Vaccine 5: Acting justly, loving mercy and walking humbly?

EXPEDITED ACCESS FOR COVID-19 IP

The following guidance explains how we approach licensing COVI-19 related IP to 3rd parties in these exceptional circumstances.

1.   OU and OUI will expedite access to Oxford IP to enable global deployment at scale of associated products and services to address the COVID-19 pandemic

2.   The default approach of the University and OUI regarding (1) will be to offer non-exclusive, royalty-free licences to support free of charge, at-cost or cost + limited margin supply as appropriate, and only for the duration of the pandemic, as defined by the WHO

The team at Oxford University started working on a vaccine  early, very early, in fact, before the problem began. With government  and charitable funding over many years, they had been working on how to quickly deliver a vaccine for an unknown epidemic, Disease X. As the first news reports of an outbreak of viral pneumonia were coming in from Wuhan,  the WHO confirmed on the 9th January 2020, the cause, a novel corona virus. The next day, even before the first reported fatality due to SARS-Cov-2, the scientists at the Jenner Institute of Oxford University had a planning meeting for an eventual vaccine for this  new problem.  Three weeks later the problem became a WHO -Public Health Emergency of International Concern, and that concern about Covid-19  officially became a  Pandemic on the 11th March 2020. So the UK based Oxford vaccine had started, much earlier by two months than an adequate  public health response.  But there was still, as we said last time, a long and uncertain wait.  Perhaps realising  that with 97% public and charitable funding it should give something back  to society,  perhaps inspired by Jonas Salk, the University  pledged a non exclusive, royalty free licencing system;  It  had clearly caught the spirit of the times. Here is their  undated web page in full 

Now over a year later we know  that the search for multiple vaccines has borne fruit which exceeded the most optimistic projections. According to the WHO by the 24th May 2021 a total of 1,489,727,128 doses of vaccine have been given, which is amazing. The Astra Zeneca vaccine is especially good for world health as even isolated places, like Bardai, have the necessary normal temperature refrigerator technology required for storage.  Unfortunately the early global solidarity expressed by Oxford University and many political leaders are long forgotten. An exclusive deal was struck for the Oxford Vaccine with Astra Zeneca on 30th April 2020. This has effectively shackled the manufacturing and rollout of the Oxford Vaccine.  Through deals, the details of which have not been published, Astra Zeneca has established manufacturing sites around the world, notably licensing  the Serum Institute of India, and aims to produce 3 billion doses of vaccine this year. This sounds good but firstly vaccines are not being produced as quickly as hoped, leading to undiplomatic wrangles between counties  and secondly the world has nearly 8 billion citizens, and has need of an estimated  14 billion doses of vaccine  for the initial  control the disease.

The Astra-Zeneca vaccine is said to be not for profit and should have been equitably distributed through COVAX for at risk populations and health workers around the world according to need. Unfortunately now the primary supplier of the Oxford Vaccine for Africa, is the Serum Institute of India.  It  will be unable to meet its obligations this year  as all of its production is needed to control the epidemic in India.  The Oxford University graph above demonstrates the richest countries are getting most of the worlds doses supplies and this will continue as long as supplies  are limited. For instance the UK has given 61 million doses  for its population of 68 million  compared to 18 million doses for the whole of African population of 1.35 billion people.

Everyone needs urgently  to have access to the vaccine which is why so many people in so many countries led by South Africa and India have been campaigning for a patent waiver and technology transfer similar to that originally  envisaged by Oxford University. Only by massively expanding the number of manufacturers can we right the injustice of having 60% of the total UK  population with a first dose of vaccine where as Africa has only vaccinated 1% of its population.  

Recently Dr Tedros Ghebreyesus (WHO- Director-General) said  at the World Health Assembley,

''There is no diplomatic way to say it: A small group of countries that make and buy the majority of the world's vaccine control the fate of the rest of the world.''

Despite great opposition from the major pharmaceutical companies the Biden- Harris administration has decided that the United States will support the planned patent waiver, saying

'' These extraordinary times and circumstances call for extraordinary measures''

The Bill and Melinda Gates Foundation, which has  supported global health an especially  childhood  vaccination over many years was strongly against the waiver but recently changed it's mind and  published,

''No barriers should stand in the way of equitable access to vaccines including intellectual property, which is why we are supportive of a narrow waiver during the pandemic''

Sadly the arguments at the WTO continue and about the only thing the UK and the European Union are capable of agreeing on is their strong opposition to the patent waiver.

 Perhaps you would like to express support for this vaccine waiver which could change the world for the better? As well as considering  sending a donation to India and Nepal why not tackle the problem at the root, by campaigning to increase the production of low cost effective vaccines as requested by South Africa, India, the USA  and a total of 118 of the 164 members of the WTO.

You could petition the Prime Minister it takes a minute of your time or even write to your the Secretary of State for Trade, it takes a little longer but may make a huge difference if we all do it . 

Can we  ''act justly, love mercy and walk humbly'' and work for a better world? 

Yes we can! 

Should we ? 

Yes we should!

Must we ?

Yes we must!

A demonstration at the Department of International Trade during the recent G7 Trade Ministers  meeting

 

 

 

 

Vaccine 4. Prevention is better than cure

The Covid-19 satellite hospital at Bardai, a  re-purposed police station. 

Cast your minds back to April 2020, the first lockdown had begun on 23rd March, but despite this the deaths  due to Covid-19 were still rising at an  alarming rate.What could be done to stem the tide of the pandemic? 

 

Hopes were already being pinned on a vaccine, but would it be possible to make one? How much would it cost?  And more importantly how long would it take? According to the Welcome Trust, in normal circumstances $500 million over 10 years. The quickest ever was 5 years for a mumps vaccine. However fortunately there were new technologies, mRNA and adenovirus vectors, and so Sir Patrick Vallance, UK Chief Scientific Officer, was suggesting 12-18 months. There were grounds for hope but a long and anxious wait was just beginning.  

Meanwhile what could be done to help people before a vaccine would become available? The first response was already in place, an unprecedented lockdown to slow the rate of transmission, the second was to boost the capacity of the NHS to cope with the number of patients needing hospital treatment especially lifesaving oxygen treatment.

On the 3rd of April, 11 days into the first UK lockdown, to prevent the risk of NHS hospitals being overwhelmed, NHS Nightingale London was declared operational. The Excel conference centre had been converted into a hospital in  less than 2 weeks. The  initial capacity was 500 hospital beds with  the possibility of 4000.  More complex equipment was harder to come by,  innovative manufacturing was needed and in the meantime some came from surprising places, such as working ventilators given by the BBC's Holby City film set. The cost of the conversion and equipment was £57 million and 6 more provincial centres were to follow. 

In Bardai, at the hospital, we were trying to respond to the situation, by delivering health education messages on hand washing, mask wearing and social distancing in the community and improving hospital hygiene and infection control. Our ADP linguist colleagues made a health education film in Teda that passed from phone to phone.

We also realised that our small hospital was at risk of being overwhelmed by even a small number of cases due to  inadequate separation of Covid and non-Covid patients and uncontrolled visiting fuelling any epidemic. The local authorities offered a very good solution; the disused police station with a perimeter wall could be transformed into a separate Covid satellite hospital. Help from the WHO and Ministry of Health would eventually arrive but in the meantime BMS supported the rapid organisation of a water supply, triage area and other changes. The main  hospital had basic equipment such as beds and trolleys in storage and so within a couple of weeks we had a unit. We even had a small quantity of disposable PPE that had arrived by chance 6 months before, that was initially supplemented by surgical gowns and scrubs made in town and eventually further supplies from the Ministry. 

Orders for plenty of oxygen masks and other essential medical equipment were made from the UK and these eventually arrived along with essential medicines such as dexamethasone, paracetamol and antibiotics from N'Djamena.  

 

Rather like the UK Nightingale hospitals, our satellite hospital has been little used, although we did have a handful of highly probable cases in the town (we had no tests to confirm them). Thankfully we didn’t get sustained transmission, but having seen the scenes from the UK, Europe and the US we were right to prepare as much as possible. Despite all our preparations the day a more transmissible variant arrives in Bardai we will be at risk and  still would have difficulty coping. The reason for this is the same as one of the drivers of the unfolding tragedy in Nepal and India, a lack of oxygen.

From the outset we were aware that this was a major weakness. In the UK we assume that nearly every bed in a hospital has a piped oxygen supply, and if not, there is a full oxygen cylinder nearby. There is no chance of replenishing our empty oxygen cylinders in Bardai, but we do have four individual patient oxygen concentrators, an amazingly high number for such a small hospital but only two were working. Fortunately, one was repaired by missionary colleagues from Germany and the Ministry of Health sent us another one. BMS bought 2 small generators that could run 6 hours on, 6 hours off to supply the necessary electricity 24 hours a day.  Large numbers of oxygen concentrators have been given by the WHO and other donors to Chad, and hundreds of thousands throughout the world but as an article in today’s Guardian shows, once an epidemic strikes there is usually not enough oxygen to meet the 10 to 100 fold increase in demand. As a consequence  Covid is no longer a disease predominantly affecting the older population, many people of all ages die. We must of course help in any way we can to get oxygen and supplies  to everyone  that need it, but the volume of equipment and the training and skill required to do anything other than the simplest oxygen mask treatments means that this can never be the best solution for most of the population in low and low middle-income countries. Building Nightingale hospitals in advance all around the world is just not possible.

What is needed is a vaccine freely and equitably available for all, after all prevention is better than cure.  

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