Governing Pool mechanisms during COVID-19 pandemic. Covid-19 Technology Access Pool (C-TAP

“Vaccine Nationalism is not only threatening access to COVID-19 health technologiesin LMICS but also in HICs.”

In contrast to this multilateral effort, certain countries (mostly high-income countries) have signed bilateral agreements with vaccine manufacturers, thereby threatening the global allocation framework developed by the international community.20,27,28 The accountability and transparency of the COVAX Facility must be ensured, especially with respect to how agreements with companies are decided, and how prices are negotiated. Covax has been thrown to the similar confidential negotiations supported by all Western countries, if they wanted to get contracts. Once again, accountability, transparency and global coordination are essential: a) to ensure that all potential access barriers are addressed (e.g., IP and technology transfer, supply, and pricing negotiations); b) to ensure enough manufacture capacity and c) to tackle the issue of vaccine nationalism.

Vaccine Nationalism is not only threatening access to COVID-19 health technologies in LMICS but also in HICs. The lack of manufacturing capacity together with the lack of transparency seems to be behind the dispute between AstraZeneca (AZ), one of the first COVID-19 vaccine manufacturer to get European Medicines Agency approval. In spite of the advanced payment totaling 336 million EUROS that the EU had made in summer 2020, AZ announced than half of the pre-financed order would not be delivered on time due to capacity constraints, while the UK was not affected. Such a decision facilitated the publication of the contract between the European Commission and AZ, that otherwise would have remained secret. Its publication did not pretend to be an example of transparency practices but to work a pressuring mechanism with the company to respect the agreed commitments.

As mentioned in Section 1, a lack of transparency, an unequal distribution of risks and rewards, and the social inefficiency of the pharmaceutical companies’ business model is resulting in suboptimal outcomes for the biomedical R&D system. Owing to these factors and the monopoly granted by patents, the system may not be fit to deliver accessible and affordable innovative vaccines at the scale and pace required to end the current pandemic. Bearing in mind these problems, and drawing from other experiences, including the Medicines Patent Pool (MPP), which facilitates non-exclusive public health-driven licenses to facilitate equitable access 30,31 to HIV and Hep treatment , and the public disclosure of the COVID-19 genetic sequence that boosted vaccine development,31 the 73rd World Health Assembly approved the creation of the COVID-19 Technology Access Pool (C-TAP), a global collaborative initiative led by WHO and the government of Costa Rica that proposed a global pool of technologies that would include clinical and preclinical data, licences for treatments, diagnostics and vaccines, technology transfer agreements, and any other asset relevant to COVID-19 R&D.31 C-TAP works to advance the pooling of efforts from public and private sources to expedite research, innovation and universal access through open collaboration and transparency.32 The aim is to remove, as long as the pandemic continues, the barriers caused by secrecy and patent-supported monopolies, facilitating the use of innovations and technologies free-of-charge or in exchange for royalties, lowering the price of innovations, and particularly expanding manufacturing capacity through technology transfers.

Governing Pool Mechanisms During the COVID-19 Pandemic. Covid-19 Technology Access Pool (C-TAP)

C-TAP is an attempt to modify some aspects of the system responsible for inefficiencies (e.g., transparency, IP, pricing). It is, however, dependent on voluntary participation, and public and private institutions have so far overlooked the solidarity call to action. The call was met with scepticism from pharmaceutical companies, which argued that a voluntary pool would threaten their IP rights. It might be worth noticing that similar arguments were used ten years ago when the MPP was created and now over 10 patent holders have licenses signed with them. Furthermore, it was not supported by many high-income countries, leaving some multilateral organisations (UNITAID, WHO), lower middle-income countries and a few highincome countries as the only sponsors.33 On a related matter, India and South Africa led a petition to the World Trade Organisation (WTO) to waive IP rights for all technology, treatments and vaccines necessary for the response to the pandemic until the majority of the world population receives effective vaccines. This would facilitate much broader production, and potential distribution of these technologies. The petition, which is supported by 99 members, mainly low- and middle-income countries of the WTO is unlikely to prosper unless a majority of WTO members support it which would need to include some high-income countries.