End Vaccine Apartheid Now

WHO calls for moratorium on COVID-19 vaccine boosters. Image Source

 

By Jack Gerson

On August 4, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), called for a moratorium until at least the end of September on the use of Covid-19 vaccine booster shots by wealthy nations, saying that the global priority should be on increasing supplies of first doses to countries that are still struggling to protect health workers and older adults.

More than 80% of the Covid vaccine doses administered to date have gone to high-income countries that account for less than half of the world’s population. High- and middle-income countries have administered nearly 100 doses for every 100 people; low-income countries have administered only 1.5 doses per every 100 people “because of lack of supply”, according to Tedros. Only about 1.5% of Africans have been vaccinated -- in Nigeria, Africa’s most populous country, well under 1% have been vaccinated.

Tedros said that the aim of the moratorium would be to vaccinate at least 10% of the population of every country, making the global priority vaccinating those at greatest risk by increasing supply of first doses to those countries -- overwhelming low-income countries -- that are struggling to even vaccinate their health workers and elderly.

Asked about the W.H.O.’s call for a moratorium, Jen Psaki, the White House press secretary, said, “We feel that it’s a false choice, and that we can do both.” (So then why haven’t we? Why aren’t we?)

In contrast, Helen Clark, former New Zealand prime minister and co-chair of an influential Covid panel, criticized affluent countries for buying up many more vaccines than they require, and for the most part only redistributing their surplus when the vaccines are approaching their expiry date.

‘“Inequitable manufacturing and distribution of vaccines is behind the wave of death which is now sweeping across many low- and middle-income countries that have been starved of vaccine supply,” said Dr. Soumya Swaminathan, Chief Scientist of the World Health Organization.’

The arrival of effective vaccines dramatically reduced death and hospitalization rates in countries able to carry out mass vaccination campaigns, providing hope that the pandemic can be brought under control. That hope persists: while vaccines are not as effective in preventing symptomatic infection from the Delta variant as they were against previous variants, they remain nearly as effective in preventing infections serious enough to require hospitalization. But the pandemic will not be brought under control so long as much of the world’s population remains unvaccinated. Covid-19 spreads and mutates most rapidly in unvaccinated areas, causing sickness and deaths and likely producing new lethal variants that will spread to more fully vaccinated countries. We see this now, as more transmissible and resistant variants have emerged, the Delta (Indian) variant, far more transmissible than previous variants. (Another highly transmissible variant of concern, the Lambda variant, has swept through Peru and neighboring South American countries, and has recently been detected in the U.S.)

No one will be safe until everyone is safe

That message has not been heeded by affluent countries and pharmaceutical corporations that dominate manufacturing and distribution of the vaccines. Promises were made, but those promises were not kept. As recently as this spring WHO had hoped that donations from affluent nations and vaccine manufacturers would make it possible to vaccinate at least 20% of the population of low-income countries. Now, we see from Dr. Tedros’s statement, the target is 10%, and even that seems optimistic.

A shift in global vaccine distribution is essential. But it’s not enough. It's not enough to just redistribute what's currently being manufactured. There needs to be a sea change in manufacturing as well as distribution. Patent walls need to come down. Technology needs to be shared and transferred, so that manufacturing is decentralized, and assistance in getting manufacturing going and up to speed takes place around the world.

In May 2020, WHO created the COVID-19 Technology Access Program (C-TAP) to provide a locus for developers of therapeutics, diagnostics, and vaccines to share intellectual property and know-how with qualified manufacturers around the world. It’s now fifteen months later, yet zero vaccine manufacturers have signed on to share their manufacturing technology.

In May 2021, Biden said that patent walls should be lowered for Covid vaccines, but that was just a pro forma statement with no teeth and no follow through. BIg Pharma issued a statement on its web site taking Biden to task for messing with "innovation" -- even though most of the key innovation for the mRNA vaccines was done in government and public labs, and the rest with public funding, including $10 billion disbursed to pharmaceutical manufacturers in spring 2020 by “Operation Warp Speed.”

What we’ve seen thus far --the hoarding of nearly all global vaccines by rich countries -- recapitulates what transpired during the 2009 H1N1 flu outbreak.Then, too, affluent nations cornered the global vaccine market and virtually locked out the rest of the world.  The 2009 flu outbreak should have been a dress rehearsal for how to respond to the current pandemic. But the 2009 pandemic fizzled out, far less lethal than had been anticipated. And no lessons were learned. Instead, the corporate pharmaceutical manufacturers were once more allowed -- even encouraged -- to profiteer, and the affluent countries locked up global supply by outbidding the rest of the world. Only this time, our luck ran out. This pandemic hasn’t fizzled.

It’s well past time to take down patent walls that prevent access to vital health care, be that vaccines, therapeutics, access to medical professionals or hospitalization. Indeed, it’s time to take the health of the world’s people out of the hands of the pharmaceutical and health insurance industries. For decades, they have held back development and provision of what people really need by prioritizing their profits and their control over what we all need.

Covid-19, alas, is not likely to be the last global health crisis, nor even the last viral pandemic, that we will face. The pharmaceutical industry has demonstrated that it won’t be ready in advance, will only act if it is guaranteed gigantic profits, and then will act in ways that favor the rich and put the poor in harm’s (and death’s) way.

What’s needed is a reorganization of the way health care, public health, and biomedicine is organized and delivered, locally and globally. Human lives should not have a price tag; health should not be sacrificed to profit. To make this happen will require a radical reorganization of social priorities and society itself. It’s not too soon to organize and fight for that.

Nearly six months ago, I wrote an article on vaccine apartheid for the South African journal “Amandla!’ It ended with the last two paragraphs above. The article’s analysis and predictions have held up well, so we’re reprinting it here now:

Vaccine imperialism: If no one is safe until everyone is safe, then no one is likely to be safe

March 16, 2021
 

By Jack Gerson

The arrival of effective vaccines against Covid-19 provides hope that the pandemic that has infected over 100 million people and killed over 2.5 million can be brought under control. But that will not happen while much of the world’s population remains unvaccinated. In largely unvaccinated areas, the virus will continue to spread and mutate, causing sickness and deaths and producing new lethal variants that will spread to more fully vaccinated countries. We are seeing this now, as highly transmissible and resistant variants have emerged in the UK, Brazil, and South Africa.

No one will be safe until everyone is safe.

But that message is not being heeded by affluent countries and pharmaceutical corporations that dominate manufacturing and distribution of the vaccines.

Big Pharma

The pharmaceutical industry has a deserved reputation for profiteering to the detriment of the public good, and it’s at it again. Pfizer expects profits of $15 billion from vaccine sales this year, while Moderna’s stock price has soared. Oxfam estimates that universal vaccine access requires a price under $3.40 per dose, but Pfizer and Moderna charge five times that, pricing their coveted vaccines too high for low and middle-income countries to afford an adequate amount. (AstraZeneca is the exception: it prices its vaccine at $2 to $5 per dose.)

Consequently, vaccines are acquired disproportionately by high income countries, who hoard supply. The US, the UK, and a few others have bought or reserved rights to well over a billion more doses than they need to vaccinate their entire populations. Rather than donating excess doses, they are buying up the rights to still more vaccine.

The U.S. position was expressed by a Biden administration official quoted in the February 18 New York Times: "The United States will not share vaccines now, while the domestic vaccination campaign is expanding."

In contrast, over 100 countries have yet to administer any vaccine. Vaccination of health workers in sub-Saharan Africa and parts of Asia has barely begun. Most of the world’s masses have little prospect of getting vaccine from Big Pharma this year.

Covax

In anticipation of such a scenario Covax, a vaccine-sharing alliance sponsored by the World Health Organization, last fall set a goal of acquiring and distributing 2 billion doses to 142 developing nations in 2021. Covax estimates that it needs to raise $33 billion to meet its target. It has only raised one-third that amount. G7 countries have only contributed $7.5 billion. Pharmaceutical corporations have pledged to make 2 billion doses available, but it’s not likely to happen this year, as the US and friends outbid Covax for available vaccine. Covax now projects that by the end of May, it will only have supplied enough vaccine to vaccinate 3.3% of the population of 142 developing nations. Covax goals are worthy, but it’s had great problems delivering on them, and even in the unlikely event that it acquires its 2 billion dose target this year, that would only be enough to vaccinate 20% of the population of its 142 target countries. It’s not negligible: at a minimum, Covax will provide enough vaccine to ensure that health workers and some of the most vulnerable have access to vaccination. But a lot more is needed.

Low and middle-income countries are scrambling on their own to find vaccine sources. Unable to afford the Pfizer and Moderna vaccines and getting only a small amount of their needs from Covax, they have been forced to look elsewhere.

Alternative vaccine sources

China, Russia, and India are exporting vaccine, and Cuba (in collaboration with Iran) is conducting clinical trials on multiple candidate vaccines.

Russia has reported deals to supply 1.2 billion doses of its Sputnik V vaccine abroad this year. Sputnik V is recognized to be highly effective, but limited manufacturing capacity makes it  unlikely that anything close to the target of 1.2 billion doses this year will be reached.

Four leading Chinese vaccine manufacturers have pledged to supply about 500 million doses abroad this year, targeting low and middle-income countries.  Inoculation with Chinese manufactured vaccines are already under way in more than 30 countries. Some vaccine from China is donated; some is sold for cash; some is sold with debt financing.

China of course expects to make foreign policy gains from vaccine diplomacy, and much of it may not be benevolent. For example, opposition Turkish legislators are accusing the Erdogan government of selling out China’s viciously repressed Uighur minority in exchange for access to Chinese manufactured vaccine.

Chinese vaccine manufacturers have not made public any detailed results from Phase III clinical trials, and the summary figures they have presented have not been impressive.

For most of the world, there’s little choice: in the words of an Egyptian official: “Vaccines, particularly those made in the West, are reserved for rich countries. We had to guarantee a vaccine. Any vaccine.”  And the right-wing Serbian nationalist Aleksandar Vucic commented: "Did we turn to the Russians and the Chinese? You have built very expensive lifeboats for you. And whoever is not rich and is small, is condemned to sink with the Titanic."

Even under the wildly optimistic scenario that Covax, Russia, and China all meet their ambitious production targets, only about 40% of the population in the 142 developing countries would be vaccinated this year. In contrast, the US, the UK, Israel, the UAE and a few other affluent countries expect to vaccinate their entire adult populations by fall. (Because of manufacturing backlogs and bureaucratic red tape, EU countries are lagging in acquisition of vaccine; some EU countries are trying to make their own deals.)

Likely scenario

It’s likely that the following scenario will play out: after the US and its affluent friends are fully vaccinated, more first generation (i.e., this year’s) vaccine will be made available to developing nations – some excess doses donated from the US et al, more made available by pharmaceutical companies, perhaps at cut rates. But by then, it’s likely that new variants resistant to this year’s crop of vaccines will have emerged, and in response Western pharmaceutical companies will be producing booster shots and second-generation vaccines effective against these new variants. The US and friends will corner the market on these. This could recur over and over, with the haves being the first to get protected and the have-nots being left unprotected again and again.

There are alternatives

This does not have to be. The rapid development of the Covid-19 vaccines shows what can be done when the research community shares information and works cooperatively. It gives us a glimpse of what could have been done over past decades when Big Pharma, acting as rent-collecting patent holders, blocked development.

Vaccines might have been developed in advance of the pandemic, including vaccines capable of stimulating immunisation against a wide range of coronaviruses. For example, five years ago virologists at Baylor University College of Medicine applied for funding to develop a vaccine that would be effective against all coronaviruses – a pancoronavirus vaccine. They were denied funding. Now such research is underway. Research is further along on developing vaccines effective against any SARS-Cov-2 variant. Clinical trials will soon be under way on antiviral nasal inhalants capable of preventing infection by blocking the virus’s entry.

Such research should take place in all health-related areas, and it should be done collaboratively with knowledge freely shared. It shouldn’t take a pandemic to make that happen. The resulting products should likewise be made available to all, especially those most in need. The covid vaccines should not be the intellectual property of Big Pharma corporations, sequestered behind patent walls. They should be in the public domain, freely accessible, no profits taken. More biotechnologically advanced countries should help others to develop manufacturing and distribution capabilities. Vaccine should be made globally available, not hoarded by the rich countries and denied to poor ones.

Covid-19 may not be the worst health threat we face in the near future. In the past twenty years, we have seen Sars, Mers, and now Sars-CoV-2 (the virus responsible for Covid-19). The pharmaceutical industry has demonstrated that it won’t be ready in advance, will only act if it is guaranteed gigantic profits, and then will act in ways that favor the rich and put the poor in harm’s (and death’s) way.

What’s needed is a reorganisation of the way health care, public health, and biomedicine is organised and delivered, locally and globally. Human lives should not have a price tag; health should not be sacrificed to profit. To make this happen will require a radical reorganisation of social priorities and society itself. It’s not too soon to organise and fight for that.

Jack Gerson is a writer and retired teacher in Oakland California. He has a PhD in biostatistics, and has worked on epidemiological and genetic research.