Applied Clinical Trials
Countries around the world have pledged billions toward COVID-19 research, but what will happen when it comes time for them to actually put up the money?
Amid the turmoil of the coronavirus pandemic and its social and economic disruption, a pile of funding promises have nevertheless been made to fund COVID-19 treatments, and a wealth of commitments made to deliver treatments around the world. This seems at first sight all the more meritorious amid instability created by an increasingly isolationist United States (wracked by its own deep racial divisions too), an increasingly assertive China, an increasingly imminent Brexit, and a faltering European dynamic.
The international pledging conference that the European Union hosted in May has surpassed its target of $8 billion, in cooperation with the United Nations, the World Health Organization, the International Labor Organization, the G20, the G7, the International Monetary Fund, and the World Bank. High-profile efforts to push that total higher are still continuing in the Coronavirus Global Response, abetted by the likes of Dionne Warwick, Hugh Jackman, Lady Gaga, and Lang Lang, in advance of a further summit on June 27. Many nations have rallied around the beleaguered World Health Organization after Donald Trump announced he would withdraw US funding for it. And WHO issued a “solidarity call for action” at the end of May “to realize equitable global access to COVID-19 health technologies through pooling of knowledge, intellectual property and data.” This urges “key stakeholders and the global community to voluntarily pool knowledge, intellectual property and data necessary for COVID-19,” and has already won the backing of Belgium, Luxembourg, Norway, Portugal, and the Netherlands, as well as countries from Africa, Asia, and Latin America. And the EU announced a coronavirus recovery plan in late May with a budget close to $2 trillion – which included a new €10 billion health program and additional projected spending on medicines to combat COVID-19.
So what can go wrong now along the pathway to early and complete solutions to the pandemic?
Plenty. And that’s without even taking account of the intrinsic scientific challenges of developing treatments and vaccines.
For a start, the pledges made so far are just that – pledges, not hard cash (and as many previous pledging conferences have shown, pledges lightly made are often not lived up to).
Secondly, there is imprecision around who should spend any of this funding, on what, and who should decide on the allocation.
Thirdly, the multiple promises and commitments about developing therapies are frequently couched in the vaguest terms, or accompanied by conditions that heavily limit their impact. The questions focus not only on who will pay for research, but who will pay for eventual products.
Fourthly, the big battalions are largely absent from this international field. The US did not even take part in the May pledging, and China’s engagement was minimal. Neither have shown any interest in the WHO solidarity call, and it has yet to attract backing from large, rich countries in Europe.
And pharmaceutical industry support for solutions – which has been strong on rhetoric so far, and ample in the examples it has given of companies diligently pursuing research with a greater readiness to cooperate among themselves – is wavering in the face of discussions of novel multilateral solutions, and particularly as more specific demands are made for radical approaches to intellectual property or pricing.
The global association of the research-based industry, IFPMA, pre-empted the WHO solidarity call with a flat rejection of what it saw as a WHO denunciation of “intellectual property rights that are not waived or licensed globally.” It accused WHO of espousing “a one-size-fits all model that disregards the specific circumstances of each situation, each product and each country.”
It is difficult to avoid the conclusion that the longstanding “them versus us” attitude, that lies beneath the fine language of international solidarity and equity, remains as strong as ever, even as the pandemic mounts its assault on the world’s population.