A healthcare worker prepares a dose of the Sinovac Biotech Ltd. Covid-19 vaccine
Covid revived vaccine development © Dimas Ardian/Bloomberg

As governments roll out the latest round of Covid-19 vaccine boosters — bracing themselves for potential resurgences and possible dangerous new variants — it should be clear that this pandemic is far from over. But, even when we do reach that point, it is important to remember that the kind of threats this virus poses will not end.

The latest research suggests the risk of Covid-scale pandemics is rising by as much as 2 per cent each year. Rather than being an outlier event, Covid could be a taste of things to come.

Driven by climate change, migration and other global trends, infectious disease is a growing threat to our lives and economies. Vaccines are our strongest defence by far. However, as we have seen with Covid, even if science can develop and rapidly produce them, geopolitical and economic factors can still determine whether people actually receive them. Indeed, one of the largest barriers to global, equitable access to vaccines — and arguably one of the biggest chinks in our pandemic-preparedness armour — is market failure.

We had our first taste of how market failure can hinder vaccine access in a pandemic in 2009, when a few wealthy governments rapidly bought up almost the entire global supply of H1N1 swine flu shots, leaving little for the rest of the world, regardless of ability to pay.

This was a key reason why Covax was created when Covid came along. It created a mechanism for global, equitable access to vaccines — to ensure ability to pay did not determine whether people received the protection they needed. To a large extent, it has been incredibly successful, getting Covid vaccines to lower-income countries just 39 days after people in high-income countries received their first jab. More than 1.8bn doses so far have been delivered through Covax to people in 146 economies. Almost all — 1.6bn — have gone to people in lower-income countries that would otherwise have struggled to afford them.

But it hasn’t been an easy journey: the scale of vaccine hoarding, export restrictions, and the complete lack of transparency among manufacturers seriously hindered the global supply of vaccines, even when money was available to pay for them. This created delays, which ultimately has cost lives and prolonged the pandemic.

Market failure is not unique to pandemics. When Gavi, the organisation I run, was created in 2000, millions of children were dying every year from diseases that could be entirely prevented through vaccination because of inherent market failures. Gavi’s solution was to pool demand from 73 lower-income countries. This meant we could buy in bulk on their behalf and negotiate lower, more affordable prices. And, by giving manufacturers demand certainty — hence reducing their risk — there was an incentive from them to scale up manufacturing, helping to bring down the cost of doses.

At the same time, Gavi helped shape markets by encouraging other vaccine makers to enter the business or develop new shots. This stimulated innovation and competition, helping bring prices down further. Since then, this unique public-private partnership model has enabled us to help vaccinate more than 1bn additional children and prevent more than 16mn deaths.

In the coming years, we will need more interventions. Covid has triggered a renaissance in vaccine development, with mRNA technology revolutionising the speed and the way in which vaccines can be developed. Because of this, and other advances, there are now many exciting, new and much-needed vaccines in the pipeline. We already have two cancer vaccines in widespread use and others are on their way. For any of these future blockbusters to make it to market, there must be viable markets for all parts of the world.

Another market failure that must be addressed concerns regional supply, particularly in Africa. Currently, only about 0.1 per cent of the global supply of vaccines is produced in Africa. This is one reason why African nations faced such delays in obtaining Covid vaccines, and ultimately it cost lives.

But, with more than 30 vaccine manufacturing initiatives across Africa, there is an opportunity to remedy that, to create vaccine supply resilience, and improve health security across Africa.

Gavi is playing its part, including looking at how a new financial mechanism might help new manufacturers enter markets sustainably and without destroying the global vaccine ecosystem that has allowed us to produce quality vaccines at scale and at low prices.

The increasing risk posed by infectious diseases means equitable access to vaccines must become a global priority. We have to look at existing market failures and anticipate future instances. This needs to happen now because, if we can’t prevent millions of people from dying from a vaccine-preventable disease like Covid-19, what hope do we have of protecting people from future threats? When science delivers, markets must too.

The writer is chief executive of Gavi, the Vaccine Alliance

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