This week saw the first Covid-19 vaccines administered to a limited number of healthcare workers in South Africa, almost two months after frontline staff and other priority groups in Ireland and the EU started to receive their first doses.
Several Southern African countries including Eswatini, Malawi, Mozambique and Zimbabwe recorded more Covid-19 cases in January 2021 than in all of 2020. Only a handful of frontline healthcare workers have been vaccinated in these countries so far, even as a new strain of the virus ravages their healthcare systems.
New cases increased exponentially in Malawi during January, doubling every four to five days. At one point, the main hospital offering Covid-19 care in Malawi’s economic hub of Blantyre was close to full capacity for patients needing oxygen support, with no prospect of healthcare staff receiving a vaccine.
A Médecins Sans Frontières/Doctors Without Borders (MSF) colleague in Malawi explained: “If we had 40,000 doses of vaccine, we could at least start by vaccinating health staff in the country’s main hotspots. Without them, the situation will soon be untenable.”
The difficulty faced by African countries in accessing vital vaccines for even frontline healthcare workers, as wealthier countries proceed with additional procurement and rollout, underscores the inequitable approach to global vaccine supply.
Since the beginning of the pandemic, the need to ensure equal global access to Covid-19 vaccines has been widely acknowledged by governments and NGOs. Yet despite this common understanding and the statements made by numerous heads of state calling for Covid-19 medical products to be treated as “global public goods”, little in the way of meaningful action has been achieved to date.
It’s clear that the pharmaceutical corporations alone cannot be trusted to deliver equitable access to Covid-19 vaccines. The industry has a poor track record of transparency, and recent actions show that relying on its exclusive rights and limited voluntary actions is not the solution in a global pandemic.
The licensing deals struck by several companies at the forefront of developing Covid-19 vaccines remain cloaked in secrecy, despite these corporations receiving unprecedented levels of public funding. For instance, a previous agreement showed that there are limits to AstraZeneca’s public “no profit” commitments for the vaccine it has developed with Oxford University.
AstraZeneca has given itself the power to declare the pandemic over as soon as July 2021, meaning that after that date, the corporation could charge governments and other purchasers high prices for a vaccine that was predominantly funded by the public. Meanwhile, just 2 per cent (40 million out of two billion) of the doses in deals struck for Pfizer/BioNTech’s Covid-19 vaccine supply for 2021 and 2022 will go to Covax, a global vaccine-purchasing mechanism aimed at ensuring global equitable allocation of vaccines.
And while public funding from different governments and collective efforts at the global level have driven much of the research and development on critical medicines and vaccines in this pandemic, pharmaceutical corporations continue to claim private monopoly over those lifesaving products that are needed by all.
To ensure fair access to vaccine supplies for all countries, a level playing field is urgently needed. One step in the right direction would be to remove intellectual property (IP) barriers so that vaccines could be produced by more manufacturers, particularly in the developing world.
This is what is currently being proposed to the World Trade Organisation’s IP council, Trips, by South Africa and India. Citing the unprecedented global public health challenge posed by the pandemic, the two countries submitted a landmark proposal to the WTO last October to ease rules which impose IP barriers that restrict access to Covid-19 medicines, diagnostics, vaccines and other tools for the duration of the pandemic.
If agreed, the proposed waiver could be a game-changer for vaccination in countries which have not been able to engage in the type of bilateral deal-making with pharmaceutical corporations seen among wealthier nations.
Even during the pandemic, the pharmaceutical industry continues its profit-oriented approach, not just by not just keeping prices high for Covid-19 medical tools, but also by prioritising access to wealthier nations. For instance, Covid test maker Cepheid has been overcharging and under-supplying the World Health Organisation’s effort to support rapid and equitable access for developing countries. According to MSF research, Cepheid has been charging four times what it should per test.
An IP waiver would allow countries to overcome these corporate roadblocks by giving them the option not to enforce patents and other IP that could impede the production and supply of Covid-19 vaccines and medical tools and facilitate quicker development.
The greater the diversity of manufacturers and suppliers, the sooner governments and treatment providers around the world will be able to access and utilise Covid-19 medicines and medical tools to save more lives. That scenario is not possible while a handful of multinational corporations hold monopolies on Covid-19 medical products.
A waiver would help avoid repeating the tragedy of the HIV/Aids epidemic when monopolies on lifesaving treatments saw people in high-income countries gain access to lifesaving antiretroviral treatments while millions in developing countries were left to die despite the existence of affordable HIV drugs.
The proposal has already been discussed several times by members at the Trips council since its initiation in October 2020, with no consensus. As well as the support of India and South Africa, the waiver is co-sponsored by a range of countries, including Pakistan, Egypt, Kenya and Bolivia. Wealthy countries, including the US, UK, Australia and Japan as well as the EU, continue to withhold their support, which is vital in ensuring that the proposal can be passed. At the next WTO General Council meeting on March 1 and 2, the ambassadors of all member countries are expected to discuss the way forward for this landmark proposal.
If Ireland and other EU member states are serious about ensuring truly equal global access to Covid-19 vaccines, Médecins Sans Frontières believes they should reconsider their joint opposition to this proposal. Ultimately, it could open the gates to allow additional manufacturing of lifesaving Covid-19 vaccines, drugs and diagnostics, increasing distribution and improving access, particularly across the developing world.
It’s the sort of action that is now needed at such a critical juncture for global public health. The pandemic won’t be over until it is over for everyone – so let’s help ensure no one is left behind.
Isabel Simpson is executive director of Médecins Sans Frontières/Doctors Without Borders (MSF) Ireland