One Year Ago, Biden Promised to Support Generic Vaccines for the World. That’s Amounted to Nothing.

A conversation with South African public health activist Tian Johnson about outrageous global inequalities in access to Covid vaccines, tests and treatments.

Sarah Lazare

Protesters march to the South African Health Products Regulatory Authority offices in Pretoria, on June 25, 2021. They were demanding that vaccines from Russia and China be supplied to South Africans PHILL MAGAKOE/AFP via Getty Images

Today marks one year since the Biden administration said it would support waiving intellectual property protections for Covid-19 vaccines” at the World Trade Organization (WTO). At the time, the announcement was met with an outpouring of hope that such a waiver, if passed, would allow Global South countries to manufacture their own generic versions of vaccines, tests, and treatments, and thereby close the international gap in access to life-saving technologies. Because the United States wields so much power at the WTO, many public health advocates assumed that if the Biden administration wanted to get a waiver passed, it could.

But in the year since, the Biden administration has failed to deliver. U.S. representatives have dragged their feet at the Council for Trade-Related Aspects of Intellectual Property Rights (TRIPS), the body that oversees intellectual property rules at the WTO. The Biden administration declined to support the version of the waiver (commonly referred to as a TRIPS waiver) that was initially proposed by India and South Africa in October 2020, and has not done enough to stop the European Union from obstructing progress on an agreement that has teeth. A new proposed agreement on intellectual property now circulating at the TRIPS Council has been blasted by global health activists for excluding tests and treatments, cutting off entire countries (like China and all developed” nations), and imposing new barriers to the production of generics. Alongside the European Union, the United States bears responsibility for some of the harmful provisions in this proposal, though the Biden administration has not yet said whether it endorses the text.

Overall, the picture is grim: The WTO seems far from passing a satisfactory intellectual property waiver, though global health activists aren’t giving up. In the meantime, U.S. funding for global vaccinations and pandemic aid has dried up, in the face of outright GOP obstruction, and the Biden administration has fallen woefully behind in delivering on vaccine pledges. With other wealthy countries failing as well, global vaccine inequalities are staggering. Just 21.3% of the population of the entire continent of Africa has received at least one vaccine dose. This compares to 79% in the United States and Canada. In Burundi, just 0.1% of the population has been fully vaccinated, and in Haiti, just 1.1%. Researchers have identified 120 manufacturers in Asia, Latin America and Africa that have the ability to start making mRNA Covid-19 vaccines, but are unable to because Moderna and Pfizer will not share the recipes and technological know-how. And as efforts to free intellectual property falter, it’s looking increasingly clear that governments will not compel those companies to do so.

In These Times spoke with Tian Johnson, founder and strategist at the African Alliance, which works to secure social justice and dignified healthcare across the continent of Africa. Johnson is also community co-chair of the African Vaccine Delivery Alliance, which is an initiative of Africa’s Centers for Disease Control and Prevention, and was set up to ensure the rapid deployment of vaccines and associated supplies/​equipment,” according to its organizational description. Johnson, who is based in Johannesburg, South Africa and does work across the continent, has been an activist for 20 years, focusing on public health support for people with HIV and AIDS, reproductive health and prevention of gender-based violence.

What would the concrete effect of having a real robust TRIPS waiver be on vaccine supply across the Global South?

Tian Johnson: A meaningful TRIPS waiver equals a step towards independence. A meaningful TRIPS waiver means that we are able to take our destiny into our own hands sooner. It means that we will no longer be beholden to pharmaceutical companies of the Global North.

But I think, also, we have to focus our energies on initiatives like the WHO mRNA hub. The hub has already been undermined by Moderna, which has applied for patents in South Africa relating to its Covid-19 vaccine, meaning the company could seek to prevent the hub from making its own version of the mRNA shot.

We cannot go into the next wave of the pandemic relying on Johnson & Johnson, relying on Moderna, to be benevolent, to be generous — not even generous, but to treat us as beneficiaries of their good will. That’s not how justice works. We’ve never demanded charity, we’ve always demanded justice. And that means if you have the answer to reducing death and hospitalization, if you have the answer to reducing severe illness as a result of the pandemic, and you are refusing to share that with us, that tells us you are not on the side of humanity — you’re not on the side of saving lives.

We’ve known this: These are the same pharmaceutical companies that took the government of Nelson Mandela to court when we were struggling for access to antiretrovirals in this country. So we are not holding our breath. We’re not waiting for pharma to have an Aha!” moment. We’re not waiting for the secret number — X billion dollars — of profits to be reached before Moderna says, Okay guys, we’ve reached the peak of our profits. Let’s now help everyone else stay alive.” We’re under no illusions that they will have a moment of reckoning, or that they will develop a conscience. This is what they do. They’ve shown us this with HIV, and now they’re showing us this with Covid. And if we don’t act drastically to destabilize the current status quo, this pattern will be repeated in the next pandemic.

[Editor’s note: In 1998, the Pharmaceutical Manufacturers Association of South Africa and 39 pharmaceutical manufacturers, including Merck, sued the South African government, accusing it of violating the TRIPS agreement through its legislative reforms aimed at expanding access to life-saving AIDS medicines. The lawsuit named Mandela as the first defendant. The companies eventually dropped the lawsuit, following bad publicity.]

One year ago today, the Biden administration said that it was going to support an intellectual property waiver. Do you feel that the administration has delivered on the spirit of that promise?

Tian: I think absolutely not, and it’s a reflection of how weak the leadership has been, from all quarters, whether the Global North or the Global South. There’s been leadership shown by South Africa and India in really pushing for this waiver, and when we heard that Biden had stated his support of the waiver, it really gave us hope.

But 12 months later, it’s very clear that the current Biden administration is under pressure by pharmaceutical companies not to share tech, not to share know-how. You can’t help but make the links and begin to think, How much influence and pressure does big pharma have on the White House?”

It will be interesting to see how this second Covid summit next week manifests. It’s stunning to us that the Biden administration can convene a global summit and not bring anything to the table. How are you expecting all of your so-called guests to put funds for the global Covid response in a bucket when your very own Congress is not only cutting Covid relief spending, but pushing back against funding the global response?

We are ready to call on Congress to have a reality check: Your third or fourth doses are great, but in Africa, where we have yet to vaccinate even half of our healthcare workers, what does that mean? This pandemic cannot be over with Africa sitting here facing our fifth wave. It’s a fifth wave of death, it’s a fifth wave of destruction of livelihoods. This pandemic is anything but over.

In the United States, there is a growing perception that the pandemic is over. Can you talk a little bit more about how it isn’t over for people in South Africa and for the continent of Africa?

Tian: In a continent where we have yet to vaccinate even half of our healthcare workers, how does anybody with a functioning mind say the pandemic is over? The reality is, the next variant will teach America, the next variant will teach Europeans — all of whom have stood in the way of expediting the end of the pandemic, and in complicity with pharma in their lust for profits over lives — that the pandemic is not over.

So, despite all the boosters, the fact that Americans are vaccinating their zoo animals, while we do not even have access to a first shot, tells us everything we need to know about the perverted global health system. It tells us all we need to know about the urgency to decolonize global health, and reminds us again that global solidarity” is a lie. So within that context, we would say to folks in America, to the world really, that it’s spectacularly naive, it’s spectacularly short-sighted, and it’s totally unscientific to say that the pandemic is over” with such large portions of this continent being unvaccinated. It’s absolutely staggering that we should even have to advocate for this.

And we’re seeing key players — from U.S. lobbyists to Bill Gates — pushing a narrative that we all just need to move on now.’ Gates just launched a book titled, How to Prevent the Next Pandemic.” So, in his mind, we’ve already moved on. And so what does that mean in a continent like ours?

Some seek to justify vaccine apartheid by making the argument, We’re giving the vaccines at the African continent, but countries are not distributing them and there was vaccine hesitancy.” What is your response to those arguments?

Tian: One of our biggest failings in the pandemic has been communication: We’ve left communities behind. We’ve seen global summits, we’ve seen press junkets, we’ve seen these high-level meetings, we’ve seen multi-billion dollar funding and donations to multilateral bodies. But none of them can convincingly stand in front of us and explain how they brought communities along.

Back in the day, I used to run programs on reproductive health. We would advocate for every dollar that you spend on a condom, you need a dollar to spend on programming it. People don’t just magically uptake these health interventions, right? And so, one of the biggest injustices is the lack of resources that have gone to community engagement, to ensure that those vaccines get into arms. And I think that’s one of our biggest tragedies.

It’s the double standard that is shocking. No one called for a halt on vaccine supply to the U.S. or the E.U., which have significant anti-vax populations. Instead, the opposite happened. America was flooded with vaccines to the point where you had no idea what to do with them. But the minute Africans started demanding the same? They’re hesitant? Can they absorb it? Can they handle it? Do they know what to do with it? What will happen to the cold storage? Will they steal the fridges?”

What are the demands that you have for the Biden administration?

Tian: First of all, we want leadership. That means the American public calling on their elected representatives to demand that a vaccine that has been developed using their money — not Moderna’s goodwill fund, not personal funding of Moderna’s shareholders — their money. It is your American taxpayer dollars that have made the Moderna vaccine possible, and it should be shared if you truly believe that your destiny is tied in with mine.

We want the Biden administration to show some leadership and take urgent and aggressive action to allow that recipe, tech and know-how to be shared. The success of the WHO’s hubs depends on it. Part of our future, and part of the way we respond to the next pandemic, depends on it. Moderna needs to share the recipe because it’s not theirs to keep.

We want you to get angry about the fact that this private pharmaceutical company, that is churning out billionaires, is refusing to share a life-saving technology with the rest of the world. And if that’s not good enough to move you, think about your next safari to Africa. Think about your next visit to Table Mountain. Think about the next time you go to Kenya to see the giraffes. And then think about that variant that will stare you in the face. Think about how your voice could have ensured that we never have to face another variant.

The second issue is around Congress. And it’s around ensuring that Congress meaningfully funds the domestic and the international Covid response. The fact that your Congress can refuse to support an international response to a pandemic that has done the damage it has done, and will continue to do, wave after wave after wave, is something that needs to deeply concern Americans.

Do you have any demands around the TRIPS waiver? Would you like to see Biden support the version that was initially proposed by India and South Africa?

Tian: Well, we would call on the U.S. to reject the leaked text. What we would like Biden to support is what South Africa and India have called for in October 2020 — a full TRIPS waiver. Anything less will lock us into this pandemic. What it practically means is that we will not be able to manufacture vaccines, tests, and diagnostics to the scale that we need to.

In this continent, if you are a teacher in Zimbabwe, half of your salary goes to a Covid test. It’s unacceptable that, in the same year, a primary school child, a seven-year-old in Germany, arrives at the primary school and they’re given a self test and they test themselves. And at the end of that testing period, the class raises their hand and they say who’s tested positive, who’s tested negative. And the children who have tested positive, they go home to rest. But the rest, they stay in that classroom and they move on with their day. So why is the right of that seven-year-old German child not comparable to the rights of a 34-year-old teacher in Harare, Zimbabwe who cannot afford a test, and who has to make the choice between knowing their Covid status or buying bread?

Why is it such a difficult equation for the world to understand that until we have vaccine equity, testing equity, treatment equity, we will be here, year after year after year? And that is why we fight and will continue to fight for justice.

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Sarah Lazare is the editor of Workday Magazine and a contributing editor for In These Times. She tweets at @sarahlazare.

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