JOHANNESBURG -- Many world leaders at this week's virtual U.N. summit hope that what comes out of the global coronavirus crisis will be a vaccine made available and affordable to all countries, rich and poor.
But with the U.S., China and Russia opting out of a collaborative effort to develop and distribute a vaccine, and some rich nations striking deals with pharmaceutical companies to secure millions of potential doses, the U.N. pleas are plentiful but may be in vain.
"Are people to be left to die?" Honduran President Juan Orlando Hernandez, a covid-19 survivor, said of the uncertain way forward.
More than 150 countries have joined COVAX, in which richer countries agree to buy into potential vaccines and help finance access for poorer ones. But the absence of Washington, Beijing and Moscow means the response to a health crisis unlike any other in the U.N.'s 75 years is short of truly being global. Instead, while the three powers have made pledges of sharing any vaccine they develop, it most likely will be after helping their own citizens first.
This week's U.N. gathering could serve as a wake-up call, said Gayle Smith, president of the ONE Campaign, a nonprofit fighting preventable disease that's developing scorecards to measure how the world's most powerful nations are contributing to vaccine equity.
"It's not enough for only some G-20 countries to realize that an equitable vaccine is the key to ending this virus and reopening the global economy," she said.
With weeks remaining before a deadline for countries to join COVAX, which is co-led by the U.N.'s World Health Organization, many heads of state are using the U.N. meeting as a high-profile chance to wheedle, persuade and even shame.
Ghana's president, Nana Akufo-Addo, pointed out the illusory nature of borders and wealth: "The virus has taught us that we are all at risk, and there is no special protection for the rich or a particular class."
The president of the covid-free Pacific island nation of Palau, Tommy Remengesau Jr., warned against selfishness: "Vaccine hoarding will harm us all."
And Rwanda's president, Paul Kagame, appealed to the universal desire for a return to normal: "Ensuring equitable access to vaccines, therapeutics and diagnostics will speed up the end of the pandemic for everyone."
FOR 'ALL HUMAN BEINGS'
Just two days into nearly 200 speeches by world leaders, it was clear the urgent need for a vaccine would be mentioned by almost everyone.
"We've never dealt with a situation where 7.8 billion people in the world are needing a vaccine at almost the same time," John Nkengasong, head of the Africa Centers for Disease Control and Prevention, said this month.
The vaccine quest must not be a "purely mercantile act," Iraq said.
Nor "an issue of competition," Turkey said.
"We must take the politics out of the vaccine," Kazakhstan said.
"We need true globalization of compassion," Slovakia said.
The Dominican Republic deployed all-caps in a statement: "WE DEMAND this vaccine be available to all human beings on the planet."
More gently, Mozambique warned that "nationalism and isolationism in the face of a pandemic are, as far as we are concerned, a prescription for failure."
However, Chinese vaccine developer Sinovac Biotech Ltd. said that countries running its final-stage clinical trials like Brazil, Indonesia and Turkey will get its coronavirus shots at the same time as China, underscoring how vaccine supply agreements could cement diplomatic ties in the covid-19 era.
One of three Chinese companies with vaccines in the last stages of testing, Beijing-based Sinovac will prioritize nations conducting its Phase III trials, and then offer doses to regions hard hit by the coronavirus, Chief Executive Officer Yin Weidong said during a government-organized media tour of the company's facilities on Thursday.
'A STUPID MISTAKE'
No matter their reputation at home or on the global stage, leaders are finding a shred of common ground as the world nears 1 million confirmed deaths from the pandemic.
"The covid-19 vaccine must be considered a global public good. Let us be clear on this," said Rodrigo Duterte, president of the Philippines.
U.N. Secretary-General Antonio Guterres kicked off the General Assembly by declaring in an interview with the U.N.'s media arm: "To think that we can preserve the rich people, and let the poor people suffer, is a stupid mistake."
It's not clear if the world leaders' remarks, delivered not in a diplomatic scrum at U.N. headquarters but in videos recorded from national capitals, will make a difference.
Health experts, activists and others anxiously watching the issue raised a collective eyebrow.
"It's important we continue to be making these speeches, but ultimately, speeches alone won't have an effect if there are no real measures put in place to make sure poor countries, and within them the poorest of poor, have access" to the vaccine, said Tendai Mafuma with the South Africa-based social justice group Section 27. It's part of a coalition pressing to make medicines more affordable and accessible.
South Africa, along with many African countries, knows the deadly consequences of having to wait. Health experts say 12 million Africans died during the decade it took for affordable HIV drugs to reach the continent.
Mafuma's countryman Shabir Madhi, lead researcher on a clinical trial in South Africa of the vaccine that Oxford University is developing with pharmaceutical company AstraZeneca, was a bit more optimistic. That most of the world's richest countries have joined COVAX "is promising," he said.
But whether this week's impassioned speeches at the U.N. will make any difference, Madhi said, is still "difficult to tell."
STRIVING FOR SAFETY
Meanwhile, two firms developing covid-19 vaccines say pharmaceutical companies are trying to give the public as much information as possible about their testing regimes as drugmakers and public health officials seek to boost confidence that any approved vaccine will be safe.
AstraZeneca CEO Pascal Soriot and Paul Stoffels, chief scientific officer of Johnson & Johnson, said Thursday that they recognize the coronavirus emergency demands increased transparency from vaccine developers to ensure the public has faith in the end product. They stressed however that there are limits to the information they can release, because they must protect patient confidentiality and the integrity of their scientific research.
Ultimately, the public will have to trust regulators around the world and the independent experts that oversee drug trials, Soriot said during a panel discussion sponsored by the World Economic Forum.
"You've got to trust that the experts whose job it is to monitor these trials and these developments are doing a good job,″ Soriot said. "Medicine should not be practiced for the media, it should be practiced by experts."
But public health experts have expressed concern that political pressure on regulators to quickly approve vaccines will undermine public confidence in their safety and effectiveness.
Public concern about a vaccine could be disastrous to its widespread acceptance and undermine efforts to vaccinate enough people to stop transmission of covid-19.
Soriot pointed out that the vaccines being developed by his company and others must be approved by regulators around the world, not just the U.S.
"You really would have to love conspiracy theories to believe that all regulators around the world will all agree to approve a vaccine that is not safe and effective," he said. "It's hard to believe that every country would do that, so you're going to have several sets of eyes from different countries looking at this data."
N.Y. PLANS REVIEW
Gov. Andrew Cuomo announced Thursday that New York would review coronavirus vaccines that are approved by the federal government.
"Frankly, I'm not going to trust the federal government's opinion, and I wouldn't recommend to New Yorkers based on the federal government's opinion," Cuomo said at a news briefing.
New York officials do not play a role in the approval process for a possible vaccine, but under the current plan they would help determine how it would be distributed throughout the state. In theory, officials could delay such distribution if they believed the vaccine was not safe.
The development and quick production of a vaccine is seen as crucial to ending the pandemic, which has claimed more than 202,000 lives in the United States, 32,000 of them in New York state.
To vet a vaccine, Cuomo said that he would assemble a panel of scientists, doctors and public health experts who would review its safety and effectiveness after the federal government approves it. He did not provide specific details about the panel's actions.
Multiple health experts said that Cuomo had reason to be concerned but that his actions risked politicizing the process even further and reducing confidence in federal government scientists.
"I don't think setting up a state board to revisit the decision and look at the vaccine's safety and effectiveness is a good idea," said Dr. Jesse Goodman, a professor of medicine at Georgetown University who was the FDA's chief scientist from 2009 to 2014 during his 11-year stint at the agency. "I think this could set a precedent that creates more of the thing that it's trying to avoid. It could create a very politicized situation."
Information for this article was contributed by Cara Anna, Andrew Meldrum, Danica Kirka and Maria Cheng of The Associated Press; by Bloomberg News; and by Michael Gold and Jesse McKinley of The New York Times.