AstraZeneca’s covid-19 (mis)adventure and the future of vaccine equity

The pandemic, for a moment, wobbled the foundations of the drug industry, with calls to elevate lives above profit.

“I personally don’t believe that in a time of pandemic there should be exclusive licenses,” the researcher Adrian Hill declared to the New York Times in the spring of 2021. Hill and others at Oxford University, UK, had produced what was then the world’s leading covid-19 vaccine candidate and planned to offer it to manufacturers royalty free. But the insurgency was put down before it ever got off the ground.

Oxford swiftly and exclusively licensed its technology to the UK based pharmaceutical giant AstraZeneca. The agreement did include a “non-profit” agreement: initially priced at cost, the vaccine saved more lives from covid-19 than any other in its first year of circulation.1 Yet the no-profit pledge also unleashed a withering crossfire—equity advocates alleging grotesque hypocrisy on one side, market forces on the other.

Financial media in the US “clearly didn’t like the idea of a low cost vaccine, undercutting the market,” Hill told the Financial Times.2 AstraZeneca’s vaccine won regulatory approval the world over, but not in the US.

Fast forward a year to 2022, and AstraZeneca seems to be exiting the stage before the pandemic ends (box 1), its good deed having earned the company a reputational thrashing.3 Few speak of the AstraZeneca vaccine, while its rivals Moderna and Pfizer-BioNTech look set to profit from ongoing booster shots tailored to new covid-19 variants. These two companies have hauled in billions of dollars during the pandemic and paved the way for a new line of therapeutics based …