Could the implementation of a Preferred Supplier model during the COVID-19 pandemic, have helped redirect R&D outcomes?

Although a model similar to the preferred supplier model proposed by ISGlobal’s Innovation and Policy team was not in place during the COVID-19 pandemic, many of the ideas included in the current proposal are not new in the field of access to medicines and innovation policy. As mentioned in Section 2, CEPI’s access policy includes clauses in its contracts to ensure some level of transparency and affordability. However, it is worth mentioning that the Coalition’s access policies were changed in 2018. Before that change, some of those clauses were closer to the pillars of the preferred supplier model presented above. In those, CEPI’s core principles were defined as equitable access, cost coverage and shared risks and benefits. 24 ● Development of plans to manufacture and maintain an investigational stockpile of vaccines ● Disclosure of pricing strategies and methodologies to ensure affordability and sustainability ● Plan stating the awardee’s obligations in terms of vaccine registration and marketing, as well as the volume of doses to be made available ● Public disclosure of clinical trial results (positive and negative results) and open access to publications, data and information sharing from CEPI-funded projects ● The shared risks/benefits policy included a breakdown of potential costs to be covered by the Coalition and reward participation clauses, such as participation in commercial benefits from licensed vaccines generated by a CEPI-funded project. ● Finally, although CEPI did not seek ownership of IP generated from its funding, they did include step-in rights in case the awardee could not meet the affordability and availability expectations. These principles and clauses, which are, to some degree, similar to the 4S Model’s principles of shared risks, needs and results, were revisited in 2018. The policy was reviewed after some vaccine manufacturers expressed concerns about the policy’s inflexibility and were not open to negotiation because they did not consider the conditions to be consistent with a competitive business model. 38 The revisited access policy is more flexible and is used more as a set of guidelines on how future contracts should be negotiated on a case-by-case basis. 39 These were the guidelines and policies applied during the negotiation of contracts between CEPI and its awardees during the COVID-19 pandemic, and even though these agreements have access-related clauses, it has been necessary to implement ad-hoc global governance mechanisms, such as COVAX, to try to improve access to COVID-19-related innovations. This experience illustrates that even though a model may appear logical and feasible, there are many factors involved in the implementation of pharmaceutical innovation policies. As explained by Maryam Bigdeli et al., 3 “economic, trade and industry objectives on one hand and public health goals on the other, may be at best disconnected or worse, conflicting”. In the case of the COVID-19 pandemic, incredibly complex factors and determinants affect the development, manufacture and supply of pharmaceutical innovations. If a preferred supplier model had been in place before the pandemic hit, it could have helped international donors to decide which companies they should work with, prioritizing those ready to share their technology to scale up production, which is one of the clear priorities to ensure universal vaccination as quick as possible. However, it is difficult to ascertain whether such a model would have helped to improve outcomes.