Should COVID-19 vaccines and drugs be not-for-profit?

From HIV to Ebola, and now COVID-19, inequality in access to medicines and vaccines has been prevalent in developing countries for decades.

In The BMJ today, Mohga Kamal-Yanni, a consultant in global health policy and access to medicines, argues that the pandemic offers a chance for governments to retain control by sharing knowledge and waiving intellectual property rules.

But Thomas Cueni, Director General at the International Federation of Pharmaceutical Manufacturers and Associations, says that debates about prices and profit are a distraction from the real problems behind inequity.

Drug companies claim that high price and high profits are essential for financing research and development (R&D). Yet COVID-19 has clearly illustrated that public funding is the cornerstone of innovation, says Mohga Kamal-Yanni.

For example, the UK public purse funded 97% of the Oxford-AstraZeneca vaccine, while the US government injected $10bn into the NIH-Moderna vaccine, and Pfizer and BioNTech received $800m in R&D funding.

What's more, the Oxford University agreement with AstraZeneca required the company to prioritize low and middle income countries and sell at non-profit price, and the vaccine was the main one used in Africa for most of 2021. "This provides clear evidence not only that products for pandemics should be provided at a non-profit price but that it is feasible to do so," she writes.

She argues that global actions are needed to expand manufacturing sites to ensure universal access to vaccines, medicines and tests. This in turn requires maximizing and diversifying production by sharing technology and know-how and waiving intellectual property rules. "Such an approach is totally different from the drug companies' focus on maximizing profit."

She concludes: "If now is not the time for governments to retain control by diversifying production, sharing knowledge, and waiving intellectual property rules during a pandemic, when will they act?"

But framing the discussion of whether COVID-19 vaccines and drugs should be "not for profit" or "non-profit" is misleading … and it directs energies away from the very pressing problems of equitable access to vaccines and treatments, says Thomas Cueni.

He acknowledges that many of the successful vaccines received public funding during the pandemic, but argues that biopharmaceutical innovation "remains a risky endeavor, where financial incentives are necessary to drive investment in R&D and manufacturing scale-up."

He points out that since the turn of the year, the ground has shifted, with supply constraints easing significantly, but warns "we are now confronted with demand constraints that hinder access, owing to a lack of absorption capacity and countries' readiness."

And he agrees that we need to have a debate about why the world failed to provide equitable access to COVID-19 vaccines, but argues that drug companies have been vital and essential partners in the largest and most rapid global vaccine rollout in history.

"While we must urgently tackle the bottlenecks in vaccine administration, it is indisputable that we all need to do more and go further," he concludes. "This includes reflecting on how to achieve more equitable allocation more quickly in the future, with more geographical dispersion of manufacturing capacity as an important component."