TICK TOCK THE CLIMATE CLOCK-PART THIRTY-THREE: CORONAVIRUS AS PREDICTOR

Over the past few months, it’s become clear that a pandemic requires a global response in a world where neither people nor goods stay put.  What’s also become clear is that, while we don’t yet have a global response, some people are working hard on one.  Whether they will succeed in herding the world’s globalist and nationalist cat-nations toward a vaccine available to everyone remains to be seen.  There are parallels between the twin catastrophes of climate crisis and coronavirus and, importantly, how we manage them.  

In both cases, borders lose meaning and become irrelevant; global cooperation becomes necessary and urgent.  And in each case, time is running out.  The climate change mitigation clock, like the coronavirus vaccine clock, is ticking.  Lives and livelihoods are at risk.  Both crises are fully upon us, but at the moment the health emergency seems more imminent, and the search for a vaccine has taken center stage, pushing the climate crisis into the background.  How we handle the distribution of that vaccine, when and if one or more come into being, will be a predictor of how we handle the climate crisis.  Will each nation think and act for the common good, or will each nation think and act only for itself? 

Wednesday’s Washington Post published an Op-Ed by Justin Trudeau, the prime minister of Canada, and the prime ministers and presidents of Ethiopia, the Republic of Korea, New Zealand, South Africa, Spain, Sweden, and the Republic of Tunisia.  The focus was the distribution of a coronavirus vaccine and the purpose was to echo the statement of UN Secretary General Antonio Guterres (below) that, "None of us is safe until all of us are safe."

 

The op-ed argues forcefully for the equitable, transparent, and scientifically sound distribution of a coronavirus vaccine, admonishing that “where you live should not determine whether you live” and making the case that “global solidarity is central to saving lives and protecting the economy.”  Specifically, the op-ed writers advocate for an existing  multilateral vaccine distribution system overseen by the World Health Organization:

Implementing an organized global flow of vaccines requires a strong multilateral mechanism ensuring mutual trust, transparency and accountability. A fair and effective vaccine allocation mechanism, guided by WHO advice and based on needs rather than means, should focus on saving lives and protecting health systems.

The authors urge cooperation with the Access to COVID-19 Tools (ACT) Accelerator, known as COVAX, a global collaboration to speed the development, production, and equitable access to Covid-19 diagnostics, therapeutics, and vaccines.  There are three protagonists in the initiative.  CEPI (Coalition for Epidemic Preparedness Innovations) takes the lead on pharma development.  Gavi, the Vaccine Alliance (founded by the Bill & Melinda Gates Foundation), oversees distribution and vaccination.  The WHO raises public awareness, determines participation rules and regulations, and coordinates membership.  You can read more at WHO COVAX, but this in a nutshell is their mission statement:

The goal of COVAX is by the end of 2021 to deliver two billion doses of safe, effective vaccines that have passed regulatory approval and/or WHO prequalification. These vaccines will be delivered equally to all participating countries, proportional to their populations, initially prioritising healthcare workers then expanding to cover 20% of the population of participating countries. Further doses will then be made available based on country need, vulnerability and COVID-19 threat. The COVAX Facility will also maintain a buffer of doses for emergency and humanitarian use, including dealing with severe outbreaks before they spiral out of control.

As of Wednesday, 165 countries “had expressed interest” in participating according to WHO COVAX:

The 75 countries, which would finance the vaccines from their own public finance budgets, partner with up to 90 lower-income countries that could be supported through voluntary donations to Gavi’s COVAX Advance Market Commitment (AMC). Together, this group of up to 165 countries represents more than 60% of the world’s population. Among the group are representatives from every continent and more than half of the world’s G20 economies.

The available details are a little sketchy on how exactly this collaboration of 165 countries will work.  For example, how are a participating country's buy-in costs determined?  Who exactly will subsidize poorer nations --philanthropists, wealthy national participants, the WHO?  And who will set the vaccine development and manufacturing costs--the vaccine start-ups, or a team of negotiators?  As WHO COVAX freely acknowledges, its success depends on cooperation, trust, and lots and lots of money:  

The success of these efforts will ultimately depend on securing enough funding from governments and commitments from vaccine manufacturers to participate at a scale large enough to deliver a global solution. The formal expressions of interest submitted are non-binding; the COVAX pillar will now begin a process of consultation with all 165 countries, with countries funding vaccines through their own domestic budgets being required to provide an upfront payment and a commitment to purchase doses by the end of August to secure involvement in the COVAX Facility.

Although the August funding deadline hasn’t arrived yet, significant hurdles to the COVAX effort are already visible.  For one thing, neither the U.S. nor China has "expressed an interest."  (If it says WHO, that spells NO for Mr. Trump.)  Second, some countries with the wherewithal, like the U.S., Germany, France, China, and the U.K., are already financing their own vaccine development efforts and have entered into binding agreements to buy vaccines from the winners they’ve backed.  Do they see an incentive to join COVAX? (Spoiler alert:  they may.)  Third, the COVAX participation agreement has no enforcement mechanism to ensure compliance with the WHO's rules and depends on the good will of participants, an unfortunate, recurring, structural problem with modern multilateral institutions.  Finally, as usual, the guys with all the money call all the shots (no pun intended).  According to AP News (emphasis added):

In a document sent to potential donors last month, Gavi said those giving money to its new “Covax Facility” would have “the opportunity to benefit from a larger portfolio of COVID-19 vaccines.” Gavi told donor governments that when an effective vaccine is found within its pool of experimental shots, those countries would receive doses for 20% of their population. Those shots could be used as each nation wished.

That means rich countries can sign deals on their own with drug makers and then also get no-strings-attached allocations from Gavi. Poorer countries that sign up to the initiative would theoretically get vaccines at the same time to cover 20% of their populations, but they would be obligated to immunize people according to an ethical distribution framework set by the United Nations.

The donor countries are “encouraged (but not required) to donate vaccines if they have more than they need,” the document says.

Beyond this blatant carrot, COVAX has in at least one case inadvertently made it possible for vaccine start-ups without a track record to build on COVAX investments to secure even more significant investments, based on little more than personal connections, as detailed in an article in NYT Novavax.  

Novavax is a company that has never delivered a vaccine to market in its 33-year history.  Nonetheless, CEPI invested $338 million in Novavax on the strength of an endorsement by Bill Gates and some novel vaccine technology.  Novavax, its proforma strengthened, then approached the former head of vaccine research at Novavax, now working at the U.S. Department of Health and Human Services, for further funds.  The tale gets a little complicated from here, but suffice it to say, Bingo!  Operation Warp Speed (could there be a more juvenile name?), HHS's vaccine R&D mechanism, invested $1.6 billion of taxpayer money in Novavax.  Some critics of the deal contend the cozy relationship between HHS and Novavax crossed the line into conflict of interest.  Others say that's just how it works in the insular biotech world. 
 
To be sure, vaccine development is a high-risk, high-reward business with very few players, and it runs on the kind of personal relationships that resulted in the CEPI and Novavax contracts.  These personal relationships are often hidden, deliberately or not, from the public.  Not surprisingly then, details of the U.S. contract, like the CEPI contract, are confidential, and the transparency called for in the Washington Post op-ed was nowhere to be seen.

The lack of transparency in a situation where a public/private endeavor like COVAX is playing on the same playground but not on the same team as the big boys, means that neither knows what concessions the other got, how much the other is paying for the same product, or what the delivery obligations are.  All of this opens the door to conflicting rights and obligations, as noted in an article in NYT Novavax:

With two major contracts, Novavax must now balance two powerful — and potentially competing — investors. Novavax has said that it can accomplish both by simultaneously manufacturing the vaccine in the United States, Europe and Asia. But because vaccine development is so unpredictable, and with these deals largely unfolding in private, it’s impossible to know how far the company will get.

But perhaps an even greater impediment to the success of the COVAX initiative are the mindsets and behavior of stockpiling and hoarding.  Much like what happened with PPE in the U.S., where the federal government used its outsized wealth and clout to compete with states and hospitals for supplies, the pandemic has also caused stockpiling and hoarding of therapeutics and could lead to the stockpiling and hoarding of vaccines.  

Stockpiling "just in case it works" happened with Hydroxychloroquine, essential for lupus patients, but with no known efficacy for Covid-19.  (By the way, what happened to that stockpile?  Where is it now?  Brazil?  And who made money on the deals?) 

Hoarding (and profiteering) is happening right now with remdesivir, a therapeutic produced by Gilead, whose CEO appears in the Oval Office above.  Remdesivir, an antiviral, was found to shorten the time Covid patients stay on ventilators, and the U.S. bought a bunch of it.  From an article in The Conversation:

To beat the coronavirus pandemic, countries need to collaborate. We need the best possible science to develop vaccines and drugs, and to test, track and contain the virus. If we’ve learned anything from the rapid global spread of this virus, it’s that we’re all in this together.

It was therefore shocking to hear, on June 29, that the US government has bought more than 500,000 treatment courses of the antiviral drug remdesivir, representing manufacturer Gilead’s entire production capacity for the next three months and effectively excluding other countries from accessing this drug.

Gilead announced its global price for remdesivir on June 29 as $390 per vial. The Guardian has reported the cost to the US government will be $3,200 for a six-day treatment. In contrast, production costs for remdesivir are estimated at $0.93 for one day’s treatment, or less than $6 for an entire course.

These are just the examples with which I am familiar; no doubt other countries have also behaved like hibernating squirrels.  (In German they call that hamstern, to buy food in huge quantities.)  What that says about human nature isn’t pretty and it is particularly nonproductive in a pandemic.  If these are the examples of global cooperation on the coronavirus, we’re in big trouble, and not just on that crisis, but on the climate crisis as well.

If the world cannot come together to develop and equitably deliver a vaccine for the coronavirus, an existing threat to the global population, how can we expect the world to come together on the “future” threat of climate change to the global population?  Both responses require rich countries to subsidize poorer or less developed countries.  Both require a coordinated, global response and a deep trust in the belief that “None of us is safe until all of us are safe.” 

That’s why I see the development and distribution of a coronavirus vaccine as a predictor for whether the climate crisis will be timely and successfully addressed.  If we come together against the virus, we might just pull it off against greenhouse gas emissions.  But if we don’t, we won’t.  The climate, like some coronavirus patients, is in crisis and needs intensive care.  That’s not a prediction.  It’s a fact.

Keep it real!  Wear your damn mask!

Marilyn