we get medical tools funded and developed. But that’s a much longer story. In the case of the ‘missing’ vaccines, a practical solution was sought in the creation of the Coalition for Epidemic Preparedness Innovations (CEPI), a product development partnership funded through public and philanthropic monies and dedicated to the development of new vaccines for diseases of epidemic potential.
CEPI has attracted a huge amount of support for its mission — so far, it has secured more than US $740 million to help develop vaccines for emerging infections. With this unprecedented level of public and philanthropic funding CEPI funds R&D, pays for investigational vaccine products (which are normally free), and even covers some indirect costs of its grantees. Then, just for good measure, CEPI hands over all research results — including all intellectual property, materials and data — to its grantees. But this generosity on the part of CEPI can only be justified if the vaccines are ultimately made available at affordable prices as soon as they hit the market.
Unfortunately, affordable pricing is not the strength of the private sector — the most common partner of CEPI. Nonetheless, CEPI seems unwilling to contractually commit its research partners to affordably price their vaccines once they reach the market.
But this wasn’t always the case. When CEPI was first launched, we at Medecins Sans Frontieres (MSF) sat on its interim Board of Directors and helped shape CEPI’s original ‘Equitable Access Policy’, which contained strong and enforceable commitments on intellectual property and affordable pricing. However, in an apparent response to critique by pharmaceutical corporations, CEPI watered down its access policy to a series of vague and toothless statements.
When we challenged CEPI over this, they released a template funding agreement which forms the basis for negotiation with its potential partners. This 29-page document somehow manages to avoid using the word ‘affordable’ at all and the only time prices are mentioned is to ensure that prices are “sustainable to the manufacturer”.
Now — we’ve had a lot of debate about what ‘affordable’ means in MSF, but this is surely the most one-sided definition I have ever come across.
While CEPI is doing invaluable work in moving vaccine development forward, this cannot be done at any cost. Keep in mind that every dollar unnecessarily spent by CEPI to entice a pharmaceutical corporation to collaborate is a dollar that could have been used to actively fight epidemics such as Ebola.
If pharmaceutical corporations are unable to accept even the most basic conditions of affordability for products from research that they won’t even fund themselves, then maybe they are just not the right partner to do this important work.
With more than $740 million, CEPI is not hostage to the support of pharmaceutical corporations and could explore new and innovative partnerships with actors who are more aligned with the goal of pricing their vaccines at an affordable level.
This week CEPI Board members will meet in Washington DC. If they are serious about their mission to “enable equitable access” then they are going to need to get tougher with their partners and include enforceable commitments on the affordability of their products in their ‘Equitable Access Policy’ and as well retain the right to step in when these commitments aren’t met.
I want to know that in the next outbreak our teams respond to, every penny of public money was used to develop vaccines accessible to the people who need them, not line the pockets of pharma investors.
*CEPI = Coalition for Epidemic Preparedness Innovations.
