**4. Three dimensions of the Corona race**

Ten COVID-19 vaccine candidates are now in late-stage trials. The world is celebrating what could be the breakthrough in fighting COVID-19. Pharmaceutical companies are also cheering the fact that the public sector has invested billions more in development. It is the private sector that will rake in the cash under existing agreements, they control the price and get profits. Pharmaceutical firms say that is fair as development is expensive and time-consuming and results are not announce. It is a gamble for governments too which are reserving millions of doses of a vaccine [11, 12].

Companies are taking billions of dollars in revenue, part of the funding for the vaccine researcher's public money but the profits stay in private hands. The companies can secure exclusive licenses to a vaccine and ultimately decide on a price because they have a monopoly [13–15]. For patents, the race to find the vaccine is in full swing and two German companies are among the leaders in the field, Cure Vac in Tübingen and BioNTech in Mainz which this weekend added promising early results from its phase 3 clinical trial. Both are working which added vaccines using messenger mRNA vaccines [16].

The vaccine takes a snippet of the coronavirus's genome to begin a defensive response without exposing it to the actual virus mRNA, essentially teaching the body to fight a dummy of the virus to help make it immune. Research into this technology has been going on for 20 years and has involved billions in public money and private investment but developing vaccines is highly risky and mixes of candidates active ingredient or vaccine candidate can fail at any stage in clinical trials because of a lack of efficacy or safety issues. Which is why pharmaceutical companies turn to public funding. This is then distributed by groups like the coalition for epidemic preparedness innovations (CEPI) which is co-funding development of some COVID-19 vaccine candidates. The main focus of this cooperation with CEPI is to produce a vaccine as quickly as possible and get it to the population. The commercial side is secondary for now although vaccine development is co-funded. The companies own licenses and distribution based on this the rules are relaxed [17–19]. That would have ensured that CEPI retains intellectual property rights to ensure a vaccine that is affordable for everyone and widely accessible. Pharmaceutical companies stand to make huge profits. If they succeed in coming up with a vaccine successfully which comes onto the market, that opens the door to a flood of similar vaccines and active ingredients that offers great opportunities so public funding could earn billions for private firms. The fear is biotech companies can name their price for access to this powerful pandemic fighting weapon according to professor of public economics Massimo Florio [20].

He argues that the problem with public funds being used to develop a vaccine for this coronavirus in the current emergency [15], that there is absolutely no alternative to disburse such funds. The government will be able to negotiate on prices and other conditions.

There are alternatives about the issue of what citizens are going to do the next time but the governments are in a bad negotiating position for what they are giving these big pharma companies. It is important in the future not to be stuck in this bad negotiating position and that governments or possibly a coalition of governments develop their own research and development capacity in this area [21, 22].

Private firms, of course, are about making a buck but that is that one of the reasons why individuals were not ready for this outbreak. The problem is that governments have entirely delegated to the private pharmaceutical industry the research and development of the weapons against pathogens and other diseases [23, 24].

There is a risk of disconnection or misalignment between the public health agenda and the private agenda if you are a pharmaceutical company. A manager of a pharmaceutical company has financial investors listed on the stock exchange [25, 26].

Some scholars, analyzed in **Figures 4** and **6**, will look into how people could solve the issue of a messenger RNA vaccine cold chain at a reasonable cost. People have heard it was minus 80 degrees Celsius if the interim results on efficacy from the candidate vaccine made by Biontech and Pfizer hold up to scrutiny [27]. By the end of November, if hurdles involving safety could be clear edit is hoped then some countries could approve it quickly maybe even by the end of the year. Companies will have already produced enough doses to vaccinate between 15 and 20 million people and should have production capacity for over a billion more in 2021. Manufacturing infrastructure has been set up in parallel with the trials to speed the whole process up [28, 29].

There is a big hurdle to overcome with this particular vaccine which is that it has to be kept at freezing temperatures minus 70 degrees Celsius to remain stable for any length of time and that the logistics will be expensive and problematic. Every step of the cold chain and the delivery process has to be as foolproof as you can make it, and you have to train people to work with products at such a low temperature [30].

Pfizer has even been building special containers for keeping its doses that could be good news and that they do not spoil instantly after thawing, but they also keep at normal refrigerator temperatures for around five days which makes the task maybe slightly less impossible [31]. There are many other vaccines going through late stage trials that might also prove safe and effective and some of them are based on other platforms with formulations that don not have to be kept at temperatures that low or anywhere close to it. With luck one or more of them will prove safe and effective too and can be used in places that don't have high-tech cold chain infrastructure [32].

This section outlines a set of matters involving the COVID-19 crisis through the exploration of three dimensions: sustainability, health care and economic growth.

#### **4.1 Health care dimensions of COVID-19**

It is common for vaccines to take 10 to 12 years to make it to the market but with a pandemic taking an unprecedented toll around the world, there are hopes that the timeline could be accelerated in this kind of situation. Things that generally might take several months to two years to go through are now being done in parallel. For example, the Coalition for epidemic preparedness innovation has set itself a very ambitious target of 16 weeks to try and do these kind of tests in parallel to find the same kind of information. This means that the regulatory authorities also have to change the approach in which they take the data on from the vaccine studies. They use what are called adaptive approaches or rolling submissions where small amounts of data based on the information found will come in sequence. They can sort of give provisional authorization along the way. It is a very different paradigm to assessing vaccines in this kind of pandemic situation compared to under normal circumstances [4–6].

Government agencies like the biomedical Advanced Research and Development Authority called Barda for short, are pushing to modernize the way the U.S. produces emergency vaccines like the flu shot. It is giving grants worth hundreds of millions of dollars to companies like Sanofi which uses recombinant DNA not chicken eggs to produce flu vaccines. One of its main jobs is to help create a market for drug companies to develop emergency vaccines through the use of its grants. In late January 2020, HSS secretary Alex declared an emergency and response to the coronavirus outbreak as part of that Barda announcement [7, 33].

The COVID-19 pandemic in the UK, may have subsided for now, but it is accelerating in many parts of the world. The search for treatments alongside a vaccine remains as urgent as ever. A landmark drug trial has revealed the steroid dexamethasone to

#### *The Economic, Climate Change and Public Health Edges of the Geopolitics of COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.96797*

be effective in reducing deaths by up to a third on many patients who come into the intensive care unit, who have a hyperimmune response. Their immune system goes into overdrive so it is the hyperimmune response which actually causes a lot of the damage to the lungs. Dexamethasone helped to just kind of dampen it all down for a 56-year-old. The patient believed that Dexamethasone saved his life because his body wasn't functioning, it was machines that were basically keeping him alive [34, 35].

It is backed by the Bill and Melinda Gates Foundation, as well as the governments of Germany, Japan and Norway. It is a relative newcomer to the global vaccine community. It was created in 2017 to help speed up the process of developing new vaccines. Furthermore, it invested about twenty-three point seven million dollars in the push to develop a COVID-19 vaccine and it plans to invest a total of 100 million dollars in order to get vaccine candidates to early-stage clinical trial [11, 36].

The Oslo based global coalition says it needs about two billion dollars more in additional funding to fully develop viable vaccines against COVID-19. Most of the Biotech companies working on vaccines or treatments already had a head start by previously working on SARS and Middle East respiratory syndrome which are part of the coronavirus family. Biotech firm Moderna has had one of the most promising starts [12].

Moderna is using a new technique had called messenger RNA or mRNA to develop its vaccine candidate. The drugmaker has already started to deliver its vaccine to national health officials. The vaccine was co-designed with the National Institute of Allergy and Infectious Diseases after Chinese scientists decoded the coronaviruses genetic sequence in January 2020 [13, 37]. Moderna set a record within the drug industry for the speed at which it developed its vaccine candidate using its mRNA method. It took Moderna about 42 days after the coronavirus's genome was sequenced, for comparison it took about 20 months to develop a vaccine to the human testing phase during the SARS outbreak in 2002 [14].

Moderna plans to start a small-scale human trial of the vaccine soon in Seattle Washington, an epicenter of the COVID-19 outbreak in the United States. It will take about three months or more to show that it is safe and then if persons show that it is safe, it has got to be put it into what is called a phase 2 trial to show that it works. The reason is that there are medical ethical and other considerations in giving this to normal people to prevent infection [15, 16].

Researchers must be sure of the medicial ethic first to do no harm. People need to make sure it is safe, citizens need to make sure it works. This entire process will take at least a year. In a year and a half Johnson & Johnson is also in the race, the company is working with Barda on a potential treatment [17].

It is also developing a vaccine using a deactivated version of the COVID-19 as mentioned earlier. Sanofi is also working with Barda on a COVID-19 vaccine, it plans to have a vaccine candidate to test in a lab within six months and on people within a year to eighteen months but approval could be as long as three years away. Inovio Pharmaceuticals has partnered with a Chinese company called Beijing to speed up the development of its DNA vaccine [18].

It received an initial grant of nine million dollars from the Coalition for epidemic preparedness. Innovations in Opium is using the same method for the COVID-19 vaccine as it did with its DNA vaccine against the Middle East respiratory syndrome. Currently there have not been any DNA vaccines approved for use on humans. Doctors and global health experts have tried to temper vaccine expectations saying that even though this stage has gone quickly, reviewing test results in getting a vaccine deployed to the public could take many more months or even a year to 18 months.

Likewise, it would still be the fastest people have ever seen a vaccine get developed and the way that breaks down right now for the lead program is that it is starting phase 1 clinical trials in people now, which will take about 3 to 4 months to determine the safety of the vaccine. Then they are going to move into phase 2 which will involve more people and remember these are healthy people.

#### **4.2 Economics dimensions and chaos in global financial markets**

The growing coronavirus outbreak is causing chaos in global financial markets. It is freezing supply chains, it is causing companies all over the world to create work from home plans and banned business travel. In late January 2020, Chinese scientists in Shanghai released the fully sequenced genome of the novel COVID-19 that was wreaking havoc in Hebei province which kicked off the race at drug companies and government labs to develop a cure for corona virus or at least its symptoms in terms of vaccines in the US [19].

The US has moved at a pace people have never seen before, still it is going to be at least a year to a year and a half until they have a vaccine broadly available to deploy. Among COVID-19 belongs to a larger family of corona viruses. That family of viruses includes the one that caused the SARS outbreak in 2002 and Middle East respiratory syndrome to spring up in 2012. The official name of the new COVID-19 is severe acute respiratory syndrome coronavirus - or SARS Cove - the one discovered in December 2019 in Wuhan China causes a disease that scientists decided to call COVID-19.

This naming convention works the same way with HIV and AIDS. HIV is the virus that causes AIDS. The disease symptoms of COVID-19 include fever fatigue and coughing. Some people become infected but don't develop any symptoms. Most people, around 80% recover without any special treatment, about 1 in 6 people with the disease end up developing a serious illness, older people and those with underlying medical conditions are most likely to come down with serious issues.

The disease travels through small droplets that spread when people cough or sneeze. Those droplets land on objects. People touch those objects and then touch their eyes, nose or mouth and that is how people catch the new COVID-19. There is no vaccine to prevent them from getting it, there is no vaccine for any of the corona viruses, for that matter. That is why vaccines have become a big market for drug companies' scientists and researchers no longer give them away. The Polio vaccine has become a thirty-five-billion-dollar market with strong and steady demand for vaccines against established diseases like polio measles and hepatitis. Creating vaccines for emergency pandemics becomes tricky.

Researchers are giving the vaccine to see if it can prevent disease, the risk tolerance is lower than if people were already sick. Companies are giving them a treatment, that is why people have to be so careful here, they say it could take perhaps eight months to get through phase two.

That is how it will take about a year before you even know if they have something that is safe and that works to protect people. Other drug companies are hurrying to develop various treatments for the coronavirus, and they could come much sooner.

The drug is already being tested at the epicenter of the outbreak in Wuhan China and Gilead is now expanding to other countries, including the United States. Researchers should know within a period of a few months whether this particular drug works. If it does the implementation of that would be almost immediate. The pressure to develop a corona virus vaccine grows each day as the number of infected people rises and the death toll climbs even higher but there is a real risk to pushing too hard and too fast. some drug companies plan to push testing schedules into human trials rather than spending months testing the vaccines on animals in labs.

That could lead to what is called immune enhancement where a person or animal who receives a vaccine ends up with a more serious disease than unvaccinated subjects according to Reuters. Leading health and drug company officials recently advocated for fast tracking human testing of coronavirus vaccines during a closeddoor meeting convened by the World Health Organization.

The question facing health officials if accelerating testing schedules is worth these kinds of risks. That all depends on whether countries like the United States can contain the fast-spreading novel coronavirus.

## **4.3 Planet conservation and COVID**

No war, no recession, no other pandemic, has had such an impact on CO2 emissions during the last century as the one observed by COVID-19 in just a few months. For example: Germany might even reach its climate goals as the corona lockdown causes the economy to produce much less CO2, the factories devoid of workers, thousands of flights cancelled, empty streets because people are working from home instead of driving to the office. Global economic activity has been put into an induced coma, bad for the world economy but from a climate perspective the corona virus pandemic is not entirely negative. Environmental activists might actually rejoice measures have been implemented immediately, thick smog has given way to blue skies [21, 22].

The current situation has seen people spending more time at home. They may have decided to have a spring-clean or get started on that bathroom renovation. Keep in mind you are responsible for the disposal of all the waste you produce [23]. Things like food scraps, demolition materials, hard rubbish and e-waste all have different requirements for correct disposal. Councils and the waste and recycling industry continue to provide waste services to the public. Like any business, some disruptions may occur from time-to-time due to physical distancing requirements, but they are not restricted activities and remain operating [24]. The regular curbside bin collections, such as recycling, household and garden waste continue as usual.

Hard rubbish collections are also available from your local council. Private waste collections, such as skip bin hire, are operating for waste such as construction and demolition materials [25]. For people working in the waste industry, the risk of transmission of coronavirus when handling waste is low. Waste handlers should continue using routine hygiene procedures such as wearing gloves and washing hands regularly for at least 20 seconds with soap. Keeping waste services operating helps reduce the potential for illegal dumping that costs millions of dollars to clean up [26].

Piling up disposable protective equipment and plastic packaging. Initially there had been a hope that the slowdown in the world economy would be good for the planet. Air traffic almost stopped completely, cruise ships were stranded in port and industrial pollution was reduced but the pandemic has had negative consequences for the environment, the world was already drowning under a sea of plastic waste but the pandemic has made the situation worse [38].

Face masks can stay in the environment for up to 450 years, it takes that long before they turn into invisible microplastic. This issue is quite serious as the human toll of the coronavirus mounts and the world economy struggles to adjust to the new normal. The wider impact on the environment is only now starting to become apparent. The global medical emergency has presented an opportunity to check on the health of the planet in the controversial new lockdown measures [39].

#### **4.4 COVID's geopolitics: the dimension forgotten in the debate**

Issues related to geopolitics and pandemics intersect through the sovereignty of the countries, to the logistics of vaccine distribution and power games. All of these issues are complex, urgent, and demand a solution through collective action based on their global and cross-border reach [22, 40].

As can be seen in **Figure 4**, the rich nations corner the market for COVID-19 vaccines and treatments. What does that mean for the world's poor? The world's largest trial of possible COVID-19 treatments has produced results that are already being used to save lives. The race to develop vaccines and treatments for the coronavirus pandemic is entering a crucial stage with large-scale trials underway [41].

The debate over opaque pricing has raised concerns that pharmaceutical companies could be charging way too much for COVID-19 treatments. The most recent disquiet was triggered by Gilead's Remdesivir at America's decision to monopolize supplies.

The U.S. government has cornered almost the entire global market of Remdesivir for the next several months. The drug has been found to shorten hospital stays for COVID-19 patients. This America first policy during the pandemic has led to expressions of outrage and dismay among some international leaders. U.S. coronavirus patients may not receive the drug if they do not have enough cash [27, 42].

The drug manufacturer Gilead says governments in the developed world will pay three hundred and ninety dollars for a treatment which will come to two thousand three hundred and forty dollars a patient. However each vial for the U.S. private health insurance system is five hundred and twenty dollars or an average cost of three thousand one hundred and twenty dollars a patient. It is not clear how much each patient will have to pay either out of pocket or in higher premiums as with many drugs that are eventually sold for profit by pharmaceutical companies. That was reported in the U.S. in January and many of those drugs are used to treat COVID-19 or used in intensive care units. Some economists wonder whether amid COVID-19 economic collapse, mass unemployment, the inability of millions to pay their rent and social unrest things may be changing. The perception of price gouging by pharmaceutical companies during a pandemic may become part of a wider reckoning for the U.S. [28–30].

Gilead says that because its drug reduces the time that COVID-19 patients spend in hospital, it priced Remdesivir fairly. Senator Bernie Sanders claimed that Remdesivir cost Gilead ten dollars a vial to manufacture and as you heard taxpayers have paid 70 million dollars towards the cost of development. That is crucial as many Americans do not have or have lost their health insurance and cannot afford to pay for the drug. The problem is Gilead has made the same claim before.

It bought the startup behind a ready to market hepatitis C drug for 11 billion dollars and began to market the drug for 84,000 allowing it to almost recoup the cost of acquisition in the first year according to Bloomberg [31, 32]. How much does big pharma spend on developing drugs? Well, on average 2.6 billion dollars according to Tufts university but advocacy group public citizen believes the cost is closer to 1.4 billion dollars as governments spend billions securing supplies of potential COVID-19 vaccines Pfizer is charging roughly 20 dollars for a dose which the company claims is 30 percent less.

Other drugmakers charge for seasonal flu jabs and because it is not receiving government money for research and development it can expect to make more than 15 billion dollars in revenue [43].

The opinion is, nothing else is working, nothing to lose. He had dexamethasone, his oxygen requirement came down and started to stay down and started to

#### *The Economic, Climate Change and Public Health Edges of the Geopolitics of COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.96797*

gradually decrease and for the first time there started to be talk of taking him off the ventilator which people couldn't even believe. The patient was given dexamethasone here at the hospital in Scotland, one of a large number taking part in a UK wide randomized drug trial being run by scientists at Oxford University. The aim to test a number of widely available off-the-shelf drugs with the hope of finding one or a combination that might work to ease some of the worst symptoms of COVID-19 [44].

The patient returning from the brink of death contributed to data that has seen dexamethasone approved as a breakthrough treatment for some of the worst cases of COVID-19. Dexamethasone has been a great result, and it now means that patients who are ventilated or an oxygen can be prescribed in a way they wouldn't been able to be before. The recovery trial has also been successful in ruling out the malaria drug hydroxychloroquine, once hailed as a game changer by president Donald Trump but found instead to be useless in treating COVID-19. As the world waits for a safe and effective vaccine that may yet be a long way off, recovery continues to look for treatments [45, 46]. Police officers in New Delhi are donating blood plasma, they are just some 2 500 police staff in the Indian capital who recovered from coronavirus but health minister Harsh Vardhan says few people have been willing to donate and has launched a campaign as the number of infections has increased [47].

This drive will encourage everyone, especially those who have recovered from coronavirus. to donate their plasma in large numbers. Plasma therapy is treating coronavirus patients around the world. Plasma from a former patient's blood is separated for a transfusion to an infected person. Plasma of recovered patients contains antibodies which can fight the virus. This person is the first person in Delhi to have donated his plasma after recovering from the coronavirus in April.

Trials to determine its effectiveness are continuing but researchers say the results so far are encouraging, it clearly reduces the need for increasing oxygen at the stage when the patient is deteriorating.

It does prevent a lot of patients from actually going onto a ventilator. Various centers across the world have shown mortality rates to be 50 to 80 percent when the patient goes on to a ventilator. By virtue of preventing a patient going onto a ventilator, it may be preventing excess deaths. Delhi state government is one of many around the country to set up plasma donation centers to make it easier for patients needing the therapy. People are struggling to find plasma from those who have recovered. Coronavirus is connected to the deaths of around 30,000 Indians with more than 1.2 million infections. As well as launching a donation campaign, the state government in Delhi is organizing transport for those willing to come to one of its centers. With far more recoveries than active infections health officials are urging Indians who were once sick to help patients who are suffering [48].

How can drug companies offset the cost of their research and offer cheaper drugs particularly to developing nations? That is a good and important question. A couple of things to note about research and development costs, first is the way that industry calculates research and development costs that include things that you and me would probably not consider research and development, for example the lost opportunity costs of foregoing investments with an annual return of over 10.

Some wealthier countries are being asked to pledge money to buy vaccines in advance which then will be distributed according to a global equitable allocation framework by the World Health Organization (WHO). Should all countries and

companies adhere to this future framework? It is out there so that vaccine supply is truly allocated based on public health need, as said by the WHO and the Bill Gates foundation and not captured by narrow political or commercial interests. How that is going to work when the world has rich nations snapping up all the available supply? That is a big concern, these bilateral deals really help no one because it has been said before that no one is safe until everyone is safe.

For the world to have herd immunity, people are going to have to beat this thing, it will be crucial that this is successful and that countries commit a certain proportion of even the bilateral deals that they have struck to a facility that will share vaccines with the world. To be fair to the likes of companies like AstraZeneca and Johnson & Johnson, both have said that they are going to produce the vaccine on a not-for-profit basis.

What does that mean for poorer nations though even on a not-for-profit basis ? Can they afford them? That is a very good question, both companies should be applauded for their commitment to not profit from the pandemic. Unfortunately what companies say and what they do is not always the same. For instance, if you take Johnson & Johnson in the past, they have claimed that their lowest global price for an important drug called Bedaquiline was a not-for-profit price but which is disputed by independent academics.

It could be produced at profit for less than a quarter of that price. There have been calls for the price to be halved and just earlier this month they actually further dropped their supposedly not for profit price by over 30 percent following intensive campaigning. It is important to mention that these pledges only apply for the pandemic period and if SARS turns endemic [49].

What about the ethics of a vaccine treatment in a hurry? For strict ethical standards this should be the case too because vaccines and drugs act differently in different patient populations but what it definitely should also mean is that the very populations on which these vaccines and drugs are being tested should have equitable access to them in the future. It cannot be that they are just the guinea pigs for clinical trials but then will not be able to access the vaccines afterwards. In the midst of a global pandemic, should generically drugmakers be given licenses to produce much-needed treatment drugs? Generic drug reproduction will be crucial to meet the demands of this pandemic and national hoarding of physical supplies of drugs or vaccines is regrettable.

Should actively using intellectual property to prevent generic ground companies be avoided? There is a wealth of research into testing kits, there is one produced in Senegal for a dollar. Is there any way of commercializing that kind of expertise as a solution for developing nations?. People having accurate rapid diagnostic tests will be incredibly important to the global COVID-19 response given that they are simple to use, and while there are over 100 tests on the market the majority have limited to no evidence on diagnostic performance. An inaccurate test is worse than no test, quality assured rapid diagnostic tests are needed but once solid evidence for rapid diagnostic tests does emerge.

It will be crucial to scale up the production as quickly as possible. An example to cite is actually an excellent example of a private company in the UK collaborating with the Pasteur Institute to develop a rapid diagnostic test and then in the future locally producing it in Senegal for a price that is affordable for governments in the region. Some state actors have also been accused of attempting to hack laboratories and drug companies for COVID-19 research and vaccine secrets as more of us are lucky enough to work productively from home. Companies are stepping up cybersecurity for employees. One company that helps businesses replace usernames and passwords with biometrics is Silicon Valley based. The cost now is if a Silicon Valley social media platform like twitter can succumb to a hack.

*The Economic, Climate Change and Public Health Edges of the Geopolitics of COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.96797*
