How Donald Trump could spark a dangerous bout of ‘vaccine nationalism’

The news that the US has aggressively bought up much of the world’s stock of remdesivir, one of just two drugs known to help treat Covid-19, does not bode well for an equitable distribution of vaccines.

In some aspects, the remdesivir story is overblown. It is true the Trump administration has bought up more than 500,000 doses, mopping up all of July's production and 90 per cent in August and September, but it is not the case it leaves none for others.

Gilead Sciences, the Californian company behind the drug, signed deals with five generics companies in India and Pakistan to manufacture and distribute the antiviral to 127 developing countries in May.

Germany, South Korea and Australia also have supplies, and in Britain, the government secured enough stock in advance “to treat every NHS patient who needs it”, according to the Department of Health and Social Care.

There are also questions about the drug’s efficacy. There is solid evidence to show it reduces the time patients spend in hospital but nothing yet to prove it saves lives.

The only drug proven to do that is the cheap as chips steroid dexamethasone which has been used from the start of the crisis by intensive care doctors around the world.

Nevertheless the precedent the remdesivir buy-up sets is not a good one. It confirms President Trump’s aggressive “America first” approach and threatens a chain reaction in which treatment and vaccine nationalism becomes the norm.

“The World Health Organization is trying to bring [people] together and some government’s are leading on this, including France and the UK,” notes Prof Devi Sridhar, chair of Global Public Health at Edinburgh University.

“But all you need is one government not to cooperate… to misbehave and not play by the rules of the game, and it becomes very hard for everyone else too.”

That game is getting ever more tense as Covid vaccines move from the laboratory into human trials.

China announced this week that its leading vaccine candidate – one of 19 – would be administered to its army after it was found to prompt a reasonably solid antibody response in phase two human trials.

Opinion is divided as to the motive. Some see it as a clever way of fast-tracking large scale phase three trials to prove efficacy and safety. Others think it’s being used to provide a degree of immunity for a crucial national cohort, with a booster shot expected later.

On the bright side, most countries – bar America – are making the right noises on the principle of equitable distribution of vaccines according to need, including China. There has as yet been no formal agreement signed but the vast majority of countries and companies involved in the race have agreed in principle to share.

Large scale production facilities are being thrown up around the world, distribution networks are being put in place and – perhaps most important of all – all the scientific teams at the coal face are said by observers to be collaborating vigorously.

Yet the remdesivir purchase could upset this. Its efficacy was established through WHO-organised clinical trials, involving large numbers of cooperative governments, physicians and patients around the world. Many involved of those involved – not least the families of patients who only received a placebo – may now be feeling aggrieved.

But this is realpolitik. Just as the quest of gold brings prospectors together, a strike is as likely as not to bring the knives out. We can only hope that better sense, nurtured through careful diplomacy, prevails when a proven cure or vaccine for Covid-19 is discovered.

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