Access to health care around the world has always been unequal.
Each vaccine dose a wealthy nation snaps up in a direct deal with manufacturers is not just a win for that country, but a loss for another – an outcome game theorists call a zero-sum game, McAdams recently explained in a live discussion on LinkedIn.
Even global efforts to expand access to the vaccine, namely the COVID-19 Vaccine Global Access Facility (COVAX), could also have limited impact, he said. COVAX pools contributions from wealthier nations to aid poor ones, but many countries, including the U.S. under the Trump administration, passed up initial opportunities to participate, he said.
“Rich countries – if we could all get together and cooperate, we would all benefit by ending this global pandemic,” McAdams said. “But individual rich countries may not have ample incentive to do so. They may be willing to free-ride on the efforts of other rich countries,” creating a space for more inequality when nations don’t contribute their fair share.
But, continuing with a game-theory analysis, there are ways wealthy nations could procure vaccine supplies that help poorer countries at the same time, McAdams and Duke colleagues suggest in a new research paper published in BMJ Global Health.
“The natural thing is for countries to race to secure doses for themselves and thereby exclude others,” he said. “But if we think about this ahead of time and plan for it, we argue that you could design these bilateral deals in a way that increases global supply.”
What McAdams and colleagues propose is that when a wealthier country, such as the U.S., secures a vaccine deal with a manufacturer, it includes measures to ensure the vaccine maker will share knowledge and technologies that would allow other vaccine manufacturers also to produce that vaccine.
He pointed to one example, an agreement that allows the Serum Institute of India, the world’s largest vaccine manufacturer, license to produce the AstraZeneca/Oxford University vaccine, including doses for a low- and middle-income countries.
Opportunities for such agreements are unprecedented, because “we’re not just racing to develop a vaccine and get it into people’s arms – we’re doing that more than a hundred times over, simultaneously,” McAdams said.
With so many vaccine candidates and many of them destined to fail, the world will be left with manufacturers with no successful vaccine to make. Those facilities could be licensed to produce one of the vaccines that is successful, and some of those doses could go to poor countries, he said.
“So this would accelerate how quickly vaccines can get to poor countries, and accelerate the end of the pandemic, turning the game from one in which we're sort of in a competitive mindset to one where we're more collaborative, because after all, we are in this together. That is my main message,” McAdams said.