COVID-19: 'VIP Vaccines' and the Global Inequality Virus

Just ten countries account for 90% of the COVID-19 vaccines available in the world, yet many of the same nations are amongst those blocking an initiative put forward to the World Trade Organization that would widen access by waiving intellectual property rights. The head of the World Health Organization has supported the idea; Finland has already demonstrated that a patent-free vaccine can be created – only for its government to invest in Big Pharma instead. Every extra day without a waiver carries a cost in human lives. 

Excitement is building. We are defeating a pandemic in record time. Just one year after the World Health Organization (WHO) declared COVID-19 a pandemic, we are already deploying new vaccines against an illness that had brought the world to a standstill. On social media we share our joy at seeing our grandparents get vaccinated, at feeling – or at least imagining – that this nightmare could soon be over. We are also enraged, however, when we see resources as precious as these vaccines being appropriated unfairly and distributed according to privilege rather than need.

But on a global scale, something very similar is happening. Nine out of every ten vaccinations take place in the most powerful countries in the world. Meanwhile, 130 other countries haven’t administered a single dose. The United States, the European Union and the United Kingdom account for fully half of the 280 million vaccinations that have been carried out. While these powerful countries are expected to achieve near-total COVID-19 vaccination coverage of their populations between September 2021 and March 2022, low-income countries will still be waiting well into 2023.

Future-supply deals: entrenching tomorrow’s global health inequalities

Aside from the inequities in the vaccines already administered, the inequities represented by the large number of future-supply deals made between richer countries and pharmaceutical companies are even more striking. The reach and depth of these commitments paint an even bleaker picture of global health inequalities.

According to data from Duke University’s Global Health Innovation Center, Canada leads the way in these future-supply deals, with agreements that could allow it to inoculate its population more than five times over. Next is the UK, whose contracts could permit it to vaccinate its population more than three times over. Then come the EU, Switzerland, Australia and the US, with enough future supply for 2.5 times their populations, and Japan, which will have provision for 124%. But these countries – along with Norway, Brazil, Ecuador, and a handful of others – are also engaged in a crucially important battle now taking place within the confines of the World Trade Organization (WTO).

Faced with such a grave and unequal situation, last year India and South Africa put forward a proposal to suspend intellectual property rights for anti-COVID vaccines, medicines, and technologies until the pandemic is over. Were it to be approved, this measure would allow all countries to start producing and using any available technologies with no fear of violating intellectual property law.

Although the proposal gained the support of over 140 countries, the WTO relies on consensus voting, which allowed the major powers that already have plenty of vaccines to prevent the passage of the resolution in question. During one of last year’s meetings of the WTO’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Council, India’s delegate observed: “these countries are buying up as much of the limited supply as they can, leaving no vaccines in the pie for developing and least-developed countries”. Vaccines that can mean the difference between life and death are being distributed according to wealth rather than need.

“Wasted time translates into lost lives”

Ayesha Jacub is a doctor and an analyst of global health policy. She was once part of the public health system in South Africa, and today she lives in Istanbul. Over email, she told me that a waiver “would ensure the positive knock-on effects that open-source information provides, which includes expanded manufacturing and competition, and therefore competitive pricing”.

In her opinion, “from any moral or public health perspective, any measure that ensures expanded access would be the route to go for”, with “a temporary waiver making the most sense” because it accelerates progress towards vaccination in ways that other options cannot. “Right now,” she said, “wasted time translates into lost lives”.

In the opposite corner, with its past of colonial domination over the countries promoting this initiative, is the UK. In his first response the motion from India and South Africa, the British delegate to the WTO argued that applying a waiver to intellectual property rights would mean using “an extreme measure to address an unproven problem”, which could be “counter-productive”.

The British delegate stated: “We have not identified clear ways in which intellectual property has acted as a barrier to accessing vaccines, treatments, or technologies in the global response to COVID-19”. Instead, he proposed measures such as technology transfer and sharing of production and distribution capabilities.

Even if the UK calls into question the production capability of low-income countries, however, the reality is that 72 of the 158 vaccines prequalified by the WHO are produced by manufacturers in the developing world. And as already noted by Dr Jacub, opening up patents and trade secrets would also allow poorer countries either to produce vaccines locally or to gain better access at lower prices.

To illustrate this better, Dr Jacub had me think about my own country, Argentina:

“Imagine a scenario,” she said, “in which trade secrets were opened up and the Argentine lab that makes the Oxford-AstraZeneca vaccine could independently produce a low-cost vaccine for the local market. Wouldn’t that be a more sensible approach in the middle of a pandemic?”

These are the same arguments that spurred WHO Director-General Dr Tedros Adhanom Ghebreyesus to lend his support to the local, low-cost manufacture proposal. In late February, he pointed out that “governments have an obligation to protect their own people, but the best way to do that is by suppressing the virus everywhere at the same time”. Dr Tedros, as he prefers to be called, went on to argue in The Guardian that “a ‘me first’ approach to vaccination won’t defeat COVID”, and concluded, “if not now, when?”

Dr Jacub also warned about the negative impacts of the “me first” approach even for high-income countries, as “‘developed’ countries face continued risk on some level from variant stains and unvaccinated populations due to porous borders, which are an unavoidable consequence of globalization”. Both Dr Jacub and Dr Tedros have characterised this as a question both of equal access and of adopting a strategy that corresponds to the realities of the ongoing pandemic.

Lifesaving coronavirus vaccines are ‘global public goods’: Médecins Sans Frontières

One of the key organisations working on the issue of COVID-19 vaccine access is Médecins Sans Frontières (MSF). In 1999, MSF won the Nobel Peace Prize for its humanitarian work and for driving social rejection of human rights violations and abuses of power. Today, it is the main civil-society organisation pushing for a patent waiver via the WTO.

“Médecins Sans Frontières maintains that COVID-19 vaccines should be treated as ‘global public goods’”. The person speaking – or writing, in fact – was Kate Stegeman, coordinator of the MSF Access Campaign in Johannesburg, South Africa. “Given the unprecedented public funding behind the global COVID-19 vaccine development effort and the urgency presented by this pandemic, MSF believes there shouldn’t be any profiteering from vaccines.”

Here, Ms Stegeman was referring to the USD$12 billion in public funding that has been invested in research and development, clinical trials and production of the six main COVID-19 vaccines (AstraZeneca, Johnson&Johnson, Pfizer, Moderna, Sanofi, and Novavax). In the case of COVID-19 at least, innovation appears to have been driven by direct investment from nation-states rather than through intellectual property law. But even this process could have been carried out more efficiently, it seems.

According to an investigation by Jacobin magazine, a patent-free COVID-19 vaccine was ready in May 2020, thanks to a prominent group of Finnish researchers led by Professor Kalle Saksela, director of the University of Helsinki’s Department of Virology. The Finnish state, however, would choose not to back the initiative, and opted instead to invest in big pharmaceutical companies. In addition to delaying the mass inoculation of the Finnish population, this decision effectively denied the rest of the world the huge benefits that could have resulted from large-scale deployment of an unpatented vaccine.

Despite these missed opportunities, MSF Access Campaign coordinator Kate Stegeman noted that “the proposal from India and South Africa will facilitate the transfer of health-related and vaccine technologies by pharmaceutical corporations in Europe to manufacturers in low- and middle-income countries, leading to increased supply and more competition over prices”.

She added that both the block on vaccine access by richer countries and the reluctance of pharmaceutical corporations to share COVID-19 technologies “demonstrate how maintaining structural barriers is prioritised over the achievement of global equitable access to the medical tools needed to combat COVID-19”.

Protecting the world from the pandemic: how can we do better?

On 10 and 11 March, the TRIPS Council met again to discuss the waiver proposal from India and South Africa. But despite significant support for the motion, no agreement was reached. The best that its advocates could manage was to open up the possibility of further meetings on the waiver issue in April, outside of the Council’s usual schedule. Sadly, as Dr Jacub noted, every extra day without an agreement will carry a cost in human lives.

Many of the world’s wealthiest nations have bought up more vaccines than they will ever need to protect their own populations. Now they are also preventing the most vulnerable countries from achieving equal access. Although we may live on a planet that has grown numb to the consequences of inequality, an intellectual property waiver for vaccines could yet give us a chance to show that crises like the COVID-19 pandemic can still bring out the best in us.

This article was originally published in Spanish in elDiarioAR. Translation into English by Asa Cusack.

The views expressed in this post are those of the author and do not necessarily reflect the position of the Atlantic Fellows for Social and Economic Equity programme, the International Inequalities Institute, or the London School of Economics and Political Science.