In 2017, a new organization was started to change the way the world researched and developed vaccines to combat new infectious diseases. It is the Coalition of Epidemic Preparedness Innovations (CEPI), a Norway-based public-private partnership whose slogan is “New Vaccines for a Safer World.” The World Health Organization had a list of pathogens for which it wanted vaccines developed, but pharmaceutical companies had shown little interest since the outbreaks were in Africa and Asia, where they had concluded the financial returns were too small to justify any investment.

Before Covid-19 was identified last December, CEPI had raised three-fourths of the $1 billion it determined was necessary to fund the innovative research for expedited development of vaccines to treat new epidemics. Japan, Germany, Canada, Australia and Norway, as well as the Wellcome Trust and the Bill & Melinda Gates Foundation, had given $460 million. In the last two years, CEPI has used that money to provide grants for some leading edge biotechnologies that could revolutionize vaccine research and production.

But what has played mostly out of public view over that same time was the organization’s failed effort to get large pharmaceutical firms to agree to be partners without insisting on substantial profits or proprietary rights to research that CEPI helped to finance and produce. That did not surprise many industry observers who knew that since the 1930s, the National Institutes of Health had spent over $900 billion on grants that drug firms relied on to patent brand-name medications.

Médecins Sans Frontières (Doctors Without Borders) encouraged a policy by which all countries would have equal and affordable access to CEPI-funded vaccines. The organization initially embraced those principles in a detailed policy paper in which it agreed to set prices to insure “equitable access” during a pandemic. Drug firms would have to share all vaccine research data. Contracts for manufacturing vaccines would be submitted first to a public review board. And CEPI retained the right to access intellectual property that companies developed with CEPI funding, even if they left the program.

Drug companies on CEPI’s scientific advisory panel, including Johnson & Johnson, Pfizer, and Japan’s Takeda, pushed back. CEPI mostly capitulated in a December 2018 two-page declaration in which it jettisoned specifics but gave lip service to its founding mission of “equitable access to these vaccines for affected populations during outbreaks.”

Last March, Doctors Without Borders wrote an open letter expressing its “concern and disappointment” about CEPI’s “vague, toothless and weak new policy.” It also concluded that CEPI had taken “an alarming step backwards. …the revised policy marks a concerning pivot away from CEPI’s early commitments to access, transparency and openness, and to breaking new grounds in terms of public responsibility. It betrays the interests of everyone who invested in CEPI because they wanted to change the deadly status quo.”

Covid-19 is the ultimate test case for whether drug firms might at last become full partners in a public-private partnership to develop as quickly as possible a vaccine that could save an untold number of lives.