A healthcare worker in Havana, Cuba opens a box of donated syringes sent by Cuban solidarity groups based in the United States on July 23, 2021Share on Pinterest
A healthcare worker in Havana, Cuba, opens a box of donated syringes sent by Cuban solidarity groups based in the United States on July 23, 2021. YAMIL LAGE/Getty Images
  • A new paper asks: “what are the obligations of pharmaceutical companies in a global health emergency?”
  • The article notes that a disorganized, ad hoc approach is hampering the world’s efforts to distribute vaccines worldwide equitably.
  • The authors of the paper present four principles that should steer the response to pandemics, such as the current one, as well as four approaches for achieving these principles.

According to the World Health Organization (WHO), there have been more than 207 million confirmed cases of COVID-19 and more than 4.3 million deaths from the disease.

Although there are vaccines that can reduce the risk of developing COVID-19, getting the global population vaccinated is a monumental task.

According to Our World in Data, just 31.7% of the world’s population has received a single vaccine dose, while only 23.7% of people worldwide are fully vaccinated. In low income countries, a scant 1.3% of individuals have received a single vaccine dose.

Coronavirus resources

For more advice on COVID-19 prevention and treatment, visit our coronavirus hub.

Was this helpful?

These numbers seem to contradict a commitment to vaccine distribution expressed in a recent joint statement from the Gates Foundation and major pharmaceutical companies, including AstraZeneca, Gilead, and Johnson & Johnson.

The statement reads, in part:

“Through partnerships with other stakeholders, we are committed to ensuring global access to diagnostics, therapeutics, and vaccines that will help to accelerate the end of the pandemic.”

A paper that appears in The Lancet seeks to identify the obstacles standing in the way of the successful, comprehensive, and equitable global distribution of COVID-19 vaccines. It also offers recommendations for doing better in the next worldwide pandemic.

The paper begins with the statement: “During a global health emergency, everyone is morally required to help to combat the disease.”

Bioethicist Dr. L. Syd M Johnson of SUNY Upstate Medical University in Syracuse, NY, explained to Medical News Today that “[w]e usually think of moral agents as individuals, but it makes sense to also think of organizations as moral agents with moral obligations.”

Dr. Johnson, who was not involved in writing the paper, said that organizations have a unique ability to contribute to the public good: “When we are talking about global problems like a worldwide pandemic, the actions of single individuals cannot have significant impact, but the actions of organizations — including governments and corporations — can.”

“The pharmaceutical companies who make COVID-19 vaccines are uniquely positioned to ensure fair, just access to those vaccines, and as collective moral agents, they have a moral obligation to do so,” Dr. Johnson also noted.

However, adjunct professor Dr. Timothy Mackey, of UC San Diego’s global health program in the Department of Anthropology, told MNT: “I don’t believe there is consensus about what exactly would constitute a moral or ethical obligation for equitable vaccine access and distribution.”

Dr. Mackey, who also was not involved in The Lancet paper, has called for a more equitable means of distributing vaccines.

In general, the paper’s authors assert that the primary issue preventing a more successful response to COVID-19 is the improvised, uncoordinated nature of the response so far. They describe the situation this has created:

“[The] WHO, the Coalition for Epidemic Preparedness Innovations, and Gavi, the Vaccine Alliance have established COVID-19 Vaccines Global Access (COVAX) to procure and fairly distribute vaccines. But much vaccine development, production, procurement, and distribution is ad hoc, generating controversy and inconsistency. Pharmaceutical companies have been criticized for knowledge hoarding, secret pricing, unreasonable profits, unfair bilateral deals, and extortionate demands for indemnification against liability. COVAX has been criticized for an absence of transparency and accountability and for ignoring need in COVID-19 vaccine distribution.”

It is not helping, either, that there are so many vaccines in use in different countries, each with its advocates and supporters. The WHO currently has approved seven vaccines for use, and that does not represent all the vaccines deployed in different parts of the world, nor are all of them equally effective.

“Conversations about access would likely be different if there was a gold standard treatment developed for COVID-19,” said Dr. Mackey.

The paper presents four principles that should govern responsible parties’ moral obligations. The authors note they are all equally important, writing that “[a]ny decision to give greater weight to some principles rather than others is inherently controversial.”

The four principles are:

  1. “optimizing vaccine production”
  2. “fair distribution”
  3. “sustainability”
  4. “accountability”

The paper also presents four possible approaches for achieving these goals, including:

  1. Tiered pricing: “Pharmaceutical companies distribute vaccines on the basis of tiered pricing, charging more to wealthy nations and less or even nothing for low income countries.”
  2. Global public goods: “Pharmaceutical companies voluntarily waive their patent rights and engage in technology transfer; vaccines are made available to all.”
  3. Partly bilateral: “Pharmaceutical companies distribute vaccines through both bilateral contracts and to an international facility (e.g., COVAX).”
  4. Fully multilateral: “Pharmaceutical companies distribute all vaccines through an international facility, such as COVAX.”

However, the paper states that pharmaceutical firms have tried most of these approaches to some degree, and none are perfect. For example, while these manufacturers could waive vaccine copyrights, it may still be the case that few other parties would have the requisite knowledge to produce the vaccine.

“There is no authoritative and widely accepted institutional arrangement for ensuring a fair distribution of burdens in response to pandemics or other global health emergencies,” say the authors of the paper.

Addressing the lack of this agreement should be our focus, said Dr. Mackey.

“Instead of focusing on principles of ethical obligations,” he said, “there needs to be a set of globally agreed-upon norms and standards around access to medicines during health crises.”

Dr. Mackey noted that there are plans to discuss a future pandemic treaty during a World Health Assembly meeting in November.

It is clear the world’s response to the spread of COVID-19 has been unsatisfactory, and the paper suggests that the one possible silver lining is what the current pandemic is teaching us.

“Improving the system requires a critical evaluation of how well the existing uncoordinated conglomeration of public and private institutions can generate and fairly distribute the benefits of innovation, and what is needed for a more sustainable institutional solution that avoids unnecessary death and suffering while ensuring sufficient incentives to respond to a future crisis,” the authors emphasize.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.