Transcript
Speaker: I'm Jane Williams, this is Red Eye Podcast, produced at the studios of Vancouver Cooperative Radio. You can hear our live broadcast on Saturday mornings from 10 till noon at 100 .5 FM. In our show today, I talk about the need for affordable vaccines with Jason Nickerson of Doctors Without Borders.
Speaker: Since the novel coronavirus was first identified in early January, researchers have been working around the clock to find a vaccine to protect against it. Estimates vary widely about how long it will take, but one thing is for sure, it's going to cost billions of dollars to get a vaccine from conception through clinical trials to widespread availability.
Speaker: Canada has already committed millions to research and development of some of the world's most promising candidate vaccines and therapeutics. However, there's no guarantee that this expenditure of public money will result in a vaccine or treatment that is affordable. Jason Nickerson is the Humanitarian Affairs Advisor for Doctors Without Borders in Ottawa.
Speaker: In a recent article in the conversation, he argues that public investment should not result in high profits for private corporations. And Jason Nickerson joins me today from Ottawa. Hello, Jason. Hi. Now, is it typical for public money to go into research and development of new vaccines and drug treatments?
Speaker: Yeah, absolutely it is. So I think that one of the things that your listeners and indeed many Canadians might be surprised to learn is that public funding and publicly funded research is actually the backbone of almost every new drug and vaccine and many other kinds of health technologies.
Speaker: We know from evidence coming out of the United States in particular, but this is true globally, that virtually 100 % of all new medicines that were registered in the United States had benefited in some way from public funds. So that could be early stage drug discovery, meaning that scientists discover a molecule or a drug candidate that looks promising.
Speaker: or it could be further down the line where the public actually contributes quite a bit of funding to do things like clinical trials, either before a drug or a vaccine comes onto market to test whether it's safe and effective, but also the public contributes quite extensively to the kinds of clinical trials that help us to understand how to use these drugs and what dosage and what kind of combination we should be using them to have the most effectiveness.
Speaker: So the public is actually heavily involved in virtually all aspects of drug and vaccine development. And as I say, is really the backbone of how this system works. Is there any kind of proviso attached to government funding that says anything about the final pricing of a vaccine or a treatment?
Speaker: So the short answer is no. And we would argue that that is something that needs to change. If you think about the way that drug and vaccine development typically works, the very common pathway begins with what I just described, meaning that
Speaker: The public typically issues funding through different grants and other funding mechanisms to researchers who are often working in universities or hospitals or other research institutes who are really doing groundbreaking work to understand how diseases in humans and in animals function and what kinds of weaknesses there might be that could be exploited in order to develop the kinds of drugs and vaccines and diagnostic tests that we need.
Speaker: But typically, these research teams don't have all of the ability to do all of the work that's needed from start to finish to move promising drug and vaccine candidates through clinical trials to test all of the ways in which they need to be tested to see if they're safe and effective.
Speaker: So what typically happens is that at an early stage, promising candidate vaccines or drugs will be licensed out to another party, and usually that's the private sector. What that means is that when it looks like there is some potentially groundbreaking science,
Speaker: That might be effective for different diseases that gets sold or licensed to usually as I say the private sector who then takes ownership of the drug or vaccine and is free to do with it what they want and that those licensing agreements.
Speaker: Generally, as a rule, contain no global access provisions and no fair pricing agreements, really very few stipulations from what we can see. So this is effectively a no strings attached model of commercialization.
Speaker: And at the federal level, and indeed at the provincial level as well, most government funders who are providing the funding to do this work don't require that recipients of public funding have any sort of access or fair pricing policy or conditions in order to receive this funding, which is something that, particularly today during a global pandemic,
Speaker: where the public is contributing billions of dollars to develop the health technologies that basically every person on the planet needs. This is something that needs to change, not just for COVID, but indeed for every other disease and health problem that the public is contributing money to help solve.
Speaker: Now you tell the story in your article about the first FDA approved vaccine for Ebola. It was actually developed in Canada by researchers at the National Microbiology Lab in Winnipeg. But you write it took nearly 20 years to get from clinical trial to approval. Why was that?
Speaker: So one of the things that I think we have to understand is that Ebola is, and for a very long time has been, a disease for which unfortunately it wasn't viewed as being a lucrative market, which is really how the private pharmaceutical industry looks at these things.
Speaker: So, for a very long time, Ebola quite simply wasn't a moneymaker for a drug company that would need to take ownership of this vaccine and invest their own money and resources into developing it. It's very expensive to do clinical trials, and I think it's important to realize that. You're talking about a drug development process that potentially runs into the hundreds of millions of dollars to do the kind of work that needs to be done.
Speaker: Even when we have seen investment in promising drug and vaccine candidates for different diseases, if there's not a lucrative return on investment on the other end, the interest from a for -profit pharmaceutical company really diminishes quite significantly.
Speaker: The alignment between public health needs and private profits doesn't exist for many diseases like Ebola, but this is also true for a whole class of diseases that are known as neglected tropical diseases.
Speaker: So although the Ebola vaccine that you mentioned was very clearly showing promising signs of being effective almost 20 years ago, it took a very long time to work its way through this commercial path and indeed really at the moment that it was sold to a private company.
Speaker: was the moment at which it stalled because there was really no financial incentive to do anything with it until the 2014 West African Ebola outbreak happened. And suddenly, countries were very concerned about their own safety and security because of the potential for it to become a global pandemic. And at that moment, the vaccine was sold to another pharmaceutical company, Merck, who are the ones who finally applied for FDA registration.
Speaker: in 2018, and it received FDA and European Medicines Agency approval late last year. But even still, the clinical trial that ultimately showed that this worked in an epidemic context was a clinical trial that was conducted with significant amounts of public funding.
Speaker: and philanthropic funding by a large number of governments and philanthropic organizations. So even after the sale of the vaccine from the Canadian government to the private sector, the public still contributed immense amounts of resource, technical know -how,
Speaker: really clearly showing that this was a vaccine that worked. So throughout this whole process, it's not as though the public sector is only really involved in early stage drug and vaccine development and then sells it to the private sector and is out of the game. In truth, the public and public sector researchers, whether in universities or in other research institutes, are often very involved in the kind of work that gets done to show that these technologies
Speaker: are safe and effective and to build the knowledge base of how we should use them in clinical practice. Does the private pharmaceutical industry have a track record of interest in addressing public health priorities?
Speaker: Well, I mean, certainly there there are game changing medicines and vaccines that have come out of the private sector. And, you know, I think that it's it's certainly fair to acknowledge that. But there are other health conditions for which there are very obvious market failures. So a prime example
Speaker: is antimicrobial resistance. So this is the term that we apply to a class of diseases that traditionally have been cured or treated with antibiotics, but now are becoming resistant to those antibiotics. So we know that we're running headfirst into a massive, massive problem where we are running out of effective antibiotics for some infections that previously were treatable, but now are becoming resistant to the drugs that we have used.
Speaker: So we need new antibiotics in order to be able to provide, in some cases, very basic medical care. But the way in which we use antibiotics doesn't actually present a very lucrative market for the private pharmaceutical industry. So we use antibiotics typically for a short period of time. You take an antibiotic for maybe five days, seven days, 10 days. It's a short period of time.
Speaker: And because we know of the risk of the development of resistance to them, we're using antibiotics increasingly sparingly. So we know that any new antibiotic that comes onto the market will be used very, very sparingly, quite restrictively. So the combination of these two things means that we're going to have drugs that any new antibiotic would be used very sparingly and just by nature is used for a very short period of time.
Speaker: So it's attracted very little interest, in fact, from the private pharmaceutical industry to the point that the pipeline is beginning to run dry of potential antibiotic candidates. So we know that this is yet another area where very likely what we are going to need is for the public to fund the development of these new medical tools.
Speaker: because there is, as I say, a market failure that's been recognized by governments and by international organizations like the United Nations and many others.
Speaker: So the track record is spotty at best, but certainly what we do know is that in an industry that is driven largely by a profitable return on investment, that profit motivation has led to significant barriers to access for our patients and millions if not billions of people around the world who need access to new medicines that are on the market, but quite frankly are priced out of reach for them.
Speaker: I guess we're looking at a very, very different situation from those two examples, the Ebola vaccine and the new antibiotics when we look at a vaccine for COVID because there are billions of dollars to be made by the pharmaceutical industry on a COVID vaccine. So what are the dangers in this situation?
Speaker: When we're talking about a COVID -19 vaccine, we're talking about something that potentially every person on the planet today is going to need access to quickly. We are living in a global pandemic where almost all of us are susceptible to infection and we know that a significant number of people who become infected.
Speaker: are going to require medical intervention, whether that be hospitalization or some other form of medical care or in severe cases are going to need critical care and being admitted into an intensive care unit.
Speaker: So this really is an urgent global health priority to be able to get vaccines to everyone who needs them, but also to be able to allocate those initial doses of vaccine to the places that have the greatest public health needs, whether that be a particularly at -risk population. But globally, I mean, there are certainly people who are living in places that have health systems that struggle to meet their everyday needs.
Speaker: you know, one of the sort of immediate challenges is to say, yes, okay, there's obviously a large global market for these vaccines, but scaling up production of them isn't going to happen overnight. I mean, what we really need is to not just let profits drive who gets access to these things. Really, what we need is a coordinated global strategy
Speaker: to first of all identify the most promising vaccine candidates and get them to the finish line. But then second, to ensure that once we identify the vaccines that are safe, that are effective, to be able to manufacture enough doses of them to be able to meet the global need.
Speaker: because global need is very high. And if we're really being honest about it, we know that there is no one vaccine manufacturer on the planet who's likely to be able to produce enough vaccine to be able to meet this demand. So the only way of truly being able to scale up rapidly
Speaker: and equitably allocate the doses of the vaccine that we need to places with the greatest need is going to be by sharing these technologies among multiple manufacturers, being able to share and have legal rights to produce enough doses of this to get it to where it needs to be. And that's not how the pharmaceutical industry typically operates.
Speaker: I mean, this is an industry that, particularly with new medicines and new vaccines, really relies heavily on monopolies. And they do that through patent protections and other different kinds of exclusivities to allow one company to basically control the global market and to set prices and, in many cases, restrict who gets access and who can produce it.
Speaker: So really what we're talking about is a change to the way that the global pharmaceutical industry operates to prioritize equitable, affordable access to COVID -19 vaccines, therapeutics, diagnostic tests, and to prioritize access and affordability over private profits, which is, quite frankly, not just the moral and ethical thing to do. It's also the only practical way of ending this global pandemic.
Speaker: It's a big ask. What kind of influence can the Canadian government have on this situation?
Speaker: Well, I mean, I think coming back to the comment that you just made, you know, it's a big ask. Absolutely it is. But it's not like there aren't options on the table. I mean, there are options on the table internationally to create pooling mechanisms for these COVID -19 technologies. So a pooling mechanism basically means that governments or the private sector agree to share the intellectual property rights, meaning in this case, usually
Speaker: patents, but also the science, the data, the manufacturing know -how with a global pool that allows anybody to access these technologies and to be able to produce them in a quality assured, evidence -based kind of way that's safe and that, you know, broadly sort of
Speaker: Distributes rights to to be able to to make in and use them so you know it's it's obviously a complicated mechanism but there's a precedent for it there is something called the medicines patent pool that was designed to do exactly this for for HIV drugs for hepatitis C drugs and increasingly for for other kinds of drugs.
Speaker: So we actually have something that is set up that's a voluntary pooling mechanism for other diseases. We have a lot of experience in negotiating how you actually navigate this sharing of rights. And so it's actually not a big stretch to apply that to the COVID -19 context. I think what's different in this instance is that the public, whether in Canada or in any other country,
Speaker: is a massive investor in doing this early stage rnd and i think needs to start behaving as as an investor and not as.
Speaker: sort of a corporate philanthropist, you know, as the Canadian government is contributing this money. And quite appropriately, I would add, I think that it's appropriate for the public sector to be contributing this large amount of funding to develop and deliver these tools. But that funding needs to be conditional on, I think, some very common sense things, including that if Canada through its
Speaker: hundreds of millions of dollars of public funding helps to discover and develop an effective COVID -19 vaccine or drug, then the recipient of that funding needs to agree to make that technology affordable and priced fairly and accessible to everyone who needs it. This can't just become a vaccine or a therapy that's available only for wealthy countries who agree to pay high prices.
Speaker: It should be treated more akin to a global public good as opposed to a private market commodity. And as a funder of this work at a very early stage, the Canadian government could very well impose these kinds of conditions on that funding. There are many other organizations that do this around the world who provide philanthropic funding to do health research and development, and they make that funding contingent on the recipients of funding agreeing to ensure
Speaker: broad, global, affordable access to the final products. I mean, I think that we've got many examples that we can point to of other organizations that do this. There is no reason why the federal government as a billion dollar investor in COVID -19 research and development couldn't do the same. Really good to talk to you today, Jason. Thank you so much. Thanks very much. It was nice speaking with you.
Speaker: Jason Nickerson is the Humanitarian Affairs Advisor for Doctors Without Borders in Ottawa. His article on the coronavirus vaccine was published in The Conversation on March 23rd. The Red Eye podcast is produced at the studios of Vancouver Co -op Radio. You can support us by supporting Co -op Radio.
Speaker: go to coopradio .org and click on the donate button. Independent media relies on the support of people like you.
