Let's talk access to vaccines: A call for change in the time of COVID-19

Avril Benoît:

Welcome. I have unmuted myself this time. Thanks for joining us for this final episode of our Let's Talk webinars series for the fall. We will surely have more of these in the future, but we are going to wrap up this particular part of the series this week. I'm Avril Benoît, I'm the executive director of Doctors Without Borders in the US. You might know of us from our international name Médecins Sans Frontières, which is French, and that's why we often refer to MSF as the acronym that we use all over the world, but Doctors Without Borders is here to talk with you today for about 45 minutes. We're going to be giving you, as always, an opportunity to submit questions.

So if you're watching on Zoom, just use the Q and A function. You know how to do it, I hope by now. On Facebook Live or on YouTube or Twitch, likewise, send your questions into the comments or chat section that you have there, and they will be fed into me and I'll ask them of our panelists today. So today we're talking about a very hot topic. It's not the first time we've reviewed some of this, but it's changing so fast that our theme today is particularly timely. And we're talking about the COVID-19 vaccine. So I'm sure many of you have been following the news with a lot of anticipation. Various announcements have been made recently.

There's a lot of hope that the vaccine will be some kind of panacea and all this misery of the pandemic will end once we all get a shot in the arm, but it's a lot more complicated than that. And we're here to delve into some of the quality issues, the research issues, the development issues, the rollout questions and with the pharmaceutical companies, we have been often pressuring them to be much more transparent and accountable for that. So we're going to explain a little bit why we take some of the positions we do when it comes to the research and development around the COVID-19 vaccine.

So today I'm joined by a couple of experts that are really perfect for this topic today, and they're here to answer your questions. So I'll introduce them now. First, Dana Gill is back. She serves as the US policy advisor on access to medicines for MSF or Doctors Without Borders USA and the Access Campaign. Hello, Dana, tell us where you are and how are you fairing these days?

Dana Gill:

Greeting for all, thanks so much. I am joining you today from Michigan, and as I look out the window, I have to apologize to everyone in advance, the universal law of all of your neighbors mowing their lawn when you're about to get on a webinar has just occurred. So hopefully you won't hear too much of that in the background, but I'm so glad to be with you and excited to speak with everyone today.

Avril Benoît:

If they have the leaf blowers going as well, it'll be the end of us, but we'll live with it. We've dealt with other issues when it comes to sound. But good to have you back with us, Dana. And Dr. Manuel Martin is with us today. He's a medical doctor working as the medical innovation and access policy advisor for the MSF Access Campaign. Hello, Manuel, how are you doing today?

Dr. Manuel Martin:

Hi, everyone, I'm doing well. Thank you. Hi everyone. I'm joining you today from Lisbon, and my apartment is right next to a traditional Portuguese restaurant that does folk music called Fado, very melancholic. So if you hear some music coming from my side, that would be why.

Avril Benoît:

Well, Fado, those Portuguese blues are very much appropriate probably these days in terms of how the numbers of people with COVID-19, people hospitalized, people dying continues to rise. It's on an uptick in many parts of the world. And that's a misery, a sorrow, a loneliness and grief that we all feel after so many months. So the vaccine is this beacon of hope, how we hope to get out of it. And maybe I can start with you, Manuel. As we look at all the avalanche of news, the announcements, how should we make sense of it? What is it that we should be looking for in those announcements from big pharma?

Dr. Manuel Martin:

That's a great question. And I think just to say that even for us following this issue so closely, it's sometimes difficult to just keep up with the news. It feels like we spend 80% of our time just staying up to date. I think that in terms of wondering about access, there's really three different areas that one can analyze when hearing about these new vaccines. First of all is the affordability of the vaccine, so what prices are they likely going to be sold at? The second one is the availability, and that speaks a little bit to the scale of manufacturing for each different vaccine candidate and who will be able to manufacture it at what stage. And then certainly, and this is very important also, the suitability of this candidate. Not all candidates are equally suitable, are equally effective, some of them need to be stored at extraordinary low temperatures, which create some logistical challenges even in high-income countries. And really that is the framework that I tend to analyze things when I get a new piece of news about a new vaccine coming up.

Avril Benoît:

Dana, you are very focused on the policy side of things. What specifically is interesting you with all this news around a vaccine and the different trials that are going on and maybe coming to a conclusion?

Dana Gill:

Yeah. Avril, one of the things that I'm thinking about a lot, and we as the Access Campaign are thinking about a lot is what this means in the larger systems, not only with the vaccine, but also with treatments and diagnostic tools and how the issues that we're seeing about exactly what Manuel just shared, will a product exist, when will it exist, who is going to have access and how much will it cost are issues that we have been watching for decades and that the Access Campaign has been working on for decades. So I find myself saying a lot, COVID is new, but these issues are not new. So we want to look at this moment of time and see if there are ways that we can make reforms so that when the next pandemic comes along, or when we are looking at the research and development system for all of the diseases that are yet to be treated, that we can have some reforms in the system to solve the problems that we're seeing today.

Avril Benoît:

Well, for all those who are rolling up their sleeves to take part in the trials right now, this is a time where there's so much appreciation for people who have participated in this. Obviously the scientists are doing the work, but also regular people have done so. We have a question already from Bruce who's watching us on Zoom and who was a participant in the Johnson & Johnson trials for their COVID vaccine. What are the various types of vaccines in development right now, Manuel? And are you looking at any of them with a little more enthusiasm than others?

Dr. Manuel Martin:

It's difficult to say, it's still early days. First of all, Bruce, thank you for participating. I think your contribution is really important to the research and development process and should be valued the same way that we value other contributions to research and development. But I will say that there's definitely some platforms that is, platforms are the basis on which vaccines are developed. These can be viruses or these can be particular technologies. Some of them are brand new. So you might've heard of the messenger RNA vaccines. These are as of yet unproven, there is no vaccine on the market currently using that technologies and other vaccines that are in development are using more old school, let's say, technologies that have been around for quite a long time period. And they all have their benefits, but also risks. A lot of it is still hypothetical, we just don't know yet. A lot of it is just speculation at this stage.

Avril Benoît:

It's speculation because we don't know enough about the number of people who are part of the trial or the composition of the people who have taken part or what are some of the aspects that can lead to the variability of one's confidence in this vaccine over another vaccine?

Dr. Manuel Martin:

So just because some of the vaccine platforms we are familiar with, there were some theoretical risks, especially at the beginning, people were very concerned about that potentially a vaccine might actually potentiate the effects of the virus. So far that has not turned out to be true, but that was something that people were worried about from the very beginning. Now a concern, just to highlight the Johnson & Johnson vaccine is based on something called the adenovirus. There's this concern that a pre-existing immunity against the virus that is used to deliver the vaccine may actually reduce the efficacy of the vaccine.

And if you're using a vaccine that requires several doses, that may be one dose might induce the immunity, which will reduce the efficacy of the second dose. So these are just some of the concerns that are out there, but it's worth keeping in mind that this is still we're moving very, very fast, and a lot of the data's still to come out and that really speaks to the need for transparency once the data is available, that companies are really expedient and publishing this data openly and transparently. What we've been seeing so far is a lot of science by press release, and unfortunately that makes it very difficult for experts to analyze and truly independently assess the promise and the efficacy of vaccines.

Avril Benoît:

This is one of the tricky issues in many parts of the world where you have skepticism around the efficacy of vaccines and whether they cause harm and we have anti-vax movements and so forth, that can be quite noisy and active at this time. Dana, can I just hear from you a little bit about that phenomenon, because obviously science by press release is not ideal. What is it that you would hope to see in order to give us confidence that whatever vaccine is being proposed for us in whatever country or jurisdiction we live in will be one of the good ones.

Dana Gill:

Yeah. And I hope you'll allow me to expand on that a little bit, Avril, because Manuel said a key word for us that we're speaking about a lot, not only as MSF, but the access to medicines movement in general, and that word is transparency. We need to be able to have independent analysis of the clinical data designs and results that are coming out in real time so that there can be independent experts looking at whether or not everyone feels comfortable with the products that are being rolled out. And we saw an announcement from New York's governor, Cuomo, that he wanted to do just that, before a state rollout of the vaccine, having an independent group of experts and scientists. So there's that research and development data transparency that will be an important piece for vaccine hesitancy and also plays into a larger transparency ask that the MSF Access Campaign has been engaged in along with other groups.

And we have originally called these the four pillars of transparency, and now it's turned into like five and maybe six pillars at this point, as we realize more and more as everything's moving so quickly, how little data we have, how big the information asymmetry is between what governments and pharmaceutical companies know and what we as public know. So some of those other areas are around prices. What at the end of the day is going to be the prices charged for these products, not just vaccines, but treatments and tests. Some of it's available, but not always. We're also talking about really digging in on the costs of research and development. If we step and look at the United States right now, tens of billions of dollars of public taxpayer money are going to the research and development and purchase of products.

And this is important work. This is important for the US and other governments to be doing, but we don't have a breakdown. We don't have a systematic breakdown of how all of those dollars are being used. And so this goes to that bigger picture, systemic question that I brought up earlier, we often hear pharmaceutical companies say that they must charge a high price for their product because they spend so much on research and development. This is a key argument that we hear so often, and we can't say, well, we know what you've spent. So right now in this time of COVID when the pharmaceutical companies are not necessarily paying for their own research and development, public dollars are paying for that. There should be the accountability and transparency of what those research and development costs are so we can start a real conversation about what fair pricing means.

So that's another pillar. We also need to know what sort of patents, what sort of IP protections, what sort of trade secrets do any of these products have, because that ends up having an impact on how quickly we can scale up manufacturing and production of products, which means more people having access if we can have a bigger set of manufacturing and production facilities, and finally understanding what those manufacturing and production costs are. Again, back to that argument of what's a fair price for these products at the end of the day? I think civil society often gets a reputation that we're anti pharmaceuticals or anti profit, and that's not the case, but we do want to have a real conversation about what a fair price is. And when we don't know how much it costs to research, develop and manufacture a product, we can't have that conversation. So this is a moment to really have those areas of transparency, to help with vaccine hesitancy, to help with fair pricing of these products down the line, and really have some systemic changes in the R&D system.

Avril Benoît:

These are the issues that are related to profiteering which is having a profit above and beyond what is reasonable. And in a pandemic, as you say, when there's public funding, tax dollars that have gone into the development and rollout of all of this, it should actually come back to countries and all those that have contributed as lower prices, more access, hopefully free to those who need it. But for those who have more questions about those issues of pricing, Dana Gill just again, is our US policy advisor for Access to Medicines at Doctors Without Borders, USA and the Access Campaign. And also with us is Dr. Manuel Martin, who is a medical doctor currently working as the medical and innovation and access policy advisor for the Access Campaign. Manuel, I have a couple of questions for you about something that's very much been reported on, and this is the whole question of the cold chain.

So Martina on Zoom is asking regarding the need to keep these vaccines at a low temperature, what potential logistics plan could be implemented to reach those remote communities with the vaccine, maintaining its quality, maintaining it in a good state? And likewise, Ben is asking, does MSF have the experience in putting together robust, cold chain plans of this nature where I think we were talking about minus 70 degrees Celsius or something like this. I mean, it's just extraordinary. And what does MSF, or what have we learned from past experiences of managing this kind of vaccine?

Dr. Manuel Martin:

That's a great question. I think when speaking about the culture and I should really flag that I'm no logistics expert, but there's two different types of cold chain. There's the regular cold chain that usually vaccines need to be transported in a refrigerated state somewhere between two and eight degrees. But then there's also the so-called ultra cold chain. And these really are some of the vaccines that are based on this novel technology, MRNA, that need to be stored anywhere between minus 20 to minus 70 degrees Celsius. So that is really much, much lower and requires entirely different infrastructure to deliver these. As MSF, obviously we have quite a lot of experience, we regularly run vaccination campaigns with normal refrigeration of vaccines, a little bit more tricky, but I should say not impossible is the ultra cold chain.

An example of a vaccine that had to be transported at very low temperatures as well was the Ebola vaccine and which we were able to deliver in the most recent outbreak in the DRC. It did require significantly more resources. It was more complicated and wasn't easy, but we did do it. And I think the important takeaway here is that regardless of how cold the vaccine, potential future COVID vaccine needs to be transported, that shouldn't preclude access in low and middle income countries. We shouldn't be saying, oh, just because this vaccine needs to be transported at minus 70 degrees, that means that it won't be any use in all of these poor countries anyway, that is simply not true. It is possible. It just requires additional effort, additional resourcing, finances and logistics.

Avril Benoît:

And it's called a chain because you can't break the temperature. If the temperature suddenly goes up as in a hot environment, a country like India, for example, or in many of the hotter countries at this time of year, it's getting colder in the North, but sometimes warming up elsewhere in the planet, you have a problem where the vaccine can no longer be effective. It just doesn't work anymore. So you use it all you want, but it won't actually protect people.

Dr. Manuel Martin:

That's correct. Yeah.

Avril Benoît:

Another question that I know has been hotly discussed in the news in terms of looking and comparing the different products that are out there or likely to come out has to do with whether you need one dose or two. Can you explain why you sometimes need two doses or boosters and things like that, and why what you're really aiming for is just one dose?

Dr. Manuel Martin:

So that is the case for a lot of vaccines, they don't provide indefinite immunity. Sometimes you can amp up your body's immune response by using a second dose, some vaccines even space the doses apart, several years. The issue of one versus two dose, I think it is pretty clear that the one dose will always be preferable. It's much easier to manage, and you can vaccinate more people with the same amount, physical amount of vaccine. With respect to the timing, for us obviously it is preferable to have those two doses as close together as possible, and not all vaccines that are currently in development have that required two doses have them spaced apart in the same way.

So you'll have some that are 28 days, roughly apart from first to second dose and others that are almost two months apart. And especially when dealing with migrant communities in terms of displaced people, having people in one place for two months is not always guaranteed, and that makes vaccination and then giving the two doses much more tricky. So even if you have a two dose vaccine, the question is how close together are these two doses, and can they be given within just a month, 20 days, or does it require much longer than that?

Avril Benoît:

Another quick question for you is on Zoom. Can you tell us about COVAX? What happens if multiple vaccines in the COVAX portfolio move forward for a disbursement? And maybe you can explain also this COVAX, because we do hear about it, but many of us don't quite understand what it implies.

Dr. Manuel Martin:

Absolutely. I think it is worth explaining because during this pandemic we've had so many new acronyms to learn that I understand why people have a hard time keeping track. So the COVAX facility was set up very much based on the Gavi Alliance for vaccines and immunizations previous advanced market commitments. And that is essentially simply put what it is. It is a bunch of countries coming together, putting money on the table and in a certain kind of way, pre-purchasing vaccines. And thereby also doing some at risk investment, into manufacturing scale-up and research and development for these vaccine candidates, with the understanding that should one of these vaccine candidates be effective, these vaccines will then be distributed amongst the participating countries.

There's a donor element where there's a certain number of countries that are benefiting from foreign development funds, for instance, to obtain these vaccines at a lower price and they don't have to pay as much for them. But high-income countries can also participate and choose whether or not they want anywhere between 10% or 50% of their population to be vaccinated. And the idea behind it is, is to prevent what we saw around the H1N1 pandemic in 2009, which was that all high-income countries hoarded all of the vaccine supplies and less than 10% ended up going to low and middle-income countries. That is fundamentally the idea of it. But if I may expand on that just a little bit, what COVAX really just deals with is from the existing vaccines that are being produced, how are they being distributed.

Using the analogy of a pie, how large of a slice do you equitably distribute across the world or across these countries. But what COVAX doesn't deal with, and that is really unfortunate that they don't, is this idea of expanding, making the pie bigger or indeed producing more pies. And what do you need to do to produce more pies in this analogy? You need to share the recipe. And in the vaccine space, the recipe consists of two things. One is the legal rights to be able to produce the vaccines, and these are the patents and intellectual property that cover them, and also the recipe, instructions that is the technical term for that is the know-how to produce these vaccines. And this typically is transferred. You can transfer this, so a developer that has been working on a vaccine and it shows to be effective, can transfer the know-how and the rights in a process called technology transfer to another company.

And ideally, if you have an effective vaccine, you will have a company share the knowledge and also the rights to produce this vaccine as widely as possibly, and as openly as possibly. Unfortunately, that is not what we're seeing at the moment. We're seeing certain vaccine companies not sharing anything. We're seeing some companies, very selectively signing technology transfer agreements and transferring this technology to certain manufacturers under very strict conditions that they, for instance, don't export out of a pre-agreed territory or that they sell it at a particular price. And that is really not ideally how you'd want to do things. In an ideal world, you'd have them share that openly, especially as, and Dana already pointed this out, we've seen an enormous amount of the research and development costs, as well as the manufacturing costs really being financed through the public funds.

This is all of our taxpayers money that is paying for this and as it should, but it also should mean that we should be using all of the capacity that exists in the world to produce this vaccine. And really that would also go quite a length to combat what we've seen and we're calling a vaccine nationalism because if you have many manufacturers across the world producing the vaccine at the same time, there's very little incentive for any one country to try and restrict the supply just within its borders and issue things like export bans on the vaccine.

Avril Benoît:

It's just so fraught, isn't it? With these dilemmas for those who would hope for fairness and ethics to drive the response to the vaccine in support of the science, which should be also driving the end of the pandemic as opposed to politics or economics. But sometimes it's just so depressing to hear these kinds of things. Dana, I have one for you from Chidinma on Facebook who's asking how possible is the data transparency for low income or developing countries that have issues with data collection? Because you were speaking to the US but how do you see it for countries that have fewer means than the US?

Dana Gill:

Yeah, I think this is a problem that we see everywhere and it's where, if we can't see these types of things happening in a country like the US, where we have websites like clinicaltrials.gov and we have well-researched, well-funded research happening all the time and kind of a well-oiled machine here, of course there are going to be issues elsewhere. And it's an important moment for the US set up a system that could lead by example and share information. We work with a colleague, Manuel and I have a colleague in South Africa that is working on exactly this issue, clinical trial data transparency. And so there are movements with civil society around the world. This isn't just MSF talking about this, this is an urgent need everywhere. And so do know that we are working with colleagues in other countries and other contexts and civil society really has taken this up in a more aggressive way, particularly during this pandemic.

Dr. Manuel Martin:

And if I may just add-

Avril Benoît:

Yeah, please go ahead. Yeah.

Dr. Manuel Martin:

Thanks. Just adding to what Dana said, I think it's important not to think that the only place you can conduct clinical trials is in high-income countries. There's plenty of middle income countries that have very extensive research networks and clinical trial sites with a lot of expertise of running clinical trials. South Africa is a great example of that. And actually there are a number of vaccine candidates currently running clinical trials in South Africa. What will be important to us is that the very communities in which these vaccines are being tested are also guaranteed access to these vaccines. Because one thing that is unacceptable is to test these vaccines in a particular population and then leave them without timely access or affordable access to those same vaccines.

Avril Benoît:

Let's stay with this policy side of things. We have a question from Daphne on Zoom who's asking, even if we had transparency, as you've talked about on the research and development and production costs, could the government actually force these big pharmaceutical companies to charge a fair price for such a valuable product? I mean, wouldn't it go against the grain of how many countries like to manage their economies? Daphne's mentioning a concept like rent control, but for a medical product like these COVID vaccines, what do you think? I don't know, Dana, do you think it will fly?

Dana Gill:

I have a little smile on my face, right? I mean, everything is a choice. Everything is a choice about lives over profit, setting up a system that is more concerned with public health and public interest than commercial interests. So in our market, a lot of the failure of the R&D system is that it is so pointed towards more lucrative products and we've set up a system that kind of feeds into itself. And so governments can take steps for price controls. We do see that happen in other places in the world, but these are choices. And I want to go back to something Manuel said a little bit earlier. Just as I was thinking about preparing for this conversation, a word he said kept coming back to me, which is sharing right? This idea of simply sharing.

If we could share our know-how and our patents, if countries would be willing to share doses, if high-income countries would be willing to share more resources to fund COVAX in a way that made sure everyone had equitable access, some of these pricing issues wouldn't be so much of an issue. So it does go against the grain of some countries' market driven processes, but these are choices and we can make different choices. And we advocate for different choices to be made. We're talking with pharmaceutical companies and the US government agencies that are working on all of this, we're really bringing up all of these pieces. How are you thinking about set asides for humanitarian settings in low and middle income countries? How are you going to share all of the data and know how that we've had? We're asking these questions to try to help officials make different choices, to make things better in the places that we work and the people we care for.

Avril Benoît:

Well let's-

Dr. Manuel Martin:

Sorry.

Avril Benoît:

Oh yeah. I just want to pivot a little bit if you don't mind, Manuel, because there's... and this is also coming back to you, it seemed to be the sharing was off to a good start when the genetic sequence was initially shared. Am I right? I mean, it seemed like, hey everybody, here's what it is. Go off in your own corners around the planet and do the work to find a solution to this, whether it's treatment or vaccine. Am I wrong to have attributed so much hope to that particular moment in time, Manuel?

Dr. Manuel Martin:

Well, I think one could have imagined a very different timeline where after a very open sharing of the initial vaccine, not vaccine, sorry, but the viral genome of COVID-19, a way of openly sharing what you find could have continued. The vaccine developers could have figured out different protein structures that address particular parts of the virus as they have gone and done, but then share that amongst one another and discuss which one is the most promising, which ones should be pursued, which ones are less likely to succeed, and continuously sharing their results. Very likely, especially if that is the case for developers working on the same platform technology. A lot of the same mistakes have been made in many different places, And really one only had to make that mistake once, and then everyone could have learned from it. It would have been a far more efficient way of doing things. unfortunately, that is not yet the world we live in.

But I think it's important to keep in mind this blue sky idea of how we could do research and development in a very time pressured way in order to address a pandemic for the next time it comes around in order to maybe set up the kinds of systems that we do need to ensure that a more open approach is taken. And a big part of that, one question that keeps coming up is like, well, if companies share everything that they do, they can't make a lot of money and it then becomes very difficult for them to have the money to continue to invest in research and development. But what we've really seen now is most of the research and development has been funded by the public, or is heavily supported by the public.

And certainly then at the end, there's a guarantee that countries will be buying these vaccines. We've been seeing a lot of bilateral deals between countries and companies. So the risks that typically are associated with drug development are not so much present here. There's much more willingness and certainly much more money on the public side that has been put into this research and development, and that could mean a much more open approach.

Avril Benoît:

So while we might be displaying some old bad habits in our approach to this, still, it's gone really quickly. I mean, this is much quicker than what was expected by reasonable people who had just looked at the history of vaccine development and how long it takes to really go toward a proper approval. I mean, it is pretty amazing. And now already people are starting to worry about mutations. So we have a question here about that from Amira on Zoom. This question of the concerns of mutations may make the vaccines that are currently under development already, not work. Can you comment on this question of mutations, Manuel?

Dr. Manuel Martin:

I can give it a go. Again, I'll flag that I'm not a virologist, I'm not a microbiologist or a vaccinologist, so this is not my area of expertise. Certainly this is a concern that I've seen coming up again and again, I have not seen any consensus amongst the experts on this. However, whenever this concern has come up very quickly, then there was a kind of counter argument that this actually wasn't such a big concern because the mutations were only changing parts of the virus that the vaccines aren't particularly targeting. One big area where this has come up is now with this new mink strain to Denmark. But again, I think that is up to debate and I'll leave it to the experts to rule on that, but I have not seen so far really serious concerns about.

Avril Benoît:

Here's one from Heena on Zoom who's joining us from Canada. We're already seeing anti-mask rallies in Canada, but also around the world. Certainly it was a huge factor in the presidential campaign as it was coming up in the US, and this is a concern that some people might not want to accept the vaccine, which I alluded to earlier. What recommendations do you have for healthcare providers or whoever it is, officials who are going to be the ones responsible for rolling out the mass vaccinations? How can they increase public acceptance of a COVID vaccine once one is approved for wherever they are? Any ideas on this?

Dr. Manuel Martin:

I think that is a good one and is very dependent on the local population communities and the specific concerns that people have. I think it also depends on the vaccine candidates. I think for some, there may be slightly more legitimate concerns than for others. Overall though, we have seen that there have not been any significant shortcuts made to the research and development process as it normally exists. So we still have had phase one studies, phase two studies, phase three studies conducted, which are meant to catch the really serious side effects. And at least some of the less serious and common ones, it may still be that we have some vaccine entering the market that has a very, very rare side effect that pops up once every 200,000 people who get it. But again, just because we'll be vaccinating so many people hopefully, that will be picked up and certainly regulators across the world continue to monitor the vaccines as they come up.

Dana Gill:

Yeah. And Avril, I'll add to that in terms of making sure that there's a disclosure of the clinical trial designs and data. We have seen a couple of the companies step back and say we need to make sure we are looking at representative communities better and making sure we have participation from representative communities in a more equitable way. And so those are good, important steps in making sure that it is an equitable allocation process that is really taking into account the communities that are most effected. So those are good steps that we have seen and we hope continue to make progress. And Avril, if you don't mind, I'd like to go back to, I think, a couple questions back when we were talking about open science too. If you're on our mailing lists or if you've followed the Access Campaign for any length of time, you've heard us talk about no patents in a pandemic.

And that's one of the things that we're talking about a lot in terms of making sure there is more rapid availability of the information. And we're also engaging in activism around some world trade organization processes that are happening right now, where India and South Africa are pushing to make sure that there aren't patents that are keeping this information held by just companies that would stop the scale up of manufacturing and production. So we're really working on that open science and open information question a lot, and you'll hear more from the Access Campaign on these campaigns.

Avril Benoît:

Let's finish up with a couple of questions because we're almost out of time, but we've had some questions about the cost of it, because in some countries, obviously the public health system, ministry of health, whatever is going to support it in a Medicare for all or socialized medicine system that you have in many countries. But in other places it's unlikely to cover everyone, particularly those who don't have private insurance. Well, Mobashir on Zoom is asking even if the vaccine is available in the market, will it be affordable? And he's talking at the individual level. And Richard on Zoom is asking, what can be done to produce more affordable versions of a vaccine from generic companies, for example? Dana, maybe you could start with that.

Dana Gill:

Yeah. Yeah. And generic vaccines is a little bit more of a technical aspect where it's not quite the same apples to oranges as generics for other medicines and treatments. But what we've been talking about in terms of sharing the recipe as it were, that's the way we're going to be able to scale up this manufacturing and make sure that there are more doses available at an affordable price more quickly all over the world. What we're seeing at the outset is that there are many commitments from government saying that this will be available free and, or very low cost. So we are seeing that commitment in a lot of places. And that's a good first step, right? That's the critical first step. What we're worried about in this bigger system, when we kind of look again at the systemic issues that need to be addressed is what happens after this is a pandemic?

When this is maybe just endemic or in many years in the future if this is more of a disease that's in our daily lives, like the seasonal flu down the line? If companies own and control these recipes that allow them to charge whatever the market will bear, that's when we're really going to have to worry about the price. It seems like there's a lot of commitment right now, but what are we going to be able to do to reform the system in this moment so that in the future we won't be faced with these types of questions that keep so many people from affording the lifesaving medicines they need?

Avril Benoît:

All right. You've talked about a lot of issues. Both of you have touched on policy issues where you're both activists. I mean, you work for our Access Campaign efforts at Doctors Without Borders at MSF. For those who are watching then, what can they do to support these objectives that you've outlined? Maybe I can start with you, Manuel.

Dr. Manuel Martin:

Sure. I think one of the things that you can do is to really engage politically on this question. It is also your tax money that is being funneled into the research and development. You will also in some way, be affected by this. This really affects everyone. And solidarity really is the only way out of this pandemic. And I think on one hand, calling on your own governments to do the right thing and share vaccines in an equitable fair way across the world is incredibly important.

But then secondly, also for governments to be transparent about the kinds of deals that they've been signing, both in terms of the doses that they've been procuring, but also the kinds of deals that they've been signing when it comes to the funding of the research and development, we have yet to see these deals really being published in a truly transparent way. And this is something that would go, I think, quite a great length to reduce the prices and also increase the affordability of the vaccines because it creates a level playing field and reduces that information asymmetry that currently exists. You get to Dana.

Dana Gill:

Yeah. And just adding on to that piece of connecting with your representatives and sharing, you'll hear from the access campaign about things we care about and see as issues that need to be addressed, barriers that need to be removed to ensure affordable and equitable access. So I mentioned one of them earlier, which is the no patents in a pandemic campaign. And then to add on to something I talked about early on, public funding of research and development. There needs to be strings attached. There needs to be conditions, we believe, that comes along with this investment. And if you choose to accept it, it's like a social contract, right? You should be required to be transparent about all of the transparency items we've talked about, to have a fair price. All of these different conditions that we call for are things that could be brought up and watched and monitored by you, and to share your voice about in the public interest and for all of the people we care for.

Avril Benoît:

Keep fighting the good fight, you two. And thank you very much for joining us today. It's been great to have such expertise on the panel. Thanks a lot to Dana Gill, US policy advisor on Access to Medicines for MSF or Doctors Without Borders, USA and the Access Campaign and Dr. Manuel Martin, a medical innovation and access policy advisor for the MSF Access Campaign. Thanks a lot and stay healthy. And we really wish you well in your work and lots of success, and we'll be supporting you all the way, and I know those who are watching will too. So thanks. That's it for our webcast today. Thanks for asking all those great questions. I'm sorry if we didn't get to all of them, but we'll try to follow up by email. We will be continuously trying to find ways to share our perspectives with you.

So while we're wrapping up this series just for the fall, don't worry, we'll be back with lots of other topics. And I just want to remind you that you can always reach the team that puts these together. If you have any follow-up questions or you have suggestions of topics that are of interest to you, we're all ears. So we have an email address you can write to, which is [email protected]. And for more information about all the issues that you heard about today, just go to our website doctorswithoutborders.org. And we also have our international website, msf.org. You can find us on Twitter, on Instagram, on Facebook, of course. And remember, wear your mask, wash your hands, keep a physical distance, and let's just hope that we can get through this together. I'm Avril Benoît, signing out for now. Have a good day. Bye.