MSF calls on Gavi to revise its global mechanism and demand pharma sell all COVID-19 vaccines at cost

As Gavi's board meet this week, MSF is calling on the organisation to revise their new funding mechanism for future COVID-19 vaccines - we need a truly fair system that allocates future COVID-19 vaccines based on public health criteria for all. Gavi must also demand that pharmaceutical companies sell vaccines at cost, and that they disclose the cost of making and producing vaccines.

The board of Gavi, the Vaccine Alliance, will meet this week on 24 - 25 June.

Top of the agenda is a discussion on the COVAX Facility, a new mechanism Gavi has developed to pay pharmaceutical corporations up front for potential future COVID-19 vaccines. The mechanism has been designed largely behind closed doors, with extremely limited input from civil society or treatment providers like Médecins Sans Frontières/Doctors Without Borders (MSF).

In first proposing its role in securing volume commitments of vaccines, Gavi assured that manufacturers would be asked to commit to transparency regarding their costs and that Gavi would aim to set a price based upon cost of production with a marginal increase.

However, in the most recent version of the COVAX Facility’s technical guidance note, there are very few requirements obliging pharmaceutical corporations to be transparent.

Two-tier system
Additionally, Gavi has now introduced an alarming two-tier system of access to future COVID-19 vaccines (bought through the COVAX Facility) based upon countries’ economic standing.

Worryingly, Gavi only requires that countries financed through donor assistance adhere to the forthcoming World Health Organization (WHO)-developed global equitable allocation framework, which ensures that the most vulnerable populations are prioritised.

However, self-financing countries are not required to adhere to the global equitable allocation framework and therefore it appears they are allowed to use their allocated doses from the Facility however they see fit. This proposed two-tier system is far from the global equitable solution that the world needs.

Do not repeat past mistakes
The COVAX Facility, which includes an Advanced Market Commitment (AMC), is modeled on a previous AMC that was launched in 2009 to pay for pneumonia vaccines in developing countries.

That previous AMC, which involved a US$1.5 billion donor-subsidised payout to two multinational pharmaceutical corporations (Pfizer and GlaxoSmithKline (GSK)) over a 10-year period, had a number of flaws. Pfizer and GSK were already reaping billions of dollars in sales for the pneumonia vaccine globally.

MSF has urged Gavi and its donor governments not to repeat the mistakes of the previous AMC, primarily by urging governments and Gavi to demand that pharma sell any future COVID-19 vaccine at cost and also disclose the cost of making and producing these vaccines.

MSF, together with over 40 civil society organisations have written a letter to Gavi board members and the Gavi secretariat ahead of the board meeting, outlining civil society’s serious concerns with the COVAX Facility.

Kate Elder, Senior Vaccines Policy Advisor, MSF Access Campaign, said:

“Gavi is not adhering to the original promise of global equitable access to affordable vaccines by now segmenting countries into two tiers: wealthier countries that self-finance vaccines and the donor-dependent countries.

“Under the COVAX Facility, wealthier countries will not have to adhere to the forthcoming WHO-developed global equitable allocation framework, which ensures that the most vulnerable populations are prioritised for vaccination, whereas donor-dependent countries are obliged to abide by the WHO framework.

“This inequitable approach proposed for the COVAX Facility isn’t the solution – we need a truly fair system that allocates future COVID-19 vaccines based upon public health criteria for all; not just those that who are dependent on donors.

“We can’t risk that the COVAX Facility be yet another big pharma giveaway with little to no strings attached to guarantee that future COVID-19 vaccines are affordable and shared equitably with people across the globe.

“Given Gavi’s previous Advance Market Commitment for pneumonia vaccines, where independent evaluations concluded that Gavi likely paid too much for the vaccine, we are very concerned. We need a smart negotiator and champion for countries that aren’t in a position to financially sponsor development of a vaccine and secure commitments.

“Gavi board members must step in and insist that Gavi works to improve this new mechanism by putting all countries on a fair playing field for future access, and demanding that pharma companies once and for all come clean about the cost of vaccine production by opening their books, so we can all see how much it actually costs to make these vaccines. 

“Some pharmaceutical corporations are pledging to sell future COVID-19 vaccines at a ‘not-for-profit’ price, but with pharma’s track record, why would we believe that when there’s no transparency to prove it?

“With governments professing left and right that future COVID-19 vaccines will be global public goods, we need to see some strong actions taken to actually make these proclamations a reality. COVID-19 vaccines must be sold at cost – now is not the time to try and turn a profit on the back of a global pandemic.”