A Covid-19 vaccine? Why licensing is so important

Once again, a large corporation seems set to win, with global public health losing out.

True public health benefit depends not just on the strength of immune response induced by the vaccine, but on its accessibility and affordability.

In order for a Covid-19 vaccine to be effective, everyone, everywhere has to have access to it. With multiple candidates racing for the finish line, and a rush of news stories mingling promise and concern, here are five core principles to help guide vaccine development in the coming months.

Principle 1

Public investment in Covid vaccine development should require hard commitments to public access. Over the coming year, at least $18bn in public and philanthropic funds are projected to be given to vaccine labs and manufacturers. Governments and other donors need to be attaching clear rules and conditions to help ensure global, equitable access. These must go beyond generic commitments to availability and include concrete conditions, such as "cost-plus" pricing (cost of manufacture plus a small "fair" return) to facilitate making vaccines free at point of use for everyone. If such rules had been attached to public funding of the Oxford vaccine, the agreement with Astra-Zeneca would not have been permissible.

Principle 2

Non-exclusive licensing is a must. Exclusive licensing promotes profits, not public health, leaving a single corporation to decide where a vaccine is available and at what price. With a global pandemic like Covid-19, we need the opposite—global, decentralised manufacturing enabled by non-exclusive licensing, so that vaccines can be produced at the volumes needed. In 2019, Astra Zeneca made close to $3bn in profit. They and other private sector actors should not have the power to decide who gets vaccine access and who doesn't.

Principle 3

Contracts and agreements on publicly funded vaccines must be transparent. Full transparency of vaccine related contracts and agreements should also be a condition of public investment. Oxford has apparently signed a deal to commercialise a potentially life-saving vaccine developed almost entirely with public funds with no contract details released, and no explanation on how this deal will impact people's lives and futures in the UK and globally.

Principle 4

Universities should prioritise universal benefit - not patents and profits - in medicines and vaccine research. Universities are major drivers of medical innovation. About a third of all new medicines and health technologies originate in academic labs. This key research role gives universities huge potential to advance global health if they choose to share medical breakthroughs under open, non-exclusive licenses or licenses that promote lower prices in low-and middle-income countries. Oxford, with an endowment of over $7.5bn and global standing as a leader in education, and other university research centres should respect and prioritise advancing the public good.

Principle 5

National dealmaking is an enemy of global pandemic control. Covid-19 has mobilised impressive government commitments, including funding of needed research and approval of critically needed economic aid packages. It has also provoked governments to hoard and stockpile personal protective equipment, active pharmaceutical ingredients that will be needed to make medicines, and other critical health supplies as they look out for "their own." The British government gave Oxford $25m for work on the vaccine two weeks before the deal with Astra-Zeneca - a company with headquarters in London - was announced. Is there a required percentage of production in the Oxford contract set aside for UK use, and how much vaccine will this leave for the rest of the world? We don't know, but should. For Covid vaccines to be fairly allocated, we need not country by country dealmaking, but a collective manufacturing and procurement mechanism—akin to the role that UNICEF plays in procurement and distribution of childhood vaccines.

The Oxford vaccine candidate is only one of many. The harsh lessons of the Oxford-Astra-Zeneca deal come early enough for us to avoid similar problems in the future.

How vaccines are licensed will mean as much as clinical trial results in determining whether they save lives.

Covid-19 has forced a reexamination of the importance of public health across the globe. Reinforcing public stewardship of vaccine research, manufacture and marketing is just as crucial for pandemic control.