An allegation that the Trump administration tried to secure exclusive rights to the production of an experimental coronavirus vaccine in Germany has revived health officials’ concerns that countries worldwide might move to nationalize key supplies to respond to the growing pandemic.

The allegation, first reported on Sunday in German media and later echoed by the nation’s health minister, centered on the suggestion that the Trump administration sought to strike a deal with CureVac, a drug maker that is based in the city of Tübingen but that also has operations in the United States.

Exactly what the Trump administration was offering, and how CureVac responded, was unclear. A U.S. official denied the reports, and the company’s main shareholders — including the Bill and Melinda Gates Foundation — immediately made clear CureVac’s vaccine would not be sold to a single country.

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Nevertheless, the ugly episode underlined very real concerns that the coronavirus could prompt some countries to nationalize drugs, personal protective equipment needed by health workers, or vaccines when they eventually become available. Earlier this month Germany banned the export of personal protective equipment, and India moved to block the export of some essential drugs.

“Most countries have laws that are analogous to the Defense Production Act in the U.S. that allows the government to requisition stuff manufactured within their borders if it serves the purposes of national defense or national security — which is understandable,” Richard Hatchett, the CEO of the Coalition for Epidemic Preparedness Innovations, told STAT last month.“But what we do not want to have happen in this epidemic is to have vaccines be developed in the places where vaccines are currently developed and manufactured — which is mostly in developed countries — and then used exclusively in those countries.”

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“That would be a disaster,” he said.

There is precedent for such hoarding. During the 1976 swine flu scare — when it was feared a 1918-like flu pandemic was starting in the United States — President Gerald Ford declared there would be vaccine for every man, woman, and child in the country. Canada placed an order with American-based manufacturers, but shipments of the vaccine were blocked by the U.S. government. (In the end, there was no pandemic and the vaccine program was halted after a number of people who received it developed Guillain-Barré syndrome.)

The World Health Organization worked for years to ensure that developing countries would have access to H5N1 bird flu vaccine in the event the virus triggered a pandemic. Countries that produced flu vaccines or that had secured contracts for pandemic flu vaccine had to commit to donate one-tenth of their supply to the WHO to be redistributed to countries that had no means to secure their own.

But when the H1N1 pandemic hit in 2009, the vaccine was difficult to produce. Countries didn’t fulfill their commitments up front and, by the time they donated vaccine, it was clear the pandemic was a mild one and developing countries no longer wanted it.

For weeks, as this new virus has spread around the world, WHO officials have insisted that global solidarity is the only way to get through this crisis.

“We have to absolutely focus now on equity and access. We cannot have a situation where people who need the drug don’t get it and people who don’t need the drug do,” insisted Mike Ryan, head of the agency’s health emergencies program. Tools to fight this virus, he said, must be distributed “on the basis of need and the basis of benefit.”

“WHO is already working on mechanisms by which we can achieve that, working with our partners both in the north and the south,” Ryan said.

It will take much longer to produce vaccines than drugs, if vaccines can be produced at all in the time frame in which they are needed. But ensuring those vaccines are used where the virus is circulating when they become available will be a challenge in the current global climate, Seth Berkley, CEO of Gavi, the Vaccine Alliance, told STAT in an interview Sunday.

“In the world today … [it’s] not like the G7 is going to get together and say, ‘We together are going to finance this.’ Or the G20. It’s a much more complicated time,” Berkley said.

What happened in the 2009 flu pandemic cannot be repeated, he said.

“If there is a shortage of vaccine, if there is eminent domain-type concern, and if there are obviously people who want this and have put orders in and locked in the market, we’re not going to see it going to the poorest countries,” Berkley said. “Which is why access initiatives are going to need to have some teeth until you get to the point where there’s excess capacity.”

In Berkley’s view, countries should keep in mind that their own manufacturers might not be successful in developing vaccines, and the vaccine they hope to acquire may end up being made abroad.

“No one country has adequate capacity to supply the world. Therefore we will need cooperation in thinking through how we will get adequate quantities of vaccines for whichever countries need them at that period in time,” Berkley said.

“If you’re paying the nationalist game, they may want to play the nationalist game as well.”

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