Image taken from video shows people working inside the UNICEF warehouse, the world's largest humanitarian aid warehouse, in Copenhagen, Oct. 13, 2020.

Medicine

As COVID-19 vaccines roll out, does the world face 'tragedy of the commons'?

David McAdams, an economist at Duke University, has been thinking a lot about the nearly 200-year-old concept lately — and how it applies to efforts to end the coronavirus pandemic.

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Image taken from video shows people working inside the UNICEF warehouse, the world's largest humanitarian aid center, in Copenhagen, Oct. 13, 2020. 

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David McAdams, an economist at Duke University, has been thinking a lot about a nearly 200-year-old concept lately. The “tragedy of the commons” centers on a group of shepherds who let their sheep graze on a “common” field.

“But because everyone is focusing on their own sheep, the grass gets eaten down to the roots, and everyone’s sheep die,” McAdams said of the hypothetical shared-resource situation.

As nations now vie for COVID-19 vaccines, McAdams and other global health experts wonder — are we living through another tragedy of the commons?

“It certainly feels that way because everyone’s trying to graze their own sheep, they’re trying to get doses for their own people,” McAdams continued.

Related: The key to combating vaccine hesitancy? Deep listening, tailored messaging.

That pressure intensified this month, as the United Kingdom became the first Western nation to approve and roll out a vaccine, starting this week. The US has poured billions into getting an effective vaccine, and two strong options are almost there.

Brazil is securing direct vaccine deals, as is Australia, Canada, Japan, Germany and France. And while a number of wealthy nations ordered the majority of the world’s COVID-19 vaccines early on, low-income countries may not get supplies until at least 2023, projects another Duke University study.

But a global mechanism formed early in the pandemic to break this hoarding pattern, COVAX — the COVID-19 Vaccines Global Access Facility — functions like a global buyer’s club, or an insurance pool made up of low-, middle- and high-income countries alike. The facility combines its resources, invests in multiple vaccines, and then secures deals for everyone who takes part.

The idea is that COVAX then distributes the supply equitably across participating nations, procuring enough vaccines to cover 20% of the population in lower-income countries. Wealthier nations have more flexibility in how much vaccine they’d want to secure and buy through COVAX’s vaccine portfolio, while also pursuing their own direct deals.

“It is bringing together all of the countries that have an interest in securing [the] vaccine for their populations, and pooling the financial resources for and on behalf of those countries, to be able to negotiate reservations of volumes from vaccine manufacturers.”

 Rajeev Venkayya, Coalition for Epidemic Preparedness, or CEPI, and Takeda Pharmaceuticals

“It is bringing together all of the countries that have an interest in securing [the] vaccine for their populations, and pooling the financial resources for and on behalf of those countries, to be able to negotiate reservations of volumes from vaccine manufacturers,” said Rajeev Venkayya, an independent adviser to the Coalition for Epidemic Preparedness, or CEPI, and a leader at Takeda Pharmaceuticals, a COVID-19 vaccine manufacturer.

Venkayya said this setup is appealing to manufacturers, but that for it to work, a lot of countries have to join, and the wealthy ones have to invest in it.

The World Health Organization oversees COVAX with Gavi, or the Global Alliance for Vaccines and Immunizations, and CEPI. On Friday, the WHO director, Tedros Adhanom Ghebreyesus, sounded an alarm: “Unless fully funded, it’s in danger of becoming no more than a noble gesture,” he said at a United Nations special session on the pandemic.

At least 189 countries have signed on to COVAX. Notably absent are the United States and Russia. Gebreyeusus said COVAX needs billions more in funding to meet its goals and contain the pandemic before it destroys the global economy.

Related: South Korean activists renew call for deinstitutionalizing people with disabilities amid coronavirus

“Sharing the fruits of science is not charity; it’s in the best interest of every nation,” Ghebreyesus said.

And yet, while the plight of COVAX versus countries who are also separately buying up the vaccines may seem like a tragedy of the commons, Duke's McAdams says it doesn’t have to be.

“You know, if every time a shepherd went out, they had to plant new grass, and they planted more grass than their sheep ate, that’s not a tragedy of the commons, right? We all benefit,” he said.

There could be a sensible way to design incentives and manufacturing deals, McAdams says, that benefits the global good. For example, do deals allow for the transferring of the technology from vaccine developers to multiple manufacturers?

“The fundamental, most important distinction is whether your deal is grabbing vaccines or growing vaccines. Depending on how you structure your deal, you can make a deal that benefits you, gets doses for your people, but also accelerates doses for everyone else.”

David McAdams, Duke University

“The fundamental, most important distinction is whether your deal is grabbing vaccines or growing vaccines,” he said. “Depending on how you structure your deal, you can make a deal that benefits you, gets doses for your people, but also accelerates doses for everyone else.”

Right now, some of these vaccine deals do that, others don’t. The world is at a pivotal moment as more of these decisions are being made. To hasten manufacturing, some are also advocating for a relaxing of patents. McAdams thinks if COVAX gets more financing and support, it could have the power to move things in a direction that’s good for everyone.

What also gives him hope in this tense, competitive time, is that if more vaccines, beyond the Pfizers, prove effective, that could mean even more grass for more of us sheep in the commons.

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