Vaccine equality: who gets it?
‘We watch daily the good news that approved vaccines are rolling out in the UK, US and rich countries in Europe,’ says Farooq Tariq from the Pakistan Kissan Rabita Peasants Coordination Committee. ‘We are happy that people in the economically advanced countries are now receiving doses and getting safe. But we also despair that this gives the impression that we are the “lesser people” living in places where the vaccine will not be available for years to come.’
Since the start of the pandemic, governments had been pinning their hopes on the discovery of effective vaccines to break the endless cycles of lockdown and social restrictions which have caused severe economic and social disruption in all countries. The development of successful vaccines in record time has been an impressive feat of science, but now nationalistic politics and corporate power are blocking fair access to much-needed doses.
Rich countries, representing just 16 per cent of the world’s population, have secured 60 per cent of the leading vaccines. That’s enough to vaccinate their entire populations almost three times over. Meanwhile, the majority of the poorest countries are only likely to vaccinate one in ten people in 2021 and many low- and middle-income countries could be waiting up to 2024 for widespread vaccination. This global divide has exposed the failings of the global pharmaceutical system.
No-one is safe until everyone is safe
Ensuring equitable vaccine access is an important part of achieving the human right to health. As the world mourns a colossal death toll of 2.7 million and counting, ensuring there are enough vaccines will help to prevent even more unnecessary loss of life. Recent research shows that we could prevent 61 per cent of deaths globally if vaccines are distributed fairly, compared to 33 per cent if rich countries hoard vaccines.
Hoarding vaccines and vaccinating rich populations first is not only unjust and morally wrong, it is also self-defeating. Allowing large parts of the world to remain unvaccinated will let the virus continue to spread and risks even more mutations that could render existing vaccines obsolete. No-one is safe until everyone is safe.
It is also economically short-sighted. The International Chamber of Commerce estimates that leaving developing countries without vaccines will cost rich countries $4.5 trillion in lost income this year. Covid-19 vaccines are such a crucial tool in the fight against the pandemic that the international coalition the People’s Vaccine Alliance is calling for governments to treat vaccines as global public goods – produced in mass quantities, affordable to all countries and free to the public. However, we are nowhere near this as there are simply not enough supplies. And in the face of scarcity, it’s those with the deepest pockets that get to hoard.
‘The world is on the brink of a catastrophic moral failure,’ said World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus in January, ‘...and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.’
Much of the media debate has been about whether rich countries should give away doses from their vaccine stockpile or how more money is needed to purchase doses. But the real questions that need to be addressed are: why are we facing scarcity for a product that the world so desperately needs? And how can we make more doses so there are enough for everyone, everywhere?
The global scarcity that we are facing is driven by pharmaceutical monopolies. Pharmaceutical companies can patent their products, which means only they can sell their vaccines or treatments for a minimum of 20 years. They also defend their monopolies through keeping their technological know-how under wraps. In other words, only they know the recipe to make their vaccines. With no competition, pharmaceutical corporations get to decide how much to produce, whom to sell it to and at what price. And during this pandemic pharmaceutical companies have been more than willing to sell their vaccines to the highest bidders.
Rigging the rules
Not surprisingly, this business model has delivered bumper profits for the pharmaceutical industry and made it one of the most profitable industries in the world. The industry is predicted to earn at least $10 billion in profits each year from Covid-19 vaccines. But these booming profits will come at the expense of global public health.
This is the same business model that priced out millions of HIV patients in the Global South at the height of the HIV epidemic. As breakthrough treatments became available at extortionate prices, only wealthy countries could afford them. Countries across the Global South were denied access by pharmaceutical corporations which refused to drop their prices and led to millions of deaths, especially in sub-Saharan Africa. More recently, countries the world over have struggled to access medicines for conditions such as cancer, hepatitis C and cystic fibrosis because of prohibitive prices sustained through monopolies.
Time and time again, whenever there is a conflict between profiteering and public health, profiteering always wins out. And that’s because the rules of the global system were written by the pharmaceutical industry in their own interests. The industry lobbied over many years to create the rules to give itself these robust monopoly protections. And in 1995 the industry won as these rules were written into a global trade agreement, Trade Related Aspects of Intellectual Property Rights (TRIPS), which meant that they could ensure compliance to these rules in almost every country of the world. The biggest losers have been ordinary people who have struggled to access life-saving treatments.
Enough doses for everyone, everywhere?
With pharmaceutical monopolies in place, supplies will always be restricted as no one company can satisfy global demand. To create a People’s Vaccine that reaches everyone, there are two initiatives which could help to unblock production. The first is the WHO’s Covid-19 Technology Access Pool, which was launched last year. This would facilitate the sharing of technological know-how and intellectual property rights with other companies and governments. The idea is to help mobilize more manufacturers to increase global supply and help lower prices.
The UK has not joined yet but Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, openly supports the WHO pool – opening up hope that the Biden administration may join. Meanwhile pharmaceutical companies have condemned the scheme, with the Pfizer boss dismissing it as ‘nonsense’.
The pharmaceutical industry’s refusal to collaborate exposes the inherent tension in our system between public health and profiteering. But right now, we are also in the middle of the worst global public-health emergency in a century and almost every business on the planet has had to step away from business as usual. It is in all our interests that pharmaceutical corporations now do the same.
All the successful vaccines have been developed with significant amounts of public funding and in total an estimated $100 billion of public money has been poured into global research and development of Covid-19 vaccines, treatments and diagnostics. Publicly funded vaccines should not be locked up by monopolies and used as privately owned commodities for profiteering. The technological know-how should be widely shared to enable the whole world to benefit, but if companies continue to boycott the WHO global pool, then this initiative will not even get off the ground.
Countries in the Global South are also pushing for the suspension of the global rules on patents contained in the TRIPS agreement during the pandemic. This proposal cuts to the heart of the problem and would help break up the monopolies, not just for vaccines but also for Covid-19 treatments, diagnostics and other health technologies. In other words, it could be a massive gamechanger.
These two proposals combined could address the fundamental problem of supply and unlock massive production across the world. So instead of fighting over limited supplies and pitting a nurse in the UK’s National Health Service against an elderly person in Malawi for vaccine access, we could have enough doses for everyone.
But though this proposal has the support of two-thirds of the World Trade Organization (WTO) member states, the WHO, almost 400 civil society organizations and even the Pope, it was blocked at the WTO in March by rich countries including the UK, US, Switzerland and the EU, claiming that they cannot disrupt the global system of intellectual property rights.
Charity versus justice
Instead of tackling the structural problems in the global pharmaceutical system which are driving vaccine inequality, high-income countries are relying on the WHO and Gates Foundation-led Covid-19 Vaccines Global Access or Covax to deliver equitable access to vaccines. Covax is a global buying scheme where countries collaborate to purchase doses together and then share them out based on a fair allocation system.
On paper, this scheme looks much more favourable than vaccine nationalism. One of the biggest funders of Covax is the British government, and yet it has undermined the scheme through its own bilateral vaccine deals on a UK-first basis. Covax is still underfunded and can only promise to deliver two billion doses this year, targeting just 20-per-cent vaccine coverage in each member country – in other words, nowhere near enough for countries to achieve herd immunity.
At a G7 meeting in February, the UK government pledged to donate surplus doses. However, there are still outstanding questions on whether countries will be charged for these doses. The French government also promised to donate some doses, but both these pledges are a drop in the ocean in terms of addressing severe vaccine inequality and a fig leaf to mask the shameless hoarding of doses. As the South African delegation at the WTO commented: ‘The problem of philanthropy is that it cannot buy equality.’
As wealthy countries focus on vaccinating their own populations, China and Russia have been racing ahead to supply countries in Latin America, Africa, Asia, the Middle East and the Balkans. Vaccines are being used to strengthen regional ties, enhance diplomatic power and global status. India is also pledging to give away millions of doses to countries in South Asia as a way to counter China’s influence with its neighbours.
The use of vaccines to shore up soft power will transform global power dynamics, but in the middle of grotesque vaccine inequality and rich-world hoarding, Russian and Chinese vaccines are reaching countries that have secured few or no doses. The most malicious case of vaccine diplomacy so far, however, is Israel’s. It has been reported that Israel is supplying its excess Moderna doses to Honduras, the Czech Republic and Guatemala – all of which are bolstering their diplomatic presence in Jerusalem. Meanwhile, Israel has sent fewer than 5,000 doses to the Palestinian Authority for frontline healthcare workers. The scramble for vaccines is turning ugly and unless manufacturing capacity is ramped up, vaccines will continue to be used as an unscrupulous bargaining chip.
The desperation to see the end of this pandemic is felt by every country. And every country deserves to have access to the vaccines and treatments to combat this virus. Archbishop Thabo Makgoba of South Africa grew up under the apartheid regime and he describes how vaccine inequality reminds him of apartheid: ‘I was, at a personal level, denied access to go into a white university because I was black and needed ministerial approval to be in a white university. So, these vaccines that are available to the Global North and the West is like… “Hey, you guys are not human enough. Wait a bit”.’
Ensuring equitable vaccine access is about human rights. And access should never have been determined by wealth. If a country only vaccinated its richest citizens first, there would be a public outcry. But this is exactly what the pharmaceutical industry and rich governments have allowed to happen on a global scale and it’s time that we raised a public outcry about it. The majority of the world’s population has been treated as ‘lesser people’ for too long.
Heidi Chow is a senior campaigns and policy manager at Global Justice Now and leads the organization’s campaign to fight for equitable global access to medicines and vaccines.