Since the covid-19 pandemic began, it is impossible not to look back and remember how humanity faced other great epidemics. For example, that of influenza A 2008. The expansion of cases around the world, the race for the vaccine, possible treatments ... "Many countries are now caring for, and doing well, their own citizens. But the The solution is not going to be a national vaccine because the best science comes from all over the world, not from Sweden, France, Spain or the United States alone, "says Seth Berkley, epidemiologist and director of Gavi, the international alliance that immunizes half of the children on the planet.
Berkley participated in a virtual dialogue this week with Joe Cerrell, director of global policy for the Bill and Melinda Gates Foundation - second largest donor to the World Health Organization - and Gayle Smith, president of One Campaign, a global organization dedicated to end curable diseases in the most vulnerable parts of the world. These three personalities from the world of global health debated what went wrong in the past and what sins to avoid when a covid-19 vaccine is found, if at all.
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Born, grow and reach everyone
In 2009, there was a true global race to acquire the influenza A vaccine. Spain announced that it would pay 266 million euros to two of the largest pharmaceutical companies to acquire 36 million doses. "Ten years later, we still don't have a global public goods management system. When that vaccine was discovered, a fight broke out between countries to buy it, and unfortunately only the wealthiest countries were able to secure supplies. That's not fair," says Smith. by One Campaign.
So that the countries with less income can play on this global board, the specialists suggest different forms of financing that do not involve a huge one-time outlay. "It is normal that when an epidemic occurs, you do not instantly have the money to cope. There are financial instruments that ensure good prices for countries and security of purchase for the industry," says Berkley. The epidemiologist explained that it is a model similar to that of paying a mortgage: "You have the money in advance but you pay it in 20 years."
Gavi proposes as an idea a project that was launched years ago in which donor countries and foundations commit to finance certain immunization campaigns over a specific period of years. This ensures that lower-income governments will be able to continue to supply and that it is profitable for the industry to manufacture doses on a larger scale.
Beyond the borders
The global scientific machinery has been put to work in these months in a way never seen before. Clinical trials of treatments and vaccines number in the hundreds. "We need global leadership to identify and prioritize vaccine candidates. That is not easy. The traditional way of doing this is by applying transparent criteria. This same leadership will be required for the second challenge, which is to guarantee equal access," he details. Berkley.
"Right now there are not many incentives to guarantee this transparency," says Smith. "This may be reasonable in the case of some pharmaceutical investigations, but in a pandemic, with this level of emergency, a greater exchange of information and sufficient clarity is necessary to know the situation beforehand and avoid the kind of commotion that occurred with the influenza A ", adds the expert.
As an example of this global coordination, Berkley recalls that one of the Ebola vaccines was designed at the Canadian Institute of Public Health, passed through an American biotechnology company, and ended up being manufactured in Germany. "This is how science works," he says.
If you take a world map and forget for a moment that there are borders, science and epidemiology will show you how to deploy a vaccine in the most intelligent way to end the pandemic
An unprecedented deployment
Experts point out that the truly successful vaccine will not be the most effective, but also the one that can be produced on a large scale. “The important thing is to start thinking now about manufacturing costs. It won't do any good if we only produce a few million doses, ”says Cerrell of the Gates Foundation. Cerrell calls for vaccine manufacturing companies to commit to expanding their manufacturing capacity, whichever wins this race.
The European Union wants to show off this unity and on Monday inaugurates a global donation marathon inviting countries and organizations around the globe to commit to help achieve the goal of 7.5 billion in funding for the fight against coronavirus. They call it Coronavirus Global Response.
The Gavi alliance supplies around 600 million doses of vaccines a year, many of them in contexts of precariousness, conflict and difficult access. "We must take advantage of the experience we have after having taken the Ebola vaccine in very difficult situations, to places like the Democratic Republic of the Congo. We must already work with countries to ensure that we can replicate it," says Berkley.
The toilets, the first
"If you take a world map and forget for a moment that there are borders, science and epidemiology will show you how to deploy a vaccine in the most intelligent way to end the pandemic," says Smith. "Who would not want to make sure that the people who are essential in the fight against the virus are the first to receive it?"
The healthcare community is, without a doubt, the most affected by this crisis of the covid-19. 20% of the cases registered in Spain affect these professionals; in Italy that percentage is 10%; in the United States, those infected reach 3%, and in China it stands at 3.8%. "Healthcare workers are at the top of the list of people who should be immunized, they are those who are most at risk of getting sick, but also those who can transmit the disease the most, something that encourages outbreaks to be out of control. Second , there would be the rest of the risk groups and finally the population in general. But it is necessary to have these conversations before we have the vaccine, "emphasizes Cerrell.
Perhaps these decisions should not depend on goodwill alone. "As far as I know, there is no legal framework for equitable access. So one of the challenges is how we set the moral and ethical guidelines and then create a guide to the deals and investments that need to be made," Berkley insists.
Delay in other immunizations
Since the pandemic was declared, Gavi has already counted delays in 35 vaccination campaigns, which has had disastrous results. Unicef has warned that 37 million children may be excluded from immunization from preventable diseases such as measles. Niger declared a polio outbreak a week ago. The confinement and the closing of borders causes shortages, a lack of health personnel and that families do not take their children to the vaccination centers. "The challenge is to ensure that routine immunization continues during this pandemic, I have no words to explain how important this is," says Berkley.
"One of the things that was least talked about in the 2014 Ebola outbreak was the increase in measles. I think international organizations like Gavi are going to take on a very important role in ensuring that there is rationalization and effectiveness to the time to buy treatments and vaccines ", defends Cerrel.
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