It's dog eat dog in the world of COVID-19 vaccines.
That's the fear of global health agencies planning a scheme to bulk-buy and equitably distribute vaccines around the world. They are watching with dismay as some wealthier countries have decided to go it alone, striking deals with drugmakers to secure millions of doses of promising candidates for their citizens.
The deals - including those agreed by the United States, Britain and the European Union with the likes of Pfizer, BioNtech, AstraZeneca and Moderna - are undermining the global drive, experts say.
"Everybody doing bilateral deals is not a way to optimize the situation," said Seth Berkley, chief executive of the GAVI alliance which co-leads the scheme called COVAX designed to secure rapid and fair global access to COVID-19 vaccines.
Pfizer said this week it was in concurrent talks with the EU and several of its member states on supplying them with its potential vaccine.
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
And in the latest swoop, Britain announced a deal on Wednesday to secure advanced supplies of potential COVID-19 vaccines from GlaxoSmithKline and Sanofi .
This, according to global health charity Medecins Sans Frontieres (MSF), will further fuel "the global scramble to hoard vaccines by rich countries" and feed "a dangerous trend of vaccine nationalism".
The concern is that vaccine supply and allocation in this pandemic will echo the last - caused by the H1N1 flu virus in 2009/2010 - when rich nations bought up the available supply of vaccines, initially leaving poor countries with none.
In that instance, since H1N1 turned out to be a milder disease and the pandemic ultimately petered out, the impact on infections and deaths from vaccine imbalances was limited.
However COVID-19 is a far greater threat, and leaving swathes of the world's people vulnerable will not only harm them, but also extend the pandemic and the damage it can cause, health experts say.
"There is a risk that some countries are doing exactly what we feared - which is every man for himself," said Gayle Smith, former head of the U.S. Agency for International Development and CEO of the One Campaign, a non-profit aimed at ending poverty and preventable disease.
'I AM WORRIED'
More than 75 wealthier countries including Britain have expressed interest in the COVAX financing scheme, which is also co-led by the World Health Organization and the Coalition for Epidemic Preparedness Innovations, or CEPI, joining 90 poorer ones who would be supported through donations.
But the United States, China and Russia are not among countries expressing interest in COVAX, according to GAVI.
And an EU source said last week that the European Commission, which is the bloc's executive arm and leads EU talks with drugmakers, has advised EU countries not to buy COVID-19 vaccines via COVAX.
"I am worried," said Thomas Bollyky, director of the global health program at the Council on Foreign Relations. "What is happening with the handful of nations that are locking up supply of vaccine competes with the multilateral supply deals.
"At the end of the day, vaccine manufacturing is a finite resource. You can expand it, but only so much."
Experts estimate the world can reasonably hope to have around 2 billion doses of effective COVID-19 vaccines by the end of next year, if several of the leading candidates prove effective in expedited late-stage trials currently underway. COVAX's aim is to distribute doses for at least 20% of its signed-up countries' populations.
ANOTHER TWO YEARS?
Berkley of GAVI said, however, that if self-interested countries or regions snapped those up to cover their entire populations - instead of sharing them across nations and protecting the most at-risk people first - the pandemic could not be controlled.
"If you were to try to vaccinate the entire U.S., (and) the entire EU, for example, with two doses of vaccine - then you'd get to about 1.7 billion doses. And if that is the number of doses that's available, there's not a lot left for others."
If a handful, or even 30 or 40 countries have vaccines, but more than 150 others don't, "then the epidemic will rage there" Berkley said.
"This virus ... moves around like lightning. So you'll end up in a situation where you will not be able to go back to normal. You won't be able to have commerce, tourism, travel, trade, unless you can get the whole pandemic to be slowed down."
He and Smith and other health experts said ending the pandemic meant ending it globally.
"It's the difference from a pandemic (for) another two years as opposed to one year," Smith added. "The economics and health consequences of that are enormous."