The missing actions on vaccine fairness

The G20 has let the world down. This is not – yet – a comment about the ongoing climate talks in Glasgow, but about the undertakings made at the recent Rome summit relating to Covid-19 and vaccinations. Perhaps companies and investors are letting the world down too.

The G20 Rome Leaders’ Declaration recognises that global vaccination is a global public good, and undertakes to “advance our efforts to ensure timely, equitable and universal access to safe, affordable, quality and effective vaccines, therapeutics and diagnostics, with particular regard to the needs of low- and middle-income countries”. Yet while recognising the World Health Organisation’s vaccine equity goals – already somewhat limited and not fully fair – of vaccinating 40% of the population of all countries by the end of 2020 and 70% by mid-2021, the Declaration is aspirational about aims rather than solid in providing genuine commitments.

The comments of Amnesty International were fairly typical of the excoriating response of civil society organisations to the statement. “These vague promises are an affront to those who have died, and to everyone still living in fear of Covid-19,” said Tamaryn Nelson, Amnesty’s Advisor on Right to Health. It suggests 500 million doses of vaccine are potentially available for redistribution to poorer countries but remain in the stockpiles of richer nations. “With just two months left of this year, only a radical change in approach will close the shameful vaccine gap. If we continue down our current path, the end of the pandemic will remain a glimmer on the horizon.”

We have a long way to go, according to figures provided by the campaigning coalition the People’s Vaccine Alliance:

Amnesty, in its 100 Day Countdown launched in September, quotes numbers as of late October that tell a similar story:

About half the global population yet to receive a single dose
Just 1.4% of people in low-income countries, and 17.5% in lower-middle income countries, are fully vaccinated
Only 2.8% of people in low-income countries have received at least one dose, and 35.6% in lower-middle income countries. This compares to 70% in high-income countries.

Amnesty’s comments highlight the core of the stupidity of the Covid vaccine inequality. It is not just that restricting the distribution of vaccines to poorer nations is unfair. It is also foolhardy because of the scope for new variants to arise in unvaccinated populations, or those with low vaccination levels. As we used to say early in the pandemic, but seem to have forgotten, ‘none of us is safe until everyone is safe’. That’s true globally, not just within individual countries. Any single country might be a source of fresh infection for the rest of the world; at the moment that remains likely to be significant a risk for more than a further year:

While the numbers now look a little better than these from early this year, we are still a very long way from delivering on the WHO targets.

The G20 has failed us. But perhaps also companies, and investors, have failed us. The pharmaceutical industry does not have a great record on sharing its output fairly around the world, preferring to oversupply the rich economies that pay generously and undersupply poorer markets that cannot afford similar prices. This remains too often the case despite the efforts of the wonderful Access to Medicine Foundation, which produces an index of the pharma businesses and how well (or badly) they share their output fairly around the world – and which inspires investors to challenge companies to do better and fairer.

But much more clearly needs to be done with regard to vaccines. The backdrop isn’t great: according to Access to Medicine (admittedly in a report that is now a few years old), the major vaccine businesses generally are simply not investing in new products that would address the challenges of much of the world:

That seems a very unfair sentence to write given how swiftly the industry did respond to the challenge of Covid and how efficiently it has produced remarkably effective vaccines against the pandemic. I personally am grateful for my AstraZeneca jabs, and grateful too for the Pfizer jabs that are protecting a number of my loved ones.

But the industry must bear some blame for the remarkable unfairness in the distribution of these wonderful products. It is clear that most of the vaccine producers are prioritising making money from their products, monetising the pandemic, ahead of delivering to developed markets. Indeed, a cynic might suggest that they have an interest in prolonging the pandemic risk, not least given that the rich economies are now happily paying for the first round of booster shots as the initial immunity from the first vaccinations begins to fade.

And some criticism is particularly pointed and specific. The remarkable podcast Pfizer’s War from the excellent journalists at Tortoise Media suggests that Pfizer in particular has chosen not just to promote its own vaccine offering but also to denigrate others’ – notably the AstraZeneca one. Public comments by the purportedly independent non-executive director Scott Gottlieb certainly seem surprising. According to the podcast, Gottlieb’s CNBC interview on February 14 (quoted extensively at around minute 15) was pointed enough to spur the AstraZeneca general counsel to write a blunt letter to his equivalent at Pfizer calling the comments misleading and worse.

For me, though, the most shocking element of that interview was the reference to AstraZeneca’s vaccine as being based on a chimpanzee virus. At the very least this seems to play up to the unscientific fears about vaccines in some way risking a crossing of the barrier between species. Such fears date back to the very first vaccination, Edward Jenner’s use of cowpox to immunise people against smallpox (the very word vaccine is sourced from the Latin for cow because of this use of cowpox). Cartoons of the vaccine turning people into cattle were rife, and similar false nonsenses are being spread as part of the antivax movement now. For someone medically trained with scientific authority because of his past role at the FDA and current role on a vaccine producer’s board to risk fuelling such fears seems – to say the very least – badly misjudged.

If I were still wielding the votes of an institutional investor, having listened to the Pfizer’s War podcast I would have no hesitation in voting against Scott Gottlieb’s re-election to the Pfizer board. His comments sound much more like those of a cheerleader for Pfizer than showing the independence and challenge that we expect and require from independent non-executive directors.

And I would feel obliged to ask some very tough questions of Pfizer, and indeed all the vaccine producers. Not enough vaccines are getting to the world’s poorest. That isn’t fair because it leaves them exposed to great risk, but it also leaves us all open to additional unnecessary risk because it means the pandemic persists. Too many of the pharmaceutical companies seem content with that – super-profits persist for as long as the pandemic does, a cynic would note.

But while investors may be making enjoying the benefits of those super-profits in the pharma sector, we are all harmed by the economic damage that the pandemic is causing in our wider portfolios – harm that goes on in spite of the current bounce back to growth. For investors that are universal owners there is a strong interest in seeing an end to the pandemic and a fuller return to normal. Even from a purely financial perspective, this ought to lead to much more pressure on all the pharmaceutical companies to address the unfairness of current vaccine distribution.

As investors consider social issues more actively, and think about systemic risks beyond climate change, these issues deserve their attention. I’m aware of various shareholder resolutions on these issues being filed (or prepared for filing) at some of the pharmaceutical businesses. They deserve strong investor support but not as stand-alone actions; instead this should be a reflection of ongoing active engagement, including strong support for Access to Medicine on this crucial area.

None of us is safe until we are all safe. We all need greater vaccine fairness, and that will need more action from governments, from companies, and from investors.

I am grateful to Raj, the investment industry’s favourite Jiminy Cricket conscience, for pressing me to write about this issue (sorry it’s taken a while, Raj!)

G20 Rome Leaders’ Declaration, October 31 2021

Vaccine Equity, World Health Organisation

G20’s vague vaccine promises ‘an affront’ to five million dead, Amnesty International, October 31 2021

Dose of Reality: How rich countries and pharmaceutical corporations are breaking their vaccine promises, The People’s Vaccine, September 21 2021

100 Day Countdown, Amnesty International

Access to Vaccines Index 2017, Access to Medicine Foundation

Pfizer’s War, The Slow Newscast podcast, Tortoise Media (also available on your usual podcast provider), September 27 2021

A ‘little PRIC’ that we all need: Pharma Responsible Investor Coalition, Ishwar Gilada, Lieve Fransen, Mamphela Ramphele, Raj Thamotheram, Preventable Surprises, September 22 2021