CHANDIGARH, INDIA - APRIL 30: Residents of sector 30 wait behind a barricade to collect LPG cylinders after the area was sealed as a coronavirus containment zone, on April 30, 2020 in Chandigarh, India. (Photo by Anil Dayal/Hindustan Times via Getty Images)
Residents of Chandigarh, India, queue to collect gas cylinders. The government has responded to coronavirus with a strict lockdown © Hindustan Times via Getty Images

As the EU launched efforts this week to raise €7.5bn from donors to accelerate access to coronavirus medicines worldwide, concerns remain that billions of the world’s poorest people will be left behind.

Much effort from industry and political leaders alike has focused on funding the development of vaccines, diagnostics and drugs to prevent, test and treat Covid-19. Far less attention has been paid to how to scale up production, and how scarce supplies will be allocated.

That worries Els Torreele, executive director of the Médecins Sans Frontières Access Campaign, which campaigns to secure access to medical treatments for those who need them. “The past has not provided good examples,” she says. “We feel there will be a scramble, and wealthy countries will first serve themselves. Unless we have binding commitments that are concrete, measurable and actionable, how will the other 90 per cent of the world have affordable access to these products?”

In late April, international leaders gathered online to support the launch of the World Health Organization’s “accelerator” for “equitable global access to innovative tools for COVID-19 for all”. “We need to develop a vaccine, we need to produce it and to deploy it in every single corner of the world, and make it available at affordable prices,” said European Commission president Ursula von der Leyen, who was involved in launching this week’s fundraising meeting.

Mandatory Credit: Photo by JOHN THYS/POOL/EPA-EFE/Shutterstock (10613709e) The President of European Commission Ursula von der Leyen holds a press conference on the European Union (EU) response to the coronavirus COVID-19 disease crisis at the EU headquarters in Brussels, Belgium, on April 15, 2020. President of European Commission Ursula von der Leyen holds a press conference, Brussels, Belgium - 15 Apr 2020
Ursula von der Leyen, president of the European Commission. The EU is aiming to raise €7.5bn from international donors to assist the fight against coronavirus © JOHN THYS/POOL/EPA-EFE/Shutterstock

Yet uncertainties in the science, competing national priorities and divergent political interests, limited manufacturing capacity and weaknesses in national health systems all bring dangers that lower-income countries will get left behind — which could mean reinfection for the rest of the world.

Already there have been complaints that wealthy countries’ capacity to test for coronavirus comes at the expense of Africa’s.

Big Pharma steps up

Thomas Cueni, head of the International Federation of Pharmaceutical Manufacturers and Associations, says coronavirus is a pivotal moment for his members. He argues that the sector is rising to the challenge with initiatives to develop the tools required and make them available affordably through unprecedented co-operation, donations and pledges on prices.

“Everybody feels this is the moment when the industry needs to do the right thing,” he says. “It holds the keys to ending Covid-19. This is 1919 and 1929 combined: the Spanish flu with the Great Depression. I’m extremely pleased to see industry reacting as society would hope, without being coerced or forced.”

Daniel O’Day, chief executive of Gilead, which has been donating supplies of remdesivir as a treatment that can accelerate recovery from the disease, concurs. “We understand the responsibility we have,” he says. “We are committed to making [remdesivir] accessible and affordable to patients around the world.”

AstraZeneca has committed to supplying vaccines at cost. Bayer, Roche and other companies exploring the use of new medicines or “repurposed” existing ones to treat coronavirus have pledged “differential pricing” based on measures of countries’ ability to pay. As yet, none has revealed detailed figures.

Operators work on the pre-filled syringes assembly line at AstraZeneca Plc's new Biologics factory in Sodertalje, Sweden, on Thursday, April 11, 2019. AstraZeneca raised its annual sales forecast, helped by demand for the U.K. drugmaker's roster of new cancer drugs. Photographer: Mikael Sjoberg/Bloomberg via Getty Images
Workers at an AstraZeneca factory. The company has undertaken to supply coronavirus vaccines at cost © Bloomberg via Getty Images

Stefan Oelrich, head of the pharmaceuticals division at Bayer, which has given away chloroquine — a drug it first identified for malaria — to governments, says: “As an industry, I think we’ve learnt that we need to treat different regions a little bit differently, reflecting market access conditions and how we price medicines.”

He points to the lessons of HIV at the start of the millennium. Pharmaceutical companies were forced to overhaul their approach after coming under fierce criticism for charging high prices for anti-HIV drugs in South Africa and other poorer countries where Aids — caused by HIV — was prevalent.

The squeezed middle

The Global Fund to Fight Aids, TB and Malaria, which channels aid money to the big three killer diseases in poorer countries, has already started spending $1bn reallocated from existing funds to respond to the pandemic — while seeking to mitigate the impact on its core programmes. “We are a logical vehicle to use,” says executive director Peter Sands. “We have all the established relationships, pooled procurement, supply chains, financial controls.”

Gavi, the vaccines alliance, which plays a similar role for immunisation programmes, is also switching funding to support the purchase of diagnostics and personal protection equipment, while trying to mobilise manufacturers to work together. Seth Berkley, Gavi’s chief executive, says: “In developing countries, we need some type of global access agreement. That will be very important, but tough in this political environment.”

NOIDA, INDIA - APRIL 30: Police commissioner Alok Singh distributes the safety kits to the cleaning workers of district hospital, during a nationwide lockdown due to coronavirus pandemic, at Sector 30, on April 30, 2020 in Noida, India. (Photo by Sunil Ghosh/Hindustan Times via Getty Images)
A policeman distributes safety kits to Indian hospital staff. The cost of coronavirus treatments may fall heaviest on middle-income countries such as India © Hindustan Times via Getty Images

If the Global Fund and Gavi are able to help some of the poorest nations cope with coronavirus, the biggest gap may be for middle-income countries with substantial inequality, such as India. Their governments are increasingly viewed by foreign donors as rich enough not to need aid, and by companies as lucrative markets with a significant middle class able to pay privately for healthcare.

Pharmaceutical executives and their critics alike argue that the industry should not be left alone by default to make such tough decisions on pricing and allocation. As Severin Schwan, chief executive of Roche, says: “We need to make distribution driven by objective criteria. Governments can really play a role.”

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