Jumping the vaccine queue

How much should a Covid-19 vaccine cost? And who should get it first? These are thorny problems that governments, companies and groups striving to secure equitable vaccine supplies are wrestling with as we inch slowly closer to a viable vaccine becoming available.

Well-off countries have rushed to strike deals with the various developers, to secure their own supplies. And alliances between states and non-government organisations are forming to try to ensure that those countries not in a position to commit to such deals themselves can still be provided for, rather than being sidelined by those with cash on hand.

At first glance, those huge orders resemble a kind of grossly unfair land-grab. But there is another side to these deals. Companies are committing to manufacturing vaccines before they are formally approved. That’s a big risk – developing manufacturing processes and building physical capacity is a significant cost. Guaranteed sales offset some of that risk, helping the whole system move faster – a good thing for everyone in a pandemic.

And as deal details emerge, there are signs that (at least in some cases) measures are in place to ensure the early doses are not simply doled out to governments who have splashed their cash, but distributed more according to need. Those who have pre-reserved their doses should, of course, get them in due time. But making sure the most vulnerable worldwide are at the front of the queue, regardless of where they live, will benefit us all in the long run. Time will tell how effective such measures will be.

Which brings us to prices. This is not the time for profiteering, and several companies have pledged to make minimal or zero profit from their sales during the pandemic. This virus is unlikely to be eradicated, so there will be time for more profitable sales to control future outbreaks or maintain vaccine-derived herd immunity once this pandemic is controlled.

In the meantime, the deals being struck clearly show that there are different interpretations of a ‘reasonable price’. The US deals (for which most financial details have been disclosed), range from £15–16 per dose for a Sanofi–GSK or Pfizer–BioNTech vaccine, to just over £3 for the University of Oxford–AstraZeneca vaccine. Oxford–AZ’s deal with Gavi, the Vaccines Alliance is less than £2 per dose.

Clearly, the costs associated with developing and scaling up vaccines based on different technology could be wildly different – some may be able to use existing infrastructure and capacity, while others may not. And of course, not all the costs are determined yet. It will be important to scrutinise companies’ claims about their profits, or lack thereof, in due course. But the first priority should be to get safe and effective vaccines out into the world.