‘A Vaccine Can Be a Public Good’

Janine Jackson interviewed Public Citizen’s Peter Maybarduk about Covid-19 vaccines and treatments for the September 11, 2020 episode of CounterSpin. This is a lightly edited transcript.

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Janine Jackson: Donald Trump says the US won’t participate in the Vaccines Global Access Facility, or COVAX, whose stated aim is to speed vaccine development, secure doses for all countries and distribute them to the most high-risk segment of each population. Global cooperation in the face of a global pandemic might make sense to some but, a White House spokesperson told the press, the US “will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China.” But when it comes to possible vaccines and treatments for coronavirus, Trump’s jingoistic sociopathy is not the only obstacle between science and public health. Peter Maybarduk is director of Public Citizen’s Global Access to Medicines Program. He joins us now by phone. Welcome back to CounterSpin, Peter Maybarduk.

Peter Maybarduk: Good to be with you.

JJ: Starting with vaccine development, how meaningful are Trump’s isolationist protestations? We know sometimes he mouths off, but it doesn’t translate to much. But could this impede Americans’ access to a vaccine?

PM: It impedes the world‘s access to a vaccine, and it’s massively consequential in that sense, and it could extend the pandemic, so that’s obviously bad for people living in the United States. This is a time when US leadership is absolutely critical in order to help the world make vaccines, get enough vaccines for the world’s people, and not see a delay of many years in access in low- and middle-income countries, for example. And, of course, the Trump administration, as you said, is hurling that to the wind, and the consequences will be a global vaccine apartheid. The consequences will be many millions of people around the world, in the most vulnerable communities, not having safe and effective vaccines when they need them, and communities that are already hard-hit or already suffering from poverty or political instability, those situations getting worse and the consequences amassing for years.

So the lack of cooperation here, it also accelerates the race, right? Trump is adding to the tension in the sense that it’s every country for themselves. And to have high-income countries buying up limited doses of vaccines and not looking at the cooperative solutions, not only to distribute equitably the vaccine doses that we will have to end the pandemic faster and take care of the most vulnerable people and make sure healthcare workers have vaccines, but also neglecting solutions that might help the world manufacture more vaccine doses more quickly through cooperation, public production, technology transfer. Instead, it’s every country from themselves, and also each corporation entrusted to act in its individual profit interest. And we’re just handing out grants to the corporations and hoping that that solves the pandemic, which is no way to proceed.

JJ: Yeah, some news media have pointed to Trump’s claims that a vaccine could be ready by Election Day as a troubling indication that the process could be “polluted by politics,” but the same outlets see nothing at all worrisome about describing AstraZeneca, for example, as being a “frontrunner in the race” for a Covid-19 vaccine. That a desperately needed medicine should be the “spoils” given to the lucky victor of an each-against-all competition is just, you know, that’s how you do healthcare for US news media, it seems; that’s nature’s way.

PM: A race is a bad metaphor, of course; it’s just all people against the virus. So it’s unfortunate.

JJ: Yeah, well, as we move from possible vaccines to treatments for Covid, we remember that America First-ism isn’t the only problematic thing, isn’t the only villain of the piece. When we last spoke to you in May, you were talking about remdesivir, a drug that had shown promise against Covid, and the CEO of Gilead, which makes remdesivir, was saying that he was “humbled” to be making it, and he was talking about collaborative efforts. What’s the update there?

Peter Maybarduk: “If we can’t deal with the problem of pharmaceutical monopolies, if we can’t deal with the problem of politics influencing health criteria,  before there is a safe and effective vaccine, then we can see that we’re in for a world of hurt.”

PM: Remdesivir is the first experimental treatment approved to treat Covid. Of course, we now know that steroids that have been on the market for a long time are also proving useful. But remdesivir has a big market, and there are hospitals and states that want it to shorten hospital stays. It’s not yet proven to save lives, but it can reduce the length of hospital stays by some days, which is important in reducing hospital burden and keeping our health facilities running as efficiently as possible.

But cities and states are experiencing shortages of remdesivir: 38 hospitals in 32 cities in 12 states have reported shortages of the drug, because Gilead is not making enough to meet demand. Gilead has a monopoly on the drug because of the government-granted patents and exclusivities. So despite the fact that there are sources of generic supply, including a company called Beximco and others that could be getting into the market, they’re precluded from getting into the US market because of monopoly.

So monopoly is leading to a shortage of the drug, but also Trump’s Health and Human Services Administration has failed to allocate the drug rationally. We ran an analysis with all the states’ remdesivir data and HHS remdesivir allocation data, built our own database, and found that states that had a bit larger pandemics and more hospitalizations were nevertheless receiving less remdesivir.

What we know actually is that states that reported directly to the White House, governors that said to the White House, “We need more remdesivir,” got more remdesivir. And so politics played a role and, unfortunately, HHS’s own stated criteria of allocating this drug according to hospital burden was not followed, because of that insider track. Now, this is all concerning for us, both because of what it means for this particular drug, but if we can’t get our act together, if we can’t deal with the problem of pharmaceutical monopolies, if we can’t deal with the problem of politics influencing health criteria before there is a safe and effective vaccine, then we can see that we’re in for a world of hurt. Things could get worse.

JJ: Let me ask you, can we ask how a drug developed with public money can actually be in shortage to begin with, or is that too communist? I mean, didn’t millions of dollars of—as the media like to say—“taxpayer dollars” go into developing remdesivir?

PM: That’s right, at least $70 million. The federal government was a partner in the development of remdesivir from early days. Remdesivir was first developed as part of a suite of candidate treatments for hepatitis C; Gilead made about $200 billion globally off its hepatitis C drugs. It was later tested against Ebola in cooperation with federal scientists and now, finally, NIH is running clinical trials to move remdesivir forward today.

But, yeah, there’s production shortages. And it’s not necessarily outrageous on its face that Gilead wasn’t making enough to meet initial demand. It’s a pandemic; everybody is sort of trying to get up to scale. But it is very unfortunate that the public is constrained from producing more because only Gilead is allowed to produce it.

JJ: Right. I worry, I guess, about the presentation of the vaccine as a kind of holy grail, as though it will magically put all of this behind us; or as a way forward, you know? That we’ll just kind of: pandemic, vaccine, pandemic, vaccine. Obviously, as you’re saying, as lots of folks are saying, this is not going to be our last public health crisis, so we have to be looking at the processes, we have to be looking at the systems that are in place. I’ve seen a lot of breathless stories on the clinical hold on the AstraZeneca study because one participant got ill,  lots and lots of coverage: What does that mean, what does that not mean? I guess I wish some of that airspace would be given to these questions that you’re bringing up, about what is our whole process for distributing life saving medicine, and what’s in the way of that?

PM: Yeah. And as you say, first there’ll be the issue of making sure a vaccine is safe and effective. And it’s very important that we get all the Phase 3 clinical trial data in. Having a misfire, an unsafe vaccine, would be a catastrophe. So as much as we’re in a hurry to get safe and effective vaccines to the world, first we’ve got to prove they’re safe.

But once there is a safe, effective vaccine on the market, it may still be the case that the first vaccine is not the best one; it may only prevent Covid or transmission for a limited period of time, it may require multiple doses. Some of the vaccines in development require cold chain storage that will be hard to deliver to remote areas. So there can be multiple candidates; it may take time to get the right candidates out there. And we just have to be doing everything we can, both to manage the pandemic meanwhile, and also deliver great volumes later on. But as you say, we can’t just sit around and wait for a silver bullet. We have to be taking the testing measures now and recognizing this is going to be a challenging process that’s going to be with us for a while and not everyone’s going to get it at the same time. The consequences of that could be very bad, but they can be mitigated.

JJ: Let me just ask you, finally, in terms of things that media could be putting their lens on: We’re not all scientists, we can’t all interpret data, necessarily. But we are all political actors who have some role in demanding transparency from our government, in calling for access, for information. I just wonder if you could turn reporters’ attention to something, what would you have them be paying attention to as we go forward?

PM: Technology transfer, or the concept of a people’s vaccine, that a vaccine can be a public good. While only you or I can take any single given dose of the vaccine, all of humanity can benefit from the technology underlying that vaccine and we can teach the world to make it. I’m not naive about that, there are massive technical challenges to producing new vaccines well. But right now we’re simply being deferential to the exclusivities, the confidential information, the patents, the monopoly control of these vaccines by individual companies who are all benefiting from public funding anyway, rather than saying,  “What’s the best technology that we as a people have? And how can we get to scale as quickly as possible as one world?” If we don’t do that, the rationing is going to be very severe.

And I think there is underreporting on the possibility that we could expand production capacity beyond current plans, and the consequences of not doing so are going to be…. It’s going to be one of the great humanitarian catastrophes of our time. And we’re going to be responsible for reporting out to the next generation how we let so many vulnerable people around the world suffer because we weren’t imaginative about this moment, because we didn’t grab the power of the US government or global production capacity and say, “We can rise to meet the scientific and technical challenge.” We’re simply being too deferential to some of the moneyed interests that are at stake, and it’s an especially dangerous time for that way of thinking.

JJ: We’ve been speaking with Peter Maybarduk, director of the Global Access to Medicines Program at Public Citizen. You can find their work, including the new study on the mishandled distribution of remdesivir, online at citizen.org. Peter Maybarduk, thank you so much for joining us this week on CounterSpin.

PM: Thanks for your reporting.