How Rich Countries Can End Vaccine Apartheid

“The world is in vaccine apartheid,” declared World Health Organization Director-General Tedros Adhanom Ghebreyesus in May, highlighting the moral crisis that many activists predicted early on. Relying on vaccine stockpiles in the millions, high-income nations in North America and Europe have been racing since December to vaccinate their populations against Covid-19, including people at a lower risk of death or hospitalization. Meanwhile, ever-more-transmissible variants of the coronavirus have continued to claim countless lives in low-income countries where, in many cases, even frontline workers have yet to receive a single dose.

In contrast to world leaders, who seem to be more willing to issue press releases about their commitment to end the pandemic worldwide than take any meaningful action, activists have come up with a range of policy proposals to get us out of vaccine apartheid as quickly as possible. Since the start of the pandemic, global justice activists have been working around the clock to stop the harms of medical patents while also developing proactive plans to help the world manufacture enough Covid-19 vaccines. Since Ghebreyesus’ May warning, however, little has changed on the global stage in terms of vaccine distribution, even as it becomes increasingly clear with the proliferation of new variants that, as activists say, this pandemic will not end anywhere until it ends everywhere.

Rather than make the bold moves activists have called for, U.S. President Joe Biden, German Chancellor Angela Merkel and their G7 peers consistently point towards their largely inadequate contributions to the Covid-19 Vaccines Global Access, or COVAX, as evidence they are addressing the global divide. Funded partially by the Gates Foundation, COVAX is a vaccine-sharing initiative set up to ensure immunizations worldwide, but it has consistently fallen short of its targets, and has so far delivered just over 120 million doses of the roughly 16 billion needed to vaccinate the globe. 

Perhaps the most surprising development in recent months has centered on activists’ call for the World Trade Organization (WTO) to suspend key patent rules for Covid-19 vaccines under its Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. After months of sustained grassroots pressure, President Biden shocked pharmaceutical companies in early May by backing the TRIPS waiver, a step that could allow manufacturers around the world to begin to develop cheaper, generic versions of the billions of vaccines urgently needed. And yet there has been little meaningful movement on this front, and the WTO announced in May it was aiming to finalize the TRIPS waiver in early December, even as thousands continue to die daily, an outcome that is largely preventable.

Activists say the proposed patent waiver, which was immediately opposed by Western pharmaceutical companies, is an important step because it would remove an obstacle to vaccine access. ​“If you think of vaccine-making as a race, a patent waiver is permission to enter the race,” said Achal Prabhala, coordinator of AccessIBSA, a project that campaigns for access to medicines and vaccines in India, Brazil and South Africa. ​“The reason that it’s important to have a WTO process rather than rely on companies to relinquish their intellectual property is that sometimes the companies don’t actually own their intellectual property. In most cases, every single vaccine that comes to market has been kind of cobbled together through patents from a range of different places that can be licensed, and then can be sublicensed. Some of those patents will be owned by the company that makes the vaccine, but definitely not all.” 

“There are typically anywhere between 100 to 200 patents covering each of these vaccines,” the activist explains. ​“A blanket waiver of the kind that we’re asking for really just removes all those legal obstacles,” he says, and prevents vaccine manufacturers worldwide from having to negotiate with various companies.”

Prabhala, who has been advocating for a people’s vaccine and a patent waiver since the start of the Covid-19 pandemic, says the TRIPS waiver will ensure that vaccine manufacturers do not face lawsuits for using patented vaccine recipes or related technology.

But ideally, activists say, an international response would go beyond merely removing an obstacle to vaccine access, and proactively help the world attain the vaccine in quantities large enough to stem the crisis. For example, Médecins Sans Frontières (MSF) has been urging wealthy countries that have vaccinated 20% of their populations to donate the rest of their stockpiles to COVAX. This, the humanitarian medical organization argues, is the fastest way to get as many shots in arms worldwide immediately, especially given that the world’s wealthiest countries have bought enough vaccines to immunize their own populations several times over. 

​“We’re now seeing rich countries hoarding the vaccines,” Lara Dovifat, campaign manager for MSF’s Access Campaign, told In These Times. ​“Rich countries are also making it difficult for poor countries to access medical tools — not only vaccines, but also potential treatments. One percent of people in developing countries have actually received one dose of 3.54 billion doses distributed worldwide. We have seen rich countries referring to their great commitments to COVAX, but [clearly] the delivery schedule is not really moving forward.”

“COVAX was probably always going to be inadequate, which is not the same as saying it’s not important,” says Peter Maybarduk, director of Public Citizen’s Access to Medicines campaign. ​“COVAX needs our support, and countries should meet the WHO Director General’s full funding request and get vaccines to as many people as possible as quickly as possible. It’s also the case that COVAX on its own can’t really retrofit manufacturing on the scale that’s needed.”

Dovifat also echoes a recent statement from the WHO condemning Pfizer and Moderna for pushing wealthy countries to consider vaccine boosters for their populations in the coming months as the majority of the world remains unvaccinated. Rather than give a third shot to people who have already built up significant immunity, WHO officials and activists like Dovifat and Maybarduk argue these 800 million shots should be going to other countries through COVAX or other supply routes. 

Dose-sharing, while the most immediate approach, is not the only thing activists at MSF and elsewhere are advocating for. As Prabhala, who calls COVAX a ​“ridiculous system that was designed to fail,” wrote in a recent piece for the Atlantic, ​“Relying solely on philanthropy or existing manufacturers has not produced enough vaccine doses — and is unlikely to do so in the future.” Western governments could help countries source the raw materials needed for developing Covid-19 vaccines to avoid a global bidding war over the necessary ingredients. And rather than use supply shortages as an excuse for delays, Prabhala adds, rich countries could also assist in the search for ​“second sources” — ingredients that can be used as replacements for materials that may be harder to acquire.

Another step is ensuring companies such as Moderna, Pfizer, AstraZeneca and Johnson & Johnson share not just their vaccine recipes but also their technology with manufacturers. As Prabhala and economist Joseph Stiglitz described in a Project Syndicate piece last year, the WHO’s Global Influenza Surveillance and Response System (GISR) already provides a successful model for the kind of knowledge-sharing and international scientific cooperation needed to address pandemics. Western governments also already have a lot more power to facilitate this process than they let on, Prabhala says. 

“The U.S. owns Moderna’s mRNA technology and the Johnson & Johnson vaccine to a large extent, having funded almost their entire cost of research and development,” says Prabhala, ​“Therefore, [the government] can force them to share their technology.” 

The U.S., British and German governments all poured large amounts of public money into developing the four vaccines that are currently commonly used. Most notably, as Prabhala indicates, the U.S. federal government has spent $6 billion dollars on the vaccine developed by the National Institutes of Health (NIH) and the Cambridge biotech company Moderna, prompting some to call it the people’s vaccine. Activists argue that this funding should in theory provide Western governments with leverage to compel the pharmaceutical companies involved to, at the very least, license their vaccines to more manufacturers. But leaders have allowed companies to retain full control over the government-funded vaccines. 

By contrast, says Prabhala, some vaccine projects, such as those in Russia, Mexico, and Cuba, have been ​“completely willing to share technology and licensing of their vaccines.” Each vaccine comes with its own unique set of conditions, processes and ingredients, making some vaccines, like the Sinovac-CoronaVac vaccine developed in China, harder to manufacture than others. It turns out, however, that among the least difficult to make are the mRNA vaccines developed by NIH-Moderna and Pfizer-BioNTech scientists. Based on this, the consumer advocacy group Public Citizen created a detailed plan in May for the United States to lead the way in producing enough Covid-19 vaccines to immunize the world’s entire population in one year.

“Leaders, including President Biden, can retrofit existing vaccine manufacturing facilities and other existing manufacturing facilities to produce safe and effective Covid-19 vaccines within six months all over the world,” says Maybarduk.

By following Public Citizen’s proposal, developed by chemical engineer Dr. Zoltán Kis and law and policy researcher Zain Rizvi, Maybarduk says a global network of manufacturers could ​“start churning out billions more doses, such that a year from now we’d have 8 billion doses of safe and effective mRNA vaccines that could make up the global shortfall and save a million lives and trillions of dollars.” According to Maybarduk, Public Citizen estimates that the cost of producing each Covid-19 vaccine could be as low as $30 per dose.

The Biden administration, Maybarduk told In These Times, could use existing legal frameworks, including the Defense Production Act, to require Moderna and Pfizer to share their taxpayer-funded technology and knowledge as the same time the U.S. government itself worked to ​“build the manufacturing capacity, coordinate the supply lines, and train the staff technical assistance” globally. The plan would ultimately create a network of regional vaccine production hubs that could later be used for any number of future disease outbreaks. The activist points out that an iteration of this idea is already taking shape in South Africa as the African continent suffers a deadly third wave.

“The South Africa mRNA hub that was announced by the World Health Organization is a more medium-term version [of the plan Public Citizen put forward],” says Maybarduk. ​“It is critically important for changing pandemic preparedness for the future and creating a greater degree of vaccine sufficiency for Africa. But it’s possible to do that on urgent footing to make a difference in this pandemic that requires much more political leadership that we’ve yet to see.”

As many activists have highlighted, there is plenty Western governments and companies can do to end vaccine apartheid. However, there is a role for everyday people to play as well. For one thing, deputy director of Justice Is Global, Ben Levenson, told In These Times that people in the United States and all over the world can join activists in direct actions and other forms of protest centered on ending the pandemic worldwide. Justice Is Global, a project run by the People’s Action coalition, is one of several grassroots movements working to raise awareness about vaccine apartheid, as well as increase pressure on leaders to improve access to Covid-19 vaccines. According to Levenson, the Biden administration’s shift on the TRIPS waiver is a great example of the power activism has to affect real change.

“We did change the U.S. government’s position on the TRIPS waiver, which breaks the veneer of this being too big, too inaccessible,” says the activist.

It’s not just the U.S. government that activists have set their sights on, either. Ahead of Merkel’s meeting with Biden last Thursday, MSF called for the U.S. leader to pressure his German counterpart to support the TRIPS waiver, while Justice Is Global held protests outside both the German embassy and the Pfizer headquarters in New York. 

“With enough people power and with the right plans that are serious and grounded in human needs and sound public health solutions,” says Levenson, ​“we can actually change the way that the whole [global public health] structure operates.”

Ria Modak contributed research to this article, and Antonia von Litschgi transcribed interviews.