The COVAX (COVID-19 Vaccines Global Access Facility) scheme, touted as a levelling measure against inequalities in vaccine access, is looking increasingly faulty. Co-led by Gavi, the Coalition for Epidemic Preparedness and Innovations (CEPI) and the World Health Organization (WHO), the aim is to supply 2 billion doses by the end of 2021.
At the end of February, over 100 countries had received vaccines, a statistic made less impressive by the fact that two countries had received more than half of the 210 million doses. Countries such as South Africa have had to pay double the price for the Oxford-AstraZeneca vaccine for fewer doses than it needs facing what UNAIDS Executive Director Winnie Byanyima calls ‘a vaccine landscape of depleted supply where it is purchasing power, not suffering, that will secure the few remaining doses.’
Wealthier countries are keeping their options numerous and open. Bruce Aylward, WHO senior adviser, has made the point that ‘some countries are still pursuing deals that will compromise the COVAX supply.’ This was a source of much worry for WHO Director-General Tedros Adhanom Ghebreyesus. ‘Our world will not recover fast enough without vaccine equity, this is clear.’
One suggested mechanism to assist in achieving vaccine equity lies in the field of intellectual property rights.
In October 2020, India and South Africa formulated a proposal waiving ‘certain provisions of the TRIPS [Trade-Related Aspects of Intellectual Property Rights] agreement for the prevention, containment and treatment of COVID-19.’ The waiver would apply to WTO members, enabling them to not apply or enforce certain provisions under Part II of the TRIPS Agreement, specifically section 1 (copyrights and related rights), 4 (industrial design), 5 (patents), and 7 (protection of undisclosed information). The General Council would agree on the duration of the waiver, at the very least maintaining it till widespread global vaccination had taken place, with the majority of the world’s population rendered immune.
In discussions held by WTO members at the TRIPS Council over 15-16 October last year, the lines of opposition firmed. They looked all too familiar. High-income, wealthier countries (Australia, Brazil, Canada, EU, Japan, Norway, Switzerland, United Kingdom and the United States) were either formally opposed to the measure, or not in support of it.
The opposition by wealthier states against any waiver lies in the merits of having an IP system. Having such protections guarantees enterprise and innovation. But more tellingly, officials from the high-income countries deny any link between vaccine access and IP barriers. ‘There is no evidence,’ insisted an EU spokesman, ‘[that IP rights in any way hamper access to COVID-19 related medicines and technologies.’ John-Arne Røttingen, the chair of the WHO Solidarity Trial of COVID-19, sees the focus on IP as distracting and misrepresentative. IP was ‘the least of the barriers’ relative to necessary facilities for production, knowledge and infrastructure.
'These divisions in vaccination strategy, covering production and delivery of inoculations, continue to perpetuate a separatist agenda in global public health.'
These claims have been ably rebutted. South African delegates did so at the October 16 TRIPS Council meeting and the Council Meeting on November 20. They pointed to restrictions on capacity by manufacturers of the monoclonal antibody therapeutics Regeneron and Eli Lilly, regulated via bilateral arrangements. South Africa also noted the locking of horns in India between Médecins Sans Frontières and Pfizer regarding the pneumococcal vaccine, protected by a patent preventing other vaccine manufacturers from manufacturing it till 2026. According to MSF, doing so deprived ‘children of the opportunity to be protected against pneumonia, which kills 2,500 kids a day.’
The waiver proposal has suffered from intentional neglect in the TRIPS Council. Requests from Australia, Canada and Chile for evidence that the waiver would achieve increased capacity for vaccine manufacturing and assist overcoming shortages have served to stall the proposition. A waiting game is being played out.
The WTO General Council meeting held this month barely touched the South African-Indian proposal. The EU and the US evidently thought the waiver dead, their explanations for rejecting it self-explanatory.
A distracting third, centre ground way proposed by the new WTO Director-General Ngozi Okonjo-Iweala sparked interest. The proposal involved improving vaccine access ‘through facilitating technology transfer within the framework of multilateral rules’ while encouraging pharmaceutical giants to license other manufacturers to produce vaccines. On the face of it, the idea is neither radical, nor particularly useful, given that drugs companies have already began doing something similar.
The TRIPS waiver proposal has found a small following in the United States and the EU. Jan Schakowsky of the US House of Representatives told a press conference last month that more than 30 members of Congress had penned their signatures to a letter urging the Biden administration to support the waiver. Of the European Parliament’s 705 members, 115 are of the view that the TRIPS waiver proposal should be embraced. A waiver, the parliamentarians urged in their February 24 declaration, would bypass legal barriers to production and facilitate ‘the sharing of know-how and technologies with GMP manufacturers from third countries’. The EU strategy prioritising domestic production had the potential to exacerbate ‘a dangerous North-South divide when it comes to affordable COVID-19 diagnostics, personal protective equipment, treatment and vaccines.’
These divisions in vaccination strategy, covering production and delivery of inoculations, continue to perpetuate a separatist agenda in global public health. It is also a troubling reminder that public health, when politicised and commercialised, guarantees inequality. The delays in production and dissemination will also have another guarantee: more deaths in poorer countries.
Dr Binoy Kampmark is a former Commonwealth Scholar who lectures at RMIT University, Melbourne.
Main image: Two people receiving the vaccine (Illustration Chris Johnston)