For Whose Benefit? Transparency in the development and procurement of COVID-19 vaccines

The urgency of the COVID-19 pandemic has demanded rapid disbursements of public funds, quick decision-making, and unprecedented public health interventions. Our analysis reveals that the development of and contracting for the supply of COVID-19 vaccines has also been accompanied by a disturbing and dangerous lack of transparency. Poor guidance and weak and inconsistent global policy mean that key information has only been shared because of the voluntary actions of certain vaccine developers, governments, and vaccine buyers. There is a pressing need for global policy reform to improve the current of standards of openness to embed transparency into development and contracting processes. The case for transparency in vaccine development and contracts is clear: the huge global demand, the vast sums of public money already and still to be invested and spent, and the need to build public confidence in vaccines as the best way to bring the pandemic under control. Yet, our analysis of clinical contracting data across 20 of the leading COVID-19 vaccine candidates, a number of which are already in use around the world, uncovered an unsettling trend of poor transparency. For instance, 30 per cent of the COVID-19 vaccines being developed at the time of our research were made by developers based in countries that do not require the reporting of clinical trial summary results within 12 months. Clinical Trial Transparency: Since March 2020, billions have been spent on the development of vaccines, with near-daily updates on new research findings. However, there is a lack of prescriptive guidance and legislation on the sharing of clinical trial results by pharmaceutical developers, funders, and drug regulatory agencies during a public health emergency. This has increased the risk of undue influence and manipulation in the clinical development process. Without legally mandated, harmonised, transparent processes and timelines for sharing clinical trial results, pharmaceutical developers can present their data in the most flattering and beneficial light or choose to withhold the data altogether. The immense pressure to rapidly produce treatments and vaccines, combined with the huge amounts of money on offer for effective products, only heightens these risks. Further complicating the picture, clinical trial transparency requirements differ widely from country to country creating a confused global policy landscape. Depending on the location of clinical trials, where the vaccines are to be manufactured and the country applied to for approval, there are different levels of data sharing. Together they have enabled a growing trend of ‘science by press release’ and the frequent use of media to announce clinical trial results without the accompanying publication of the associated data analysis. This facilitates potentially dangerous misinformation and misunderstanding. Contract Transparency: Public procurement – the process whereby governments contract suppliers for products - in health is historically vulnerable to wastage and corruption, resulting in fewer life-saving products efficiently reaching those it is intended for. Transparency in contracts to supply vaccines provides vital information such as price per dose that can ensure that public funds are spent as effectively as possible, saving more lives. Governments can improve their understanding of procurement processes, use pricing information in contracts to make informed choices. Civil society and journalists can monitor the process to identify irregularities and investigate corruption. Legislators can scrutinise the details of a deal, monitor its performance. This additional oversight reduces the risk of grand corruption or malfeasance such as state capture or illicit enrichment. Despite these clear benefits, which have been recognised by governments around the world, robust guidance on contractual transparency in public health emergencies was not in place at the onset of the pandemic. As a result, there has been an extremely low publication rate of COVID-19 vaccine contracts worldwide. Even in published contracts there are significant redactions which hide key details of public interest and may play a part in explaining why many countries lost out in the initial race for vaccines. Based on the limited information available, we also found that there is notable variability in pricing of vaccines. Some buyers are paying more than we would expect when compared to GDP per capita. Further, the inclusion of extensive indemnification clauses in the available contracts suggest that contracts are pushing financial risks onto national governments, and away from the developer.Transparency Internationa