A ‘once-in-a-generation’ chance to reset vaccine innovation in Canada

The $925-million public-private partnership to enhance the manufacturing capacity of Sanofi’s influenza vaccine facility in Toronto is only the latest in a string of deals meant to protect Canada against this, if not future, pandemics. Occupying the grounds of what was once “Connaught Labs,” Canada’s famed, publicly controlled vaccine manufacturer, the transfer of $470-million in taxpayer money to a multinational corporation has increased debate about whether private industry’s grip on biopharmaceutical production adequately serves the public good. Before COVID-19, industry had shown little interest in developing treatments against coronaviruses. This led many to suggest that we should rethink how we encourage biopharmaceutical innovation for public health emergencies. And they pointed to Connaught as the alternative—a public supplier, which prioritized public health problems identified by provincial governments, and ensured that the resulting therapies were affordable not only to Canadians, but also populations in other parts of the world. Connaught’s history is, like most things, more complicated. While it was connected to the University of Toronto for most of its existence, the university seldom funded its operations. Instead, most of its resources derived from charitable donations, the occasional sum from the Ontario government, and funds from the sale of excess product which Connaught redirected back into research. Each provincial department of health was represented on Connaught’s advisory committee. But the decisions about what diseases to focus on, or how to ensure that the products that Connaught produced were affordable, owe more to the ethics of Connaught’s directors and affiliated scientists than government direction. The deal that Connaught, in coordination with U of T’s Frederick Banting and Charles Best, struck with Eli Lilly to scale up production of insulin in the early 1920s is celebrated to this day because the people involved made sure that the insulin manufactured under the arrangement would be accessible to all those in need. Connaught’s achievements, in other words, don’t simply follow from its university home. Rather, they are grounded in the efforts and ethics of individual people that infused the organization with a commitment to public good. By the same token Connaught’s unravelling did not happen overnight when it was privatized in the 1980s. On the contrary, Connaught had been in steady decline since the second world war when sales of its excess product declined, limiting Connaught’s ability to maintain lab equipment and other infrastructure. The pharmaceutical sector was also growing through the 1950s and 1960s, creating competition. The historical record suggests that this may have pushed Connaught towards a for-profit approach even before it morphed into a Crown corporation in 1972, and long before the Mulroney government sanctioned its sale to what stands today as Sanofi’s soon to be enhanced manufacturing plant in Toronto. The point is that labels like ‘public’ and ‘private’ only tell us so much. What matters is whether the public good is clearly built into the institutional design and carefully maintained by an organization’s leadership. Too often that is not the case. Almost every drug and vaccine that has meaningfully improved public health in the last 50 years originally emerged from university and government labs. But the public sector’s contributions, in terms of financing, risk, and scientific labour, are never reflected in the resulting treatment’s price. Academic norms have also shifted substantially. Researchers and universities have internalized commercializing a discovery as their responsibility but, unlike Banting and Best, typically take a hands-off approach to questions of accessibility and affordability as the product moves toward patients. We can’t say whether the partnership with Sanofi will serve the public good because the terms of the deal are not in the open. But if Sanofi was given full control over which diseases to ultimately prioritize, how to evaluate new products in clinical trials, whether to share important information such as manufacturing know-how, and what price to charge for the plant’s products, then the deal fails to protect the public good. Contrary to many recent news headlines, Canada has always had some domestic vaccine manufacturing capacity in a number of public and private facilities. Rather, the fundamental problem that has been magnified by the pandemic is that Canada has–since Connaught’s heyday—had virtually no say over when and how to produce a drug or vaccine. It appears that the Sanofi deal has done nothing to change that situation. The government has dubbed the Sanofi deal a “once-in-a-generation” opportunity. We fear that opportunity has already been squandered. Rather than learning from the lessons of Connaught, taking advantage of a world-leading academic research community, and integrating commitments of transparency, affordability, and public governance into the partnership, our governments went with business-as-usual instead. That approach left us vulnerable to COVID-19, and it will not help us to be better prepared for the next pandemic. Matthew Herder is the director of Health Law Institute, Schulich School of Law, Dalhousie University. Srinivas Murthy is a clinical associate professor in the Department of Pediatrics, Faculty of Medicine, at theUniversity of British Columbia. The Hill Times