Global Affairs

Covid-19: The weaponising of medicines

The Covid-19 pandemic has underscored the point that when push comes to shove, politics is never far away and national interests come first in securing vaccines. This has implications for how governments will go about locking down medical supply lines in future.

ST ILLUSTRATION: MANNY FRANCISCO

The war of words between Britain and the European Union over access to vaccines shows no signs of abating. On Thursday, EU leaders will have to decide whether to approve a threat by Dr Ursula von der Leyen, the head of the European Commission, the EU's executive body, to stop exports to Britain of vaccines produced in Europe, unless the British accept reciprocity in its distribution.

The political stakes are huge for both sides. EU leaders face a backlash for messing up their vaccination programme, while Britain has already succeeded in vaccinating half of its entire adult population. Prime Minister Boris Johnson has presented his country's vaccination programme as a vindication of Britain's decision to leave the EU, and as a redemption for his own poor record of managing the pandemic. The tactic seems to have worked, going by his popularity ratings. However, his reputation is now tied to the success of his vaccination programme, and that could be imperilled by any vaccine supply war which may erupt this week.

There are no saints in this episode. While proclaiming the virtues of free markets in goods and services, Britain is guilty of protectionist, nationalist measures while Europe's current response also points in the protectionist direction. As Dr von der Leyen put it bluntly over the weekend: "We have the option of banning a planned export. That's the message to AstraZeneca: You must fulfil your contract with Europe first before you start delivering to other countries."

Whichever way this saga concludes, the future belongs to more rather than less protectionism in trade in pharmaceutical products.

CLOAK-AND-DAGGER GAMES

The prevailing narrative as to why the United Kingdom seems to enjoy abundant supplies of vaccines while the rest of Europe is stumbling from one supply shortage to the other is that the Brits were simply better at signing the contracts with pharmaceutical companies. The EU, meanwhile, supposedly behaved like the curmudgeonly auntie, haggling over the price of future vaccines, and simply ended up at the end of the queue.

Only that this is not what happened. For both the British and the European Union governments intervened in the pharmaceutical markets right from the start of the pandemic, with the Brits simply being more brazen.

The British government offered large financial grants to Oxford University, which had a lead in developing vaccines, as early as January last year, on the condition that, if the vaccine development is successful, the 67 million-strong population of the United Kingdom will have first call on the product.

The Europeans also invested heavily to boost European capabilities and in keeping these capabilities in European hands. The German government, for instance, rushed to buy shares in the CureVac company to block efforts by the Trump administration to entice the company's labs to move to the United States. And the BioNTech company, which developed a successful vaccine, was also assisted by large contributions from the German taxpayer, and EU funds as well.

The only difference is that, while the Brits wrote into their contracts from the start clauses which gave Britain priority access to the Oxford vaccine, European governments did not, probably because they took it as granted that they would end up being able to have these vaccines.

The EU signed up to a contract with the AstraZeneca company earlier than the British. But what European Union negotiators did not know was that by partnering with Oxford University, AstraZeneca inherited the obligation which the Oxford University researchers accepted to allow the UK first access. The EU remained a true believer in free markets in vaccines and ended up a loser.

The EU in the past two months exported about 10 million doses of various jabs to Britain but got none in return. The British insist that its agreement with AstraZeneca gives it first call on output from both EU and British plants.

The more we know about the cloak-and-dagger games which went on last year over access to vaccines, the more it becomes clear that both the UK and the US prioritised national interests above all else.

OPERATION WARP SPEED

One of the key measures of Operation Warp Speed, the Trump's administration's effort to secure supplies of vaccines, was the use of regulations to ensure that any vaccines produced in the US remain in the US.

That is why soon after Germany's BioNTech company completed its vaccine research and entered a production arrangement with the Pfizer pharmaceutical company, the US government was in no hurry to sign supply contracts because it knew that it could always have exclusive access to whatever Pfizer produced on the US territory, so any other country which signed contracts with Pfizer would have to source it from the country's other plants outside the US, and especially from the Pfizer plants in Europe.

The British were fully cognisant of the US intentions. In the early stages of the race for the vaccine at Oxford University, the university's preferred commercial partner was Merck, a multinational pharmaceutical company based in the US. Yet the British government apparently vetoed this link-up, precisely because London knew that the Americans would have first call on whatever Merck ended up producing. So, AstraZeneca, a part-British company, stepped in instead, a move which went unnoticed in the European Union.

There is no question that the British have been far nimbler at this game. Perhaps because British negotiators represented one nation rather than 27 EU countries, they were more single-minded and coordinated.

There is also no question that British negotiators were better-informed about the sector: They undertook to cover some of the legal liabilities of pharmaceutical companies, provided a faster track to licensing the vaccines for general use and invested in bottling plant capacity well before the vaccines rolled off the assembly lines, thereby eliminating the production snags which plagued the Europeans.

Yet when all is said and done, the reality remains that Britain and the US have had a head start because, while proclaiming their belief in the free market, they ensured that their people benefited first.

The EU was left to discover to its horror that while it has no ability to tap the two AstraZeneca production facilities in the UK since these have always produced exclusively for the British government, the British also appeared to have priority access to the two additional AstraZeneca facilities in Europe in order to fulfil contracts which were exclusive to the UK.

To add insult to European injury, the US' ban on the export of vaccines produced on its soil has meant that, ridiculously, Canada and Mexico have also had to source their Pfizer vaccines from Europe, rather than from a few hundred kilometres across their respective borders with the US. And if you thought this was odd enough, there is also the fact of the US getting part of its vaccine supplies from Europe.

None of this excuses the EU of its own mistakes. EU member-states were also far too slow in organising their vaccination programmes. They believed - erroneously - that a slow start to the vaccination campaign would reassure Europeans who were doubtful about the process, and instead ended up with an irate population and plenty of anti-vaxxers as well.

EU governments were also far too quick to express doubts about the safety of the AstraZeneca vaccine, with the result that they have plenty of vaccines from this company but not too many takers, while at the same time they berate Britain for not letting Europe have more vaccines.

Blocking supplies to Australia and perhaps Britain as well is no way to improve the vaccination campaign and will not result in extra supplies for Europeans either. And to add to the surreal air of the current dispute, the AstraZeneca contractor's production site in the Netherlands which the EU may ban from exporting to Britain is still not authorised to distribute its products to Europe.

Yet when this crisis is finally over, every single European government will be looking at its own supply lines to ensure that no such experience can be repeated. The pandemic has acted as a reminder that, when the chips are down, nations will beg, steal, or borrow to serve their own interests. Perhaps that was always predictable. But it took today's health crisis to make this clear.

DEVELOPING NATIONS

Developing nations remain, as always, at the end of the queue in such tussles. According to current production schedules - and notwithstanding various pledges to provide vaccines to developing countries - the 85 poorest nations on the planet may not be able to start vaccinating their people until 2023.

Removing the patents on vaccines to facilitate generic production everywhere - a proposal often made in health crises - remains a deeply counterproductive move. For it will not only remove the incentive to innovate but may also persuade pharmaceutical companies to ignore research into many communicable diseases which afflict only poor nations.

Besides, even if vaccines are produced by generic manufacturers, the main problem would remain: Poor sections of the world's population would be just as unappealing a market for manufacturers of copycat drugs as they are now for companies with approved vaccines. So, the incentive for mass production would still be low.

Philosophy professor Thomas Pogge at Yale University in the US recently suggested an innovative scheme for governments to establish what he calls a global Health Impact Fund which will provide incentives for the pharmaceutical companies by paying them annual premiums according to the contribution the companies make to reducing the burden of disease in poorer countries; pharmaceutical companies would no longer get their profit for the sale of a drug, but from the health effects achieved.

But although he estimates that the fund will not require more than around 0.3 per cent of the current world-wide spending on drugs each year, it seems highly unlikely that anything of the kind will be created; the professor is far too idealistic.

What is clear, however, is that few developed nations will ever again place their trust in the market economy to govern supply chains in medicinal and pharmaceutical products.

From face masks to the humble rubber gloves or the generic paracetamols, and right up to the high-end science of vaccine development, countries will insist on not merely knowing exactly how all the production and supply chains work, but also on controlling the most critical aspects of the process.

It is an odd fact that a pandemic which has reminded us of how dependent we are on each other has also provided a strong impetus to the renationalisation of medical know-how and the weaponisation of medicines.

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A version of this article appeared in the print edition of The Straits Times on March 23, 2021, with the headline Covid-19: The weaponising of medicines. Subscribe