In May 2023, the World Health Organization (WHO) published the global vaccine market report. Underpinning this technical report on vaccine market dynamics was a strong push by WHO’s Director-General, Tedros Adhanom Ghebreyesus, for increased transparency and equity; transparency is mentioned 15 times in the report. Perhaps most striking was the Director-General’s call for “predefined and binding rules for vaccine distribution in times of scarcity”.
In the overview, WHO noted that the report aimed to:
capture lessons from the COVID-19 pandemic and to highlight the opportunity for more ambitious global action: expanding sustainable access to vaccines for all towards the Immunization Agenda 2030 and pandemic prevention, preparedness and response efforts. The report is organized in two sections: the first section provides WHO insights on global vaccine market dynamics, drawing from data provided by Member States, which are, in turn, analysed and displayed in the second section.
The Director-General’s foreward noted:
While COVID-19 reminded the world of the immeasurable power of vaccines as key public goods, it also highlighted inequities in access that are sadly the rule rather than the exception globally. Lower-income countries struggle to access vaccines that are in demand across the world. For example, the human papillomavirus vaccine, which protects against cervical cancer, has been introduced in only 41% of lower-income countries, while it is saving lives in 83% of high-income countries. While prices tend to be tiered by income, further efforts are needed to alleviate pricing disparities, with middle-income countries paying as much as – or even more than – wealthier countries for several products. Regions without sizeable manufacturing capacity of their own lose out and intellectual property monopolies continue to severely limit access to vaccines.
We will not recover from the historic backsliding in essential immunization if we continue to allow market dynamics alone to shape global vaccine priorities. Nor will we achieve equitable access to vaccines globally unless we have more transparency and active government oversight. We must also work to shape a more favourable intellectual property landscape and for proactive technology transfers, and to increase the building and retention of technical, manufacturing and regulatory capacity in every region.
The WHO report provides several key insights.
While the base of vaccine manufacturers has expanded to more than 90 manufacturers supplying WHO member states in 2021, supply is concentrated on fewer than 10 manufacturers “with broad portfolios, global reach, and a diversity of deployable technology” (Page viii, WHO Global vaccine market report 2022).The WHO African and Eastern Mediterranean regions, in particular, are affected by regional supply insecurity, making their vaccine access “heavily dependent on the policies and supply chains of other regions.” (Ibid)
Barriers to vaccine manufacturing scale-up include:
[V]accine supply has historically been unable to rapidly respond to significant changes in demand, both owing to technological challenges and to a lack of market incentives. Vaccines are typically manufactured in product-specific facilities and product changeovers are cumbersome, limiting flexibility. At the same time, manufacturing know-how, intellectual property rights protection, non-linear production costs, uncertain demand and displacing competition limit manufacturer incentives to scale up.
The report acknowledged that vaccines are “under-invested” and that “free-market dynamics do not optimize for social and health impact” while highlighting the need to “reconsider the value of vaccines as a fundamental and cost-effective public good rather than a commodity.”
In relation to the Covid-19 response, WHO noted that:
equitable access to COVID-19 vaccines has been highly problematic as a result of dynamics repeatedly experienced in other vaccine markets.
The lack of transparency along the value chain of vaccine manufacturing and distribution and the lack of government oversight made it hard
for governments to plan and use vaccines most efficiently within national boundaries as well as across countries.
Looking towards the future, the WHO made the following observations.
The report contained recommendations for governments, industry, and international organizations. Here are the report’s recommendations in relation to transparency, intellectual property, and technology transfer.
WHO called on governments to:
Ensure transparency and oversight along the vaccine value chain towards enhanced health impact, as well as, define principles and operational mechanisms for collaboration across countries in times of scarcity, including for intellectual property and the circulation of inputs and goods.
In relation to industry, WHO called on the private sector to “[e]stablish provisions for technology transfer” and ensure transparency along the vaccine value chain” and “[c]ommit to specific measures allowing for equity-driven allocation of products.”
WHO called on international organizations to continue to “call for technology transfer and for the application of resolutions on market transparency for health products.”
Note: A draft of this report was published on 9 November 2022. Devex reported on the draft report in a piece entitled, Global vaccine market ‘dealing with oligopolies,’ WHO says.
Jaume Vidal, Senior Policy Advisor at Health Action International (HAI) provided the following reflections.
This important report by WHO acknowledging the shortcomings of the international community regarding access to vaccines during the pandemic and, more importantly, addressing the underlying causes: lack of transparency, too stringent IP protection and cumbersome tech transfer. The repeated calls for transparency as a proactive responsibility of governments and other stakeholders are most welcome as is the explicit acknowledgment of vaccines as public goods. Hopefully WTO and WIPO will heed the call. Will governments do the same while negotiating the pandemic accord and other PPPR instances? We certainly hope so.
Ellen ‘t Hoen, LLM, PhD, Director, Medicines Law & Policy, provided the following response.
This report sends a very clear message to the WHO member states that are currently negotiating the pandemic treaty that we need stronger and compulsory provisions to ensure access to IP, know-how, data and materials needed to research & develop and produce vaccines in order to expand and regionalise vaccine production. Kindly asking the industry to do this has proven an unsuccessful strategy during the Covid-19 pandemic.