Emma Ross
Good morning and thank you for joining us for this week’s Chatham House COVID-19 briefing with our Distinguished Fellow, David Heymann. We have with us today Professor David Salisbury, who is a leading expert on all things vaccines, from developing them to getting them to those who need them. He’s one of our Associate Fellows, and previously chaired WHO’s Strategic Advisory Group of Experts on Immunization and Co-chaired the Pandemic Influenza group of the G7 Global Health Security Initiative.
As usual, just some housekeeping things, briefly, first. This briefing is on the record, and you can tweet using the hashtag #CHEvents. Questions can be submitted, using the ‘Q&A’ function on Zoom. Upvoted questions are more likely to be selected, so if you like a question, please do upvote it.
So, this is quite an opportune moment to be talking vaccines this week, not only because of where we are with COVID-19, but also, given that in the last week, we had the 40th anniversary of the success in eradicating smallpox, which had been plaguing humanity for maybe 3,000 years, but was beaten, and a vaccine was used in that. And today, we’re going to be talking about the challenges of developing a vaccine, producing enough and delivering it, and some of the other issues yet to be tackled, such as who’s going to get it, who’s going to pay for it, and other issues.
So, welcome, Davids, and I was hoping to start with David Heymann. You were involved in the smallpox eradication campaign, in your younger days, and I was hoping you could inform us on how important you think a vaccine was for smallpox eradication. Was it the vaccine that beat it? And what does that experience show us about what we’re facing now [pause]?
Unmute, David.
Professor David Heymann CBE
Thank you, Emma.
Emma Ross
You’re unmuted.
Professor David Heymann CBE
Still?
Emma Ross
No, it’s okay.
Professor David Heymann CBE
Okay. Thanks, Emma. Yeah, that’s right, 40 years ago, and the eradication of smallpox was certified. And smallpox eradication was accomplished with a vaccine, which had been available for many, many years, but there had been poor access to that vaccine by many in developing countries. So, smallpox eradication not only signalled a success in public health, in getting rid of smallpox, but it also was the first time when there was universal access to a health good, and that was to the po – to the smallpox vaccine. Today, we’re seeing polio eradication, and the same issue is true. When polio eradication began in 1988, there was no access, in many countries, to this vaccine to the people who really needed it and that access now has been guaranteed, and all countries do have access to the vaccine and it made great progress in getting rid of another disease, polio, although it still exists.
But the equitable distribution of vaccines was solved through smallpox eradication, through polio eradication. It hasn’t been solved for many other infections, such as pandemic influenza. But there have been great steps in making that progress – in making progress to making sure that there will be at least some access. And that occurred because of a very bold Minister of Health in Indonesia who, back in 2007, was asked by her Minister of Health, or by her President, rather, to obtain two million doses of a vaccine which they’d made from a virus, which the country of Indonesia had freely shared with WHO.
WHO provides viruses to manufacturers to develop vaccines at no cost, and when the Minister went to this company that had taken the virus from Indonesia to make a vaccine, she was told that there was no vaccine available for Indonesia, that it had already been sold to other countries, and there were many countries waiting to get that vaccine, once it was produced. So, she had to go back to her President empty-handed, which began a whole issue of equal benefits for equal sharing. The Minister had shared a virus, yet she didn’t have any benefit from that, and that led to a series of discussions in WHO, which finally came out with a new framework called the Pandemic Influenza Preparedness Framework, which – in which private sector companies that are developing pandemic vaccines for influenza, or that will do that during a pandemic, agree to provide a certain percentage to WHO for distribution to countries. But this is a very small percentage of all production and it certainly won’t be something that is equitably distributed through all countries around the world. So, we have made progress in vaccines. We have made progress in equitable distribution. But those problems will certainly continue, as we see whether or not there is the possibility of developing a vaccine for COVID-19.
Emma, you’re on mute.
Emma Ross
Sorry. The muting thing. David Salisbury, a lot of hope has been pinned on the arrival of a vaccine to rescue us from this pandemic, with experts saying that until then, [audio cuts out – 05:38] a lot of candidates in development. But lately, experts are starting to address the assumption that a vaccine will come, or at least that a decent vaccine will come in time to make a difference to our lives, before the virus is given time or the opportunity to run its course naturally. What is your thoughts on the prospects of getting a vaccine at all, or in time to make a meaningful difference in this pandemic?
Professor David Salisbury CB
Well, thanks, Emma. Clearly, whilst this virus continues to circulate, or we face the threat of it coming back and recirculating, we remain at very high risk and therefore, we have to look at all of the possible interventions that could be brought forward. And a vaccine, as long as it’s safe, effective and its protection is long-lasting, would be a great solution. However, there are many hurdles that we have to go through, or go over, from that point through actually delivering. And the first, of course, is can we make a safe and effective vaccine that would deal with this threat?
Now, that sounds simple, but it’s not. Partly because we don’t even know, at this point, what vaccine we should be making. Now, we know the virus, and we know the sequence of the virus, but there are many techniques for making vaccines, and different people are opting for different techniques. We have got old techniques, like growing the virus and killing it and then you’ve got an inactivated vaccine. We’ve got techniques like making a live, attenuated virus vaccine, and polio and measles are good examples there and then there are techniques where you make virus-like particles, and you just take the piece that’s going to code for immunity into recipients. And then there are some really novel techniques, like RNA vaccines, which have not been successful so far, but might be a solution to making large quantities of cheap vaccine for this virus.
So, we really do have challenges ahead of us and like any horse race, you pick your horse and you hope it’ll win. But we don’t know which of these candidate production methodologies is going to be the one that wins. So, we have a lot of problems even deciding where to put your money on the right candidate.
Emma Ross
Do you think that the groups that were working previously on a SARS vaccine – this is for both of you, David may have a view, given his experience on SARS, do you think they will have a bit of a head start, or might be frontrunners in this? Or is their experience with that a shared experience now through collaboration?
Professor David Salisbury CB
I think that their experience is valuable, of course, because they were already trying to develop a coronavirus vaccine. But the hard piece of that is, they didn’t succeed. So, we have to acknowledge that this is really difficult. They will have learnt from their experiences trying to make a SARS vaccine about what not to do, and they will have good ideas of what they should do, so clearly, they have a head start over people that want to use a different technology.
Professor David Heymann CBE
I might just add, Emma, also, that there was also work on a MERS coronavirus vaccine and that vaccine – there has been a vaccine developed for use in animals. As you remember, with MERS coronavirus, it’s carried by camels in their nasal passage and the vaccine has been developed, and there have been some studies of that vaccine. But again, no successful vaccine has yet been developed, either, for the MERS coronavirus. So, as David said, both the SARS coronavirus and the MERS corona vaccines have not yet been successfully developed. It’s quite a challenge to develop a vaccine.
Emma Ross
Is there something particularly tricky about coronavirus, or was that a matter of demand melting away?
Professor David Heymann CBE
I might start, and then David will certainly want to add more. But, you know, with the SARS coronavirus and the other coronaviruses, we just don’t know how long immunity might last. So even if there is a vaccine that’s been developed, we don’t know whether or not it could be used, and would have to be given first in two doses, or whether it could be given in one dose and then a booster later on. And we don’t even know if the vaccine can produce an immune response, which would protect against a future infection, because we know that other coronaviruses don’t provide long-lasting immunity after infection.
As you remember, there were four human coronaviruses. None of them provide long-lasting immunity, but they do provide a short-term immunity, so that you can be infected with the virus this year, and then next year infected with that same virus.
Professor David Salisbury CB
If I can just follow onto that, I think what David is opening up is a real can of worms. Because if vaccine-induced immunity was not long-lasting and the virus continued to circulate, we would be on a track of flu vaccine equivalent, but worse, because every single year, or whatever frequency, we would have to be doing this over and over and over again. And if you think about flu vaccine programmes, at the moment they are done pretty much only in high-income and some middle-income countries. They are not done in low-income countries and, by and large, they are not well delivered. So, if we find ourselves on the same track with the coronavirus, I see this as being potentially a very difficult long haul. So, we really want a safe and effective vaccine. Of course one-dose vaccine would be even better, because you have to have two doses, you have to have an interval in-between, and then, you have to double the number of doses you need and the number of people that you’re going to vaccinate. So, having to face short-term immunity will be really problematic.
Emma Ross
But before we move on to more development questions, I just want to – still in the anxiety of what if we don’t get one at all, or in a timeframe that’s meaningful for this pandemic? David Heymann, do you think smallpox could have been beaten without a vaccine? Was that the lynchpin? And, to both of you, if we don’t get a vaccine, are we really in bad shape, or will we make it through, or what does that mean for us if we don’t get a vaccine?
Professor David Heymann CBE
And thanks, Emma. You know, smallpox was a disease for which every infection was clinically expressed the same way, so that if you were infected with the smallpox virus, you knew that you would have these terrible pox on your face, on your hands, on your body, that would leave scars eventually. Every infection was – could be identified. With the coronavirus, with the COVID-19, SARS coronavirus 2, we aren’t seeing that every case is expressed in the same way. In fact, there are many, many cases that are asymptomatic, and many, many more that are very mild and not recognised as this infection. So, to come back to smallpox, if you could identify every case, you could have isolated those persons who were infected and made sure that their contacts were isolated, so that if they became sick, they wouldn’t transmit further and you could probably have stopped that infection without a vaccine.
With the new coronavirus today, that would not be possible. What may be possible, though, is to develop a drug, which cures, or an antibody preparation, which might modify disease or even be used to prevent infection in some populations. But this is a long way off. We don’t yet understand the immunity. But coming back to vaccines, possibly smallpox could have been eradicated without a vaccine. But a vaccine certainly facilitated that process. Over to David.
Professor David Salisbury CB
Well, whilst I’m a huge enthusiast for vaccines, unless we have a vaccine available in unbelievable quantities that could be administered extraordinarily quickly in all communities in the world, we will have gaps in our defences that this virus can continue to circulate amongst. I think that David’s point about treatment and other ways of prevention is really important here, because testing an antiviral is much more straightforward than testing a vaccine. You test the antiviral in people who’ve got the disease, and you hope to see that those that you treat with the antiviral get better and survive better than those who have a placebo or an alternative treatment. So, the scale of your clinical trial may only be hundreds or, perhaps, thousands. But what you’ve got to do with a vaccine is, you’ve got to show that it stops people actually getting infected. So, you’ve got to use it in a time and a place when the virus is circulating and you’ve got to use it in very high quantities, to make sure that you actually stop the infection and you can prove it.
So, an antiviral may actually be quicker and easier, and the same quantities are not going to be needed for a preparation, an immunoglobulin, that would actually act as a passive immunity, so that you will give people immunity. And you could either do that at an early stage of the disease to stop the virus replicating, or even as some form of treatment where it might buy you six months of avoidance of risk, and then every six months, you’d have a top-up of your passive vaccine. So, there are a number of other ways in which we could deal with this virus, as well as, obviously, wanting to develop a vaccine. Thanks.
Emma Ross
Okay. So normally it takes about ten years to develop a vaccine, if all goes well. I’m interested in how are they going about accelerating the arrival of the vaccine, the machinery behind that, and what – are there sacrifices that are going to have to be made to make that happen? Can we expect it not to be quite as good as if it was developed at a normal pace? Are there safeguards in place to make sure we don’t rush into something that may be bad for us? I mean, how are we going to accelerate this and what may be sacrificed, if anything, during that?
Professor David Salisbury CB
Can I have a go?
Professor David Heymann CBE
Please.
Professor David Salisbury CB
I don’t think anybody will sacrifice safety. We must be giving a vaccine to the public that they can trust to be safe. Now, effectiveness is not quite so straightforward. We would, of course, like to have a vaccine that is 95/100% effective. But we might accept a vaccine with lower effectiveness, if it was actually going to help to block transmission. So, we may make compromises on that. Now, there are of course important issues about how are we going to develop a new vaccine as fast as we possibly can, without diverting resources that would be used for other things? And clearly, some resources are going to have to be diverted towards developing a vaccine for this virus. Now, that means that Scientists who are working on other vaccines and other immune mechanisms and other drug development, are going to stop doing that work to work on COVID-19. So, there’s an opportunity cost, simply in the diversion of science towards developing vaccines and treatments.
Then, there’s the diversion of resources to make such a vaccine. Now, I was reading that one group in the United States is looking at how you could use measles virus to express the protein, the S-pro – spike protein for coronavirus and so, you would trick measles viruses to carry this protein, and then you would make a vaccine, like we make measles vaccine. Well, that sounds fantastic. But you’re only going to be able to do that in the places that currently make measles vaccine and then there’s an opportunity cost. Does that mean that we set aside our measles vaccine production that is currently saving millions of lives? Or do we somehow magically expand capacity where nobody had plans to expand capacity of measles vaccine? So, there are going to be opportunity costs here and then, when we have a new vaccine, there is going to be opportunity costs in actually administering it.
Industrialised countries have vaccine programmes. They may not be very good, but they have vaccine programmes for giving, for example, flu vaccine to older people, and people in risk groups. Middle-income countries may not have them at all. Low-income countries do not have adult vaccine programmes. So now we get a COVID vaccine, and we want to give it to older people and high-risk people, and we have no process of administering it. So that means we have to divert resources from existing fragile health systems to do this and that’s an opportunity cost, because other things won’t get done.
So, we’re going to have to start balancing. What is our priority here and how can we fulfil that priority? So, the opportunity cost issue runs right the way from the science in the development of vaccines, right the way through to who is going to go along with the syringes and needles, vaccinating people to save them from COVID, but leaving them exposed to other health risks that otherwise might have been dealt with. Thanks.
Emma Ross
David, do you want to add anything to that?
Professor David Heymann CBE
Yeah, I might just add that…
Emma Ross
Sacrifices to accelerate?
Professor David Heymann CBE
Yeah, I might just add that countries have locked down in Europe and in other places and the lockdown has been touted as pending the availability of a vaccine. So, what’s happened is, we have a very low level of transmission of the virus in many countries, while at the same time, the political leaders are saying there will be a vaccine and hopefully there will be a vaccine that can help out with that problem. But as David says, there are many problems in making sure that that vaccine can be produced in a way that it is not disrupting other vaccine production. And what’s happening is that governments, UK and the US government, for example, are going to begin to fund production of what looks like the most promising vaccines to them within this year. At some point, they will begin production of those vaccines, even though they’re not yet even finalised and licensed. So, we’ll be seeing a whole new way of working, hopefully, to increase production capacity. But to produce vaccines available in the whole world will be very, very difficult and a great challenge and if we don’t have vaccines for all countries with an equal availability, then we will see this virus continue to threaten all countries, because one country, in today’s world, is a threat to all other countries, as far as infectious diseases.
Emma Ross
Okay. Can we do a reality check on allocation and amount? What are the prospects that we will have enough vaccine for everybody and how do you both see the issue of global vaccine allocation playing out? Who’s going to get what, who’s going to pay for it, and what’s going on there? And, you know, given the discussions that are going on now, what do you think we’ll be looking at?
Professor David Heymann CBE
I think that, you know, it’s very difficult – it will be very difficult for countries to decide who gets vaccine first and what the logical flow would be is that the elderly would have that vaccine first. Those people who might have a weaker immune system, but who really need to have that vaccine and hopefully, the vaccine would work in that population equally as well as in the younger population. And then it would have to be given out to others, much as the influenza vaccine is sometimes given only to the elderly, to health workers and to the very young. But David will have many more views on that. David, over to you.
Professor David Salisbury CB
Yeah, thanks. I mean, I agree with you that with in-country, there will be prioritisation, and that prioritisation will probably be based on risk, and I’ll come back to that, if I remember to, in a moment. There is a fundamental issue, though, that I don’t believe anybody is addressing seriously, and that is the concept that vaccine will be distributed to the whole world.
Now, if you think of vaccine production, once we know that it’s going to be successful, coming out of factories, and imagine that vaccine production is a cake, and every week the factory produces a cake, and that cake is going to be divided amongst the customers. And the more customers that you have, and the cake is finite, the smaller the slices become, and each of those slices has now got to go to more and more people, because we’ve got more and more customers. And that means that no customer is going to get anything like the quantity that they felt that they needed, in the time that they needed to protect their population. So, we end up in an inherently ineffective position, where everybody gets a tiny amount of a scarce resource, but never enough, quickly enough, to stop transmission. So, I think that there are some realities that we have to bring to bear, when we talk about vaccine being available for all. Unless something utterly transformative happens, in the quantities of vaccine that can be produced, there will be a form of rationing. One way or another, there will be a form of rationing and that means that we end up with an inefficient process.
I want to just come back to the issue of prioritisation. David raised it. We might start with older people and we might then also do healthcare workers and so on. I have experience of vaccine programmes where we used prioritisation. We ran, in the UK, a meningococcal vaccine programme where it was very clear that the highest risks were young children and teenagers and so, as the new vaccine became available, so we vaccinated according to risk. And we rolled the programme out for young children first, along with the teenagers, and then we went down the age groups. I took a phone call one afternoon from a man who said that he was really pleased that his 16-year-old son had been vaccinated in school three weeks before, in accordance with the risk profile of the programme. His 11-year-old son had died the day before, because he was not eligible, according to the prioritisation. So, every time we make priorities, according to risk, which is probably the only way we can do this, there will be casualties, and that’s unavoidable. Thank you.
Emma Ross
Okay, going back to what you said about the cake. Can you not just make a bigger cake, throw up more vaccine factories like we’re doing for the beds, and therefore, bigger cake, everyone can have some? Is that realistic? What about that?
Professor David Salisbury CB
I mean, making a hospital, which is a converted conference centre, is very much easier than making a vaccine production facility. And anyone who thinks that you can take a greenfield site and six months later manufacture vaccine out of it, I fear it may be deluded. You’ve got to build a vaccine factory, and you’ve got to build one that’s big enough for your purposes. You’ve got to be able to have it approved, that it is a fit and safe place to make vaccine. Then you’ve got to put the technology in there and show that it actually works and your vaccine that you want is what comes out at the end, and these are biological processes, and they cannot be guaranteed. And what are they going to do with the factory, which was big enough to deal with this instance, every day thereafter? So, there are huge complexities that sound straightforward, “Let’s build a factory,” and actually, I think that you have to step back and say this is not easy. Thank you.
Professor David Heymann CBE
There’s one more issue also, Emma, and that is the fact that most countries have legislation in place that doesn’t permit exportation of vaccines that they’ve manufactured within that country until national demand has been satisfied. So that will cause an even greater problem in making sure that there’s a fair and equitable distribution of vaccines. Especially, as we’ve seen now, there are countries, allies, countries that are allies in many different ways, are competing for the same masks, or the same ventilators, and offering to pay higher prices, in order to get them. So, it’s a very difficult issue that needs to be resolved and certainly, if there is a vaccine production facility developed that can produce the quantities of vaccine required, it would be ideally in a country with a low population, so that that demand could be satisfied early and then vaccine could be exported.
All these are hypothetical problems, but they’re important for our political leaders to understand, so that we’re not just saying we’re waiting for the vaccine. Malaria leaders, in countries in Africa, have been saying for years that there will be a malaria vaccine. Finally, there’s a vaccine, but its effectiveness is not as good as we would like to see it. Yet, it does have a role to play. So, we can’t be promising vaccines at this point in time. We can only be hoping that our Scientists, in the many different ways that vaccines are being developed, will lead to one that is available to all populations and effective in its use.
Emma Ross
Okay, I’m going to move onto questions now, ‘cause I’ve gone a bit over of our normal thing, but this was so fascinating. I think there’s a lot of need for this kind of discussion and it seems like, to me, that vaccines are probably going to be the ultimate test of global solidarity. So, really interesting to see how that pans out.
So, I’m going to go to questions now. This is from Maryam Lauwooti and she’s asking about what happened to natural immunity. “We hear that most affected are asymptomatic with mild symptoms.” To kind of latch onto that, could you address, in the context of a vaccine or waiting for a vaccine, what the virus’s intention is, as far as its natural course? And that is as well as natural immunity, the herd immunity situation. Well, maybe not herd immunity, but, you know, infecting as many people as it can before we have a vaccine.
Professor David Heymann CBE
Emma, I’ll start with that by saying that remember, we’ve talked about, many times in the past, that we don’t understand the immune response that’s created by this virus. We understand, from other coronaviruses, that immunity is possible, but that it’s short-term. It’s not long-term and so, what we’re hoping is, that in this virus, immunity will be longer-term. But at present, we can’t even make such predictions, as we could insert people who are immune or have antibody, back into safe work, because we don’t know if they’re protected or not.
So, there’s a lot to understand about both the immunity that occurs after the virus is introduced into a human, but also, the innate immunity, the ability of those cells that go after alien viruses when they enter without any immunity, whether they’re effective in dealing with this virus either. So, we have to look at both innate immunity, that immunity which is present in everybody, and then the antibody immunity, or the immunity, which occurs when a virus infects a person. And we just don’t understand that yet, although there are studies in mice and in macaque monkeys, which are giving some answers to some of these questions in the animal kingdom, and hopefully, they’ll be transferrable to humans. But at present, we just don’t understand enough about immunity to say whether things like an immunity passport, saying that if you’re antibody-positive you can go to work, are not even feasible at present, because we just don’t have that understanding. Over to David.
Professor David Salisbury CB
Well, I think David’s done beautifully with the recipient side of the story. If I just pick up on the virus, the virus has no intention. The virus doesn’t have an intention. We have heard so many adjectives linked to this virus, as if it was a sentient being that had a cunning plan. It doesn’t. You know, it isn’t an evil virus, it’s just a virus. The fact is it has no intention. We have to understand that this is a phenomenon that will happen. We’ve just got to find the best way to deal with it. We’ve got to find the best way to make our immunity durable, and we’ve got to find the best vaccine that will do all of that, and we’ve got to find the best treatment. But don’t think that this virus has an intention to do anything. It doesn’t. It’s a virus. It’s the most simple piece of genetic code that just goes and disrupts our cells. So, it hasn’t got a cunning plan. We have to have the cunning plan.
Emma Ross
Thank you, David. Yes, yeah, well put. So, a question from Ashleigh Furlong from POLITICO, “How likely is it that we don’t get a vaccine?” Oh, we’ve dealt with that, actually. The second part of the question is what I want to ask you. “Considering that Europe is the most vaccine-sceptic continent, how will public health experts convince people who are vaccine-hesitant or against vaccines to get immunised?” And another aspect of that is, to what extent do you think the movement, the anti-vaccination movement, will get traction during COVID? Do you think that’ll be a big problem? Or is – yeah. Basically, are they going to get traction? Is that movement going to get traction? Is this going to be a problem, the acceptance, public acceptance of a vaccine?
Professor David Salisbury CB
Well, I sincerely hope it does not. I don’t think it’s fair to label Europe as the most vaccine-sceptic. I think within Europe there are some unhelpfully vaccine-sceptic countries, but I think it’s a bit unfair to label the whole of Europe that way. Nevertheless, people will make judgements, and they will make judgements based on what they see as risk. And if their perception of risk is that this virus can kill them or make them extraordinarily ill, and the studies to date so far show that the vaccine is safe, it would be, I think, a foolhardy choice to put yourself or your family at unnecessary risk. And I hope that perception would be that the balance of benefit is far, far greater than any theoretical, hypothetical, unproven or even scientifically ridiculous risk. Thank you.
Emma Ross
Here’s one from Tim Willasey-Wilsey, sort of an upvoted question. “There are reputed to be 14 strains of COVID-19. If that’s true, how does this affect the quest for a vaccine?”
Professor David Heymann CBE
Well, that’s a good question and, you know, what happens with influenza is each year, the seasonal influenza viruses, those viruses that are in human populations, drift a little bit genetically. That means that there are slight mutations. But those slight mutations are enough to require a new constitution in the vaccine for the following season. We don’t have any evidence that that might occur with COVID-19, but we don’t have any evidence that it won’t, either and so, there are many things that Vaccinologists must be able to understand, as they develop a vaccine. And hopefully, all those questions will come to light, as the intense research and development on vaccines continues. So, there are some very positive outcomes that will come from all this research and development and hopefully, those positive outcomes, even if they don’t lead to a successful vaccine, will help us better deal with this virus. David?
Professor David Salisbury CB
Yeah, I think – I don’t want to get into too much, sort of, a molecular-level discussion here, but I think it depends entirely on which bit of the virus mutates. And if the bit of the virus that mutates is not the bit that actually is critical for the development of immunity, then it’s irrelevant. But if the bit of the virus, and let’s just say the spike protein, if the spike protein, which is the bit that we’re using to develop our immunity, was to mutate, then we would have problems about making sure that future vaccines match the mutation. But as long as it’s the bit that we want to make our immunity against stays constant, then I think we should worry less about mutation.
Professor David Heymann CBE
I would agree with that, but I want to remind us also, that they haven’t yet found that part of the influenza virus, of the seasonal influenza virus, and so, you know, all of these things are coming together in better understanding. And hopefully, this research will benefit other vaccines as well, such as David just said, finding a part on the influenza virus, for example, or on any virus, how to find that part, that is stable, that does cause immunity. A real challenge and this increase in research and development for this COVID vaccine will certainly open up new doors of research and understanding for other vaccines.
Emma Ross
Okay, this – still on this research and development co-operation, this is from Prashant Rao from The Atlantic. It’s also an upvoted question. “Is there a benefit to the competition underway at the moment to develop a vaccine or could there be greater collaboration, or is that a false choice between competition and collaboration?” And then – well, no, I’m not going to tack on the other question. So that’s the question, the competition versus collaboration.
Professor David Salisbury CB
Well, I think it depends rather on, you know – it depends entirely on the pricing strategy that individual producers will come to. If, for example, there is a single price for any new vaccine, irrespective of who makes it and how they make it, then clearly, the issue will be what profit margin is acceptable to recoup the development costs, to recoup the production costs? And if there is just one fixed price, then there is no particular financial advantage in pricing of one over the other.
In terms of equity, actually, that would be one good solution, that everybody pays the same price. That would perhaps stop some of this rush to contracting. But the rush to contracting that countries will be engaged in is, of course, to secure their own position and so, we’ve come back to that dilemma of, are we looking for equity or are we looking for self-preservation?’ And the political handling of equity, as opposed to self-preservation is, I think, one that our Politicians have not necessarily fully understood. The more they talk about vaccines for the world, the more difficult it’ll be for them to look to their own population and say, “We did our own – utmost to save you first.”
Emma Ross
David, do you have anything to add?
Professor David Heymann CBE
No, I think David’s observations are right. I think, in general, Politicians and the general public don’t understand all the issues associated with getting a vaccine and making it equitably distributed throughout the world. Rotary International, actually, has understood that message very well, and has influenced many governments, by encouraging them to provide funding for polio eradication, to make sure that there is equitable access to the polio vaccine. So there will be a role for not only the private sector in developing vaccines and governments in procuring those vaccines, but in other groups for making sure that there is an understanding of the need for equitable distribution, such as has been done by Rotary International for polio.
Professor David Salisbury CB
We also do have tiered pricing, already, such that the price paid by industrialised countries for their vaccines is very significantly higher than the prices at which, for example, UNICEF is able to purchase vaccines for less wealthy countries. So, we already have tiered pricing and we have Gavi, an organisation whose function is to make vaccines, particularly new vaccines, available at affordable prices for countries that otherwise wouldn’t be able to buy them. So, we do have global mechanisms already. We just have to make sure that they’re going to be applied to this circumstance, so that we don’t have people priced out of the market and pushed aside by those with big pockets. Thank you.
Emma Ross
There’s one thing I forgot to ask you that I think is quite an important aspect, but I don’t think it’s got a lot of attention yet and that is, what is going on, or will be the issues, with intellectual property rights? Which, I guess your discussion of pricing kind of sparked that in me. Is there any activity or any efforts going on to deal with intellectual property rights? Is that going to be an issue with the vaccine or not? For both of you, I guess.
Professor David Heymann CBE
David?
Professor David Salisbury CB
Well, I was just going to say that David Heymann has already dealt with the uncomfortable issue that arose over flu virus and Indonesia. I think one has to say, and to the credit of China, that they did release the genetic sequence very quickly and that was a hugely positive step that allowed other researchers to start the process of learning about the virus, and also, vaccine development. So, you know, there has been that sort of sharing, and I think that that’s terribly important. It would be again, I think, very unfortunate if intellectual property rights got in the way of free access to scientific information for development of vaccines, therapeutics, that we will need to save lives.
Emma Ross
Is that going on now? Is it in the way or have you seen them, you know, waived, or whatever? What is actually going on?
Professor David Salisbury CB
I don’t know. I think that’s a degree of commercialism that I don’t know at the moment.
Emma Ross
David Heymann, do you have any knowledge of what’s going on there?
Professor David Heymann CBE
No, I really don’t know. All I can say is that there are many problems to be solved, and many issues to be dealt with and if we can deal with that properly for this pandemic, that will be a precedent for the future.
Emma Ross
And is it a big deal, intellectual property issues, or is it really not a big consideration?
Professor David Heymann CBE
Well, certainly intellectual property is a very important issue for the private sector research and development of new vaccines and drugs. And the World Health Organization actually tried to deal with this back in the 19 – late 1990s and early 2000s, trying to understand if there was something, which could replace intellectual property, that might still stimulate industry and the private sector to develop vaccines, and at present, nothing has been found that could replace that. And it would be a mistake to try to replace that now, when we do need all this innovative technology developed, mainly by the small biotech companies that are trying to develop these vaccines and it’s a very complex issue that needs to be solved out at some point. But WHO, with its Commission on Intellectual Property, was not able to replace intellectual property with anything else that would continue that innovation, which is so necessary for new health goods.
Professor David Salisbury CB
I mean, it would be very unfortunate if we found ourselves in a certain – in a situation where lawsuits were actively going on that were preventing the development of vaccines because competitors were claiming that their intellectual property had been infringed. If there was an adverse consequence from that, that we ended up without vaccines, that would be indeed unfortunate.
Emma Ross
Unfortunate, very British thing to say. Okay, I think we’re coming to time. We’ve run a little bit over, but there’s one more question I wanted to get asked. It’s the most upvoted. It’s from Dimitrus Monoudous, “Any update on reliable rapid testing kits, in view of international travel relaxation? There seems to be a high ratio, over 15%, of false-positives and false-negatives still being reported.”
Professor David Heymann CBE
The rapid diagnostic tests are not yet completely validated, unfortunately. Validation requires enormous amounts of different bloods from different people who have had disease, and people who haven’t had disease, to make sure that what is being detected as antibody is not an antibody to another coronavirus, for example or, that it’s being detected, even if it’s present in low titres, low numbers. So, it’s a very difficult process. It’s one that is going on. FIND Diagnostics, which is a group in Geneva, is now validating over 40 different rapid tests to look for antibody presence in humans, yet none of those studies have yet been completed. They will be completed shortly and WHO will be able to make some recommendations. But for now, diagnostic kits that are on the market as being ‘rapid diagnostic tests for home use’, none of those have yet been validated as being sensitive and specific enough to be used by the general public to understand what’s going on. The only true test is what’s called a neutralising antibody test, which takes bloods into a laboratory, looks to see whether the antibodies present actually stop growth of this coronavirus.
Emma Ross
Okay, thank you both so much. There was – I have a – loads of questions on my list that we never got to, so – and also, from audience questions, so I apologise that we couldn’t get to everything in the 45 – sorry, 49 minutes. But we’re going to wrap up now and thank you both for joining us. It was a really fascinating conversation and thank you, everybody, for tuning in. And if any of you came on late, the full recording will be on the Chatham House website this afternoon and for Journalists, who may want to follow-up with questions with either of the Davids, if you could get in touch with the Press Office, they will do their best to get you in touch with them. And, everyone, please join us next – same time next week, when we’ll be talking with David and global health expert Devi Sridhar. So that’ll be a couple of days after the virtual World Health Assembly, so should be an interesting conversation then, too.
Okay. Thank you so much, everyone. Bye.
