Margaret Keenan, 90, became the first person in the world to receive a non-trial shot of the Pfizer/BioNTech vaccine in the United Kingdom on December 8, officially launching the United Kingdom’s mass inoculation program. This development follows initial results from Pfizer-BioNTech, Moderna and Russia’s Sputnik V vaccine showing over 90% efficacy rates, providing a welcome dose of hope. The United Kingdom had issued an emergency approval of the Pfizer-BioNTech vaccine. The United States, the European Union and the World Health Organization (WHO) are reviewing the Pfizer-BioNTech and Moderna vaccines in the coming weeks.
Revelations on December 8 that the Trump administration had passed on the opportunity to lock in additional supplies from Pfizer has many of Trump’s critics up in arms. But the bigger story is that the richest countries in the world are buying up the world’s supplies. Over the past several months, before any vaccine is approved for sale, the wealthiest nations have pre-purchased massive stockpiles of vaccines from frontrunner producers. Of the 9.8 billion doses already reserved, over half are claimed for the United States, Europe and Australia alone, where just over a tenth of the world’s population resides. The United States has purchased enough doses to vaccinate 555 million people (though it only has a population of 331 million), and has negotiated the potential to purchase an hundreds of millions of doses beyond that. The United Kingdom has purchased enough doses to vaccinate three times its population, and Canada for five times its population. The rest of the world, should it be able to afford the vaccine, must draw from diminished stocks. This scenario threatens to unleash a global apartheid of immunization and disease.
Activists and humanitarian organizations are in a race against time to secure a more equitable distribution of Covid vaccines, as the world prepares for the most ambitious mass rollout of immunizations in history. Equitable distribution requires both fair pricing and ramped up manufacture of vaccines, in order to ensure that there is enough supply to go around. But the kind of large-scale production necessary to immunize the globe is being held back by patent laws and hoarding of the technological know-how to produce the vaccines that we need in the quantity that we need them.
Activists from organizations across the globe are putting forward the politics of solidarity and global cooperation, as against vaccine nationalism and pharmaceutical profits. From open letters aimed at the incoming Biden administration, to rallies that target pharmaceutical companies, to social media campaigns aimed at raising awareness, organizers are demanding that governments, universities and corporations share patents and technological information in order to ramp up production of vaccines and effectively treat this global crisis.
Yuanqiong Hu, senior legal and policy advisor for the Médecins Sans Frontières’ (MSF) Access Campaign, which aims to increase access to essential medicines, tells In These Times, “The more inaction and excuses continue, the more life is in danger. Governments have a shared responsibility to make sure we actually end this pandemic.”
The weight of history hangs heavily as organizers at MSF look ahead. “Twenty years ago, when HIV/AIDS killed so many people, it was the monopoly of the companies that hindered the distribution of life-saving medicine,” says Hu. “Global society only came to an agreement a few years after the tragedy had already happened.”
Activists from a half dozen organizations that spoke to In These Times agreed. As Emily Sanderson from Health Gap, an international advocacy organization working for access to HIV medications, puts it: “It’s our responsibility to make sure that in twenty years, we’re not fighting for a Covid vaccine for people in South Africa and Mozambique and Kenya. It’s all it’s the same playbook. It’s just a different year.”
Patents versus public health
Two global solutions are at the center of organizing efforts on the part of humanitarian organizations and activists.
One is the initiative put forward by South Africa and India within the World Trade Organization (WTO) to temporarily suspend patent laws, which are currently in place through Trade-Related Aspects of Intellectual Property Rights (TRIPS). The proposal to waive patent restrictions for the duration of the pandemic has been on the table at the WTO for the last couple of months. WTO representatives will discuss it again at their next meeting on December 10, and will vote on the proposal on December 17. MSF has been gearing up for this vote with a social media campaign and Twitter storm on December 8.
The second is the WHO-backed Covid-19 Technology Access Pool, set up as a repository for all health-technology-related knowledge, intellectual property and data. Organizations are attempting to put pressure on governments, universities, and pharmaceutical corporations to participate. An expansion of the technology access pool would go even further than patent waivers, because releasing patents does not require companies to share the technological know-how necessary to produce and store the vaccines, even if it grants them permission to do so.
Pharmaceutical companies have thus far balked at both proposals.
Dr. Albert Bourla, chairman and CEO of Pfizer, told reporters in a not-so-veiled threat in May: “I think it’s nonsense and at this point of time it’s also dangerous. There’s a giant effort right now happening to find a solution. The risks we are taking [represent] billions of dollars and the chances of developing something are still not very good. So to have a discussion, to say keep in mind that if you discover [a vaccine or drug], we are going to take your IP [intellectual property], I think it’s dangerous.”
Some pharmaceutical companies and governments of wealthy nations instead support another WHO-backed initiative, dubbed COVAX, which aims to raise money to collectively buy enough of the vaccine for 20% of the population of developing countries. COVAX is being spearheaded by Gavi, a project of the Bill and Melinda Gates Foundation.
By pooling resources from different countries and working with pharmaceutical companies, the hope is that COVAX will be able to provide some relief for countries that have been priced out of the bidding wars for vaccines. Indeed, most middle- and low-resource countries will have no choice but to get their vaccines through the COVAX initiative. But, apart from providing an additional windfall for pharmaceutical’s profits, thus far COVAX has collected only a small fraction of the doses needed.
“It’s a step up from vaccine nationalism,” says Heidi Chow an organizer with Global Justice Now, a grassroots campaign in the United Kingdom which focuses on justice and development in the Global South. Chow leads Global Justice Now’s pharmaceutical campaign to fight for access to medicines in the United Kingdom. “But the problem with COVAX is that it doesn’t deal with the structural issues of patents and guarding knowledge. Therefore, it has no answer to the question of where you’re going to buy doses from, because it’s already been bought up by the rich countries.”
The problem is ultimately one of supply. According to Krishna Udayakumar, founder of Duke University’s Global Health Innovation Center, “If we look at the overall purchases of vaccines today, we’ve counted about seven billion doses that have already been purchased, of which only 10 percent — or 700 million doses — are purchased through the COVAX facility.” Udayakumar estimates that it will take three to four years at earliest to achieve global herd immunity given the skewed distribution of the vaccine.
Tobita Chow, director of Justice Is Global, a grassroots campaign focused on equity and sustainability in the global economy, argues that this inequity is both a moral question, and a question of self-interest: “On the one hand, this is cruel to billions of people,” he tells In These Times. “It’s also racist. This form of global exclusion would not be possible, were it not for the ability of the U.S. government to write off the lives of billions of people of color around the world.”
“But it’s not just cruel and racist,” Tobita Chow continued. “It’s also really self-destructive. One lesson that we ought to all take from this pandemic is how deeply our lives are intertwined around the world and how the destiny of people across the United States is linked together with the destiny of people in every other country. This virus doesn’t really care about these borders that we’ve invented. And the only way that we’re really going to overcome this global crisis is by dealing with it everywhere.”
Indeed, with large parts of the world unvaccinated, the virus will be able to spread and mutate, eventually rendering the hoarded stockpiles of vaccines useless. “So the saying,” explains Heidi Chow, “that no one is safe until everyone is safe, is not just a glib expression. That’s what reality actually means.”
Public health as a public good
Activists around the world are setting their sights higher. Global Justice Now in the United Kingdom has organized an aggressive grassroots campaign to build awareness and to pressure the government to support the patents waiver at the WTO. The British representative to the WTO has been deluged by a recent email campaign by activists, and over a hundred members of parliament have signed on to an open letter supporting the waiver.
In the United States, the incoming Biden presidency has made at least verbal commitments to the idea that vaccines and medications should be shared more freely across the globe. Activists hope that this will create an opening to push for policies that support these principles on the ground. A Biden presidency could make some decisions by executive action — for instance, supporting efforts to suspend patent requirements at the WTO — which could have an immediate impact.
Peter Maybarduk, director of the Medicines and Knowledge Economy Group of Public Citizen, a consumer advocacy organization, explains that a Biden administration could also license the patents that the government already owns, such as stabilized spike proteins, to the WHO. It could further insist that Moderna share its vaccine storage technology with Pfizer, in return for compensation.
“There is popular support for these measures,” Maybarduk argues. “The pharmaceutical industry is not very popular in this country. So it’s really a matter of organizing the masses of people who are out there, that agree with us, and do not have any interest in excluding billions of people from vaccines for the sake of Pfizer’s profits. And if we can mobilize enough of those people, we can exert enough power to get some real wins from the administration.”
To do so, activists will need to counter the pressure exerted by pharmaceutical companies, which have showered both Republicans and Democrats with campaign contributions for years. In this past election, the pharmaceutical industry largely put its weight behind the Biden campaign, despite a longstanding history of favoring Republican candidates.
Tobita Chow notes, “The big question is going to be, once they are in office, are they going to be able to summon the political will to take on the pharmaceutical industry and their lobbies, and the enormous investments that these corporate lobbies have in protecting the intellectual property rights regime, in order to continue to hoard profits?”
A focal point will be an international day of action on December 14, to bombard Pfizer, Moderna and AstraZeneca with demands that these companies join the WHO’s Covid-19 Technology Access Pool (C-TAP). In the United States, the day of action is being coordinated by a People’s Vaccine Alliance, made up of humanitarian organizations.
Among the organizations affiliated with the People’s Vaccine Alliance is the Free the Vaccine Campaign. Free the Vaccine is a campaign that was launched by Universities Allied for Essential Medicine (UAEM), a network of students working to pressure their universities to allow global access to the health research and patents that come out of their facilities. Free the Vaccine, according to UAEM North America Director Merith Basey, was tailored to the needs of socially distanced activism. It has organized 300 activists from 29 countries, ranging in age from their teens to their seventies, to develop creative, weekly actions that “lead with joy,” as Basey put it.
It’s aiming pressure primarily at the universities, which receive billions of dollars from the National Institutes of Health (NIH) in the form of grants, to participate in C-TAP. Basey explained: “It’s an upstream solution to this downstream issue of high priced drugs and a lack of access. We’re trying to change the way that these universities that behave like corporations, especially in the United States, think about access.”
Among its weekly actions, Free the Vaccine organized a protest at Moderna’s headquarters in August, a “Funk Rally” in October outside of Health and Human Services, and was responsible for a popular riff on Dolly Parton’s Jolene.
Socialized investment, privatized ownership
These activists face big challenges. Heidi Chow explains, “Rich countries have been hoarding vaccines for the last six months at an astronomical rate. They’ve got the money and the power and the resources to stockpile potential vaccines. The reason that they’re hoarding is because they know there’s a scarcity of doses. And the reason there’s a scarcity of doses is because of the patent system. A patent system that will mean, for example, that the Pfizer vaccine can only be made by Pfizer.”
“No one company is going to be able to supply the world on its own,” Chow continues. “And if they could, they couldn’t do it quickly. So the answer really needs to be lifting the barriers that are preventing other suppliers from making it.”
An additional challenge, according to Hu, is getting the vaccine to large swaths of the global population that have no access to health care at all: “For many people, refugees and internally displaced people, for instance, it’s unclear how they are being accounted for when it comes to distribution and allocation. They are not part of the official healthcare system. How are they going to get vaccination? We don’t know.”
Pharmaceutical industries that are now producing vaccines have all benefited tremendously from government funding of research. In the United States, this has taken the form of taxpayer money to the NIH, which is then dispersed in the form of grants to universities, companies and organizations.
As research by Public Citizen has highlighted, most of the leading Covid-19 vaccine candidates are “using a spike protein technology developed by the U.S. government” via NIH grants. This applies whether or not companies have participated in Donald Trump’s “Operation Warp Speed,” which has poured billions of dollars into the development, manufacture and distribution of vaccines.
Maybarduk explains, “These vaccines, like most medical innovations, have been developed through public-private collaborations funded by taxpayers. And the government has considerable rights in the technologies as a matter of law, and considerable rights in the technologies as a matter of morality. But the standard political economy today is we give very large grants to these companies to accelerate the development of the clinical trials. And we’re not asking a lot in return.”
The U.S. government will take on the responsibility of vaccine distribution, but will put few conditions in place on whether companies must share technological know-how or expand manufacturing capacity in order to reach more people, more quickly.
In light of these realities, struggles for an equitable global distribution will be an uphill battle. And their consequences will not only be felt by people living in countries of the Global South. In the richest nations, too, the vaccines will only be as strong as the vaccination programs disseminating them. In the United States, there is no national health care system currently capable of effectively immunizing the whole of the population. Nor is there a population sufficiently educated and supportive of a vaccination program.
The depth of current crisis, and the widespread yearning for a just solution, might provide an opportunity to shift course. “I think that we have to find a way to populate the collective imagination with this concept of a moonshot of a people’s vaccine,” Maybarduk says, “and not miss our chance to make such a difference in this moment of humanity’s great need.”
Hadas Thier is an activist and socialist in New York, the author of A People’s Guide to Capitalism: An Introduction to Marxist Economics, and a regular contributor to Jacobin Magazine. She tweets at @HadasThier.