Photograph by Yann Libessart
Opinion article |

Norway has invested 200 million euros in epidemic preparedness, but are they getting what they’re paying for?

Photograph by Yann Libessart

Author: Dr Karine Nordstrand – President, MSF Norway

When Médecins Sans Frontières (MSF) responded to the 2014-2016 Ebola outbreak in West Africa we did not have the tools we needed to save lives or curb transmission of the deadly virus. We had no vaccine. No simple diagnostic test. No treatment.

MSF faces the same tragic obstacles for numerous neglected diseases that threaten the health and survival of people we serve in more than 70 countries today. The reason people affected by these diseases are neglected is quite simple: pharmaceutical corporations won’t invest in developing new treatments. Why? Because a majority of potential patients are poor. And poor people cannot pay for expensive new medicines. 

That is one of the reasons the Coalition for Epidemic Preparedness Innovations (CEPI) was established in the wake of the Ebola emergency. CEPI’s mission is to accelerate the discovery and development of vaccines for emerging infectious diseases and enable access to these vaccines during outbreaks. It has supported Ebola vaccine clinical trials and is also focused on developing vaccines for Lassa fever, Nipah virus and Middle East respiratory syndrome (MERS).

Norway, among other countries and institutions such as Australia, Belgium, Canada, Germany, Japan, the UK, the European Commission, the Bill and Melinda Gates Foundation and the Wellcome Trust put up the money to overcome this market failure and to make sure the world is prepared next time.

And Norway paid up. 200 million euros have been allocated so far by the Norwegian government, making it CEPI’s largest donor. Prime Minister Erna Solberg said at the time CEPI was launched in Davos in January 2017: “A global initiative is paramount to be prepared”. Also, CEPI’s headquarters are situated in Oslo. Safe to say, the Norwegian government have given their share of resources. Are they getting what they paid for?

As first responders in outbreaks and emergencies, MSF was an early proponent of the coalition, and our International President, Joanne Liu, enthusiastically joined the interim Board when the initiative was first established. However, having finished her term and involvement with the Board and seeing the policy decisions recently taken by the newly configured Board, we are worried that CEPI is taking a detrimental, ‘business-as-usual’ approach to its partnerships with commercial industry developers. This threatens the public investment and collective effort that underpin CEPI and creates unacceptable risk that the vaccines it develops will be inaccessible or unaffordable for the people and countries that need them most.

One of CEPI’s distinguishing features is the tremendous size of its mostly taxpayer-funded pocketbook. The organisation has raised an unprecedented 750 million euros to date for vaccine research and development Stewarding these considerable resources is ultimately the job of CEPI’s Board, who will meet in Tokyo on 7–8 March. The Board is composed of 12 voting members and five observers, including the World Health Organization (WHO) and World Bank.

Like other such ‘public-private partnership’ initiatives – or PPPs – CEPI does not develop vaccines on its own. Rather, it selects and funds researchers and commercial developers to carry out vaccine laboratory studies, clinical trials, and stockpile manufacturing. Ensuring the success of PPPs is complex business, requiring careful checks and balances, clear policies and robust contractual arrangements that protect public investment and ensure affordable access to medical innovations once they emerge. Provided they strike the right balance, these partnerships can deliver. For instance, the non-profit Drugs for Neglected Diseases initiative (DNDi) recently celebrated the launch of fexinidazole, a groundbreaking, all-oral cure for African sleeping sickness that the group developed with their research partners in Africa and commercial partner Sanofi, who has agreed to provide the treatment free of charge through WHO.

In February 2017, CEPI, with considerable input from MSF, approved a policy that would make sure the vaccines developed through the coalition are affordable for those who need them most. Regrettably, the policy was never implemented or used to shape access provisions in the contractual agreements CEPI began signing with pharmaceutical corporations in 2018. Last June, reportedly due to industry actors’ dissatisfaction with the policy, CEPI took the decision to draft a new access policy and an alarmingly weak one was adopted by its new Board in December. It replaced many of the earlier policy’s clear requirements with broad statements of principle that lack specificity and provide no real basis for holding CEPI and industry developers accountable to appropriate intellectual property, transparency and pricing obligations. Norway now risks funding lucrative deals for pharmaceutical corporations that can set their own prices without considering the affordability of the vaccines they develop with public and philanthropic financing.

The people and countries that need these vaccines deserve a much fairer deal – and so do CEPI’s public investors, like the Norwegian taxpayers. As the public is footing the bill to develop vaccines, they should not be on the hook for paying excessive prices for them when they are needed to save lives during outbreaks. 

CEPI’s mission is to stimulate and accelerate the development of vaccines against emerging infectious diseases that pose a real and growing threat to global health security. However, the ambition to safeguard global health security will fail if access to these vaccines for the people most in need is hampered by excessive prices. One would expect such consequences to be of concern to the Norwegian government.

MSF urges CEPI Board members, especially Norway’s representative as its main donor, to work quickly to reform CEPI’s access policy to safeguard the public’s massive investment in the initiative. CEPI cannot continue writing blank cheques to its commercial partners if it wants to succeed as a model for health innovation and deliver on its promises to the people it aims to protect.

This article appeared on Dagbladet (originally published in Norwegian) on 7 March 2019.