President Joe Biden is meeting with the G7 leaders of other wealthy nations Friday to discuss global plans to defeat COVID. Meanwhile, the United States is under growing international pressure to reverse course from the Trump administration and lead the world toward ending massive global disparities in vaccine and treatment access that threaten to stretch the deadly pandemic out for years.
Hanging in the balance are an untold number of human lives — and the profit margins of private pharmaceutical companies that developed vaccines and the technology needed to make them with help from the U.S and other rich governments.
In October, India and South Africa asked the World Trade Organization to waive international patent and intellectual property agreements covering COVID vaccines, treatments and diagnostic tests until global herd immunity is reached. This step would allow all countries to quickly manufacture and distribute generic and biosimilar versions. Falling in line behind the Trump administration, the European Union and wealthy nations such as Australia and Japan have opposed the waiver while hoarding supplies and vaccine doses.
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Negotiations at the WTO over the waiver have stalled, and proponents say time is running out. The virus is mutating into multiple variants that may spread more easily and undermine some of the efficacy of current vaccines (although vaccines have so far still been shown to prevent lethal COVID). The virus also knows no borders, and efforts by wealthy nations to vaccinate their populations first will be meaningless if the developing world is left behind, according to Mustaqeem De Gama, a South African ambassador to the WTO.
“It cannot just be the case where rich countries can buy up all the vaccine production, vaccinate all their populations, and expect the problem to go away, because these mutations will not respect any borders, they will not respect creed or color,” De Gama said during a virtual press conference on Thursday.
Under President Donald Trump, the U.S. embraced “vaccine nationalism,” prioritizing the vaccination of its own citizens and disregarding the rest of the world. The country funneled billions of public dollars to private pharmaceutical companies to develop a vaccine and then bought vaccine doses to distribute only within its borders. Trump also shunned various international pandemic agreements and attempted to withdraw the U.S. from the World Health Organization, a move quickly reversed by Biden, who pledges to restore U.S. leadership on the global stage.
Other wealthy nations have also rushed toward vaccinating as many of their own people as possible by pre-ordering billions of doses as vaccines are developed. On Wednesday, United Nations Secretary General António Guterres warned that global vaccine development has been “wildly uneven and unfair,” and just 10 countries had administered 75 percent of vaccine doses, while 130 poor countries had yet to receive a single dose.
Currently, wealthy nations and the European Union have pre-ordered 4.6 billion vaccine doses – more than half of the 8.2 billion doses currently reserved globally, according to the Duke Global Health Innovation Center. Another 4.7 billion doses are under negotiation or reserved as optional expansions of additional deals between wealthy nations and manufacturers.
In contrast, the world’s poorest nations have pre-ordered about 670 million doses. COVAX, an international private-public fund for providing vaccines to the developing world, has reserved another 1.1 billion doses, a number De Gama and other proponents of the WTO patent waiver say is vastly insufficient. Under current projections, there will not be enough doses to cover the world’s population until 2023 or 2024 unless global trade policies change and production is increased. Meanwhile, Canada and some other wealthy nations have reserved enough doses to vaccinate their population several times over.
Rep. Jan Schakowsky, a Democrat from Illinois who works to lower drug prices, told reporters on Thursday it’s “embarrassing” that the Trump administration backed the intellectual property rights of pharmaceutical companies that want to profit off the pandemic by opposing the WTO patent waiver.
“The fate of humanity right now in many ways is riding on this waiver … with the variants that are developing, time is of the essence right now,” Schakowsky said.
Along with a coalition of U.S.-based activist groups and leaders of lower and middle-income countries, Schakowsky is petitioning Biden to reverse U.S. opposition to the WTO waiver. The congresswoman is currently rallying support for the waiver among House Democrats, and she said Speaker Nancy Pelosi recently signaled her support.
Advocates say manufacturing technology, trade secrets and technical “know-how” are at the center of the intellectual property fight. The limited number of pharmaceutical companies that have developed vaccines, often with help from governments, are unable to manufacture enough doses fast enough to contain the pandemic globally.
Monopoly rights over the vaccines themselves drive up prices, giving wealthy nations first access. However, with access to patented technology and proprietary manufacturing knowledge, lower-income countries could develop their own vaccine supply lines to satisfy global demand. Taxpayers in the U.S. and other countries have already paid for vaccine development — the U.S. alone budgeted about $18 billion through a private-public vaccine development program — and advocates argue that resulting technology and know-how should be shared with the world.
Opponents of the WTO patent waiver and the pharmaceutical industry point to voluntary licensing contracts between major vaccine players and firms in lower-income countries that allow for increased vaccine production globally, but many of these contracts remain shielded from public view and are designed around private profit margins.
For example, De Gama pointed to a voluntary licensing agreement between the U.S.-based company Johnson & Johnson and the South African firm Aspen to manufacture Johnson & Johnson’s candidate vaccine. The vaccine could soon be approved in the U.S., but Johnson & Johnson is reportedly low on supply.
While voluntary licensing will allow Aspen to manufacture 300 to 400 million doses in South Africa, under the agreement only 9 percent of doses will stay in the country, while Johnson & Johnson can redirect the rest to buyers in other nations, De Gama said. However, with a WTO patent waiver, countries like South Africa could scale up capacity to produce and distribute vaccines as quickly as possible.
“The biggest obstacle so far has been the political will of governments to cooperate and find common solutions to a global problem…. The longer we take to reach an agreement, the more people who will die,” De Gama said.
In addition to supporting the WTO patent waiver, experts say there are other steps that can be taken quickly. The U.S. can leverage its stake in the Moderna vaccine, which was developed with $2.5 billion in taxpayer funding from U.S. health agencies, to share the mRNA vaccine technology with manufactures around the world.
With a $25 billion investment from Congress that would reimburse Moderna and repurpose existing manufacturing infrastructure for vaccine production, the U.S. could produce enough vaccines for all developing countries for about $3 per dose, according to research by Public Citizen’s Access to Medicines Program. In contrast, the price tag of Biden’s proposed pandemic relief package is $1.9 trillion. A recent study by the International Chamber of Commerce found that the global economy stands to lose as much as $9.2 trillion if advanced economies fail to develop vaccine access for the rest of the world.
“In shortening the pandemic, this proposal would pay for itself many times over,” said Peter Maybarduk, director of the Access to Medicines Program. “It would save hundreds of thousands of lives. It would shorten the period of mitigation measures which are costing trillions in lost economic output.”
In an email, Maybarduk said that a U.S.-led global vaccine production program would complement efforts to scale up vaccine manufacturing capacity in the developing world by lifting trade restrictions on sharing intellectual property and patented manufacturing technology at the WTO.
“The [WTO patent] waiver lifts intellectual property barriers to countries manufacturing their own diagnostics, medicines and vaccines,” Maybarduk said. “Technology sharing can make those efforts operational and, in every case, manufacturing investments are needed to help get the world to scale.”
Schakowsky said she remains confident that Biden will reverse Trump’s policies and support global efforts to boost the production of COVID vaccines by sharing information and technology, even if that “know-how” is considered proprietary under current international trade agreements. For now, all eyes are on Friday’s meeting of the G7 nations, which includes Japan, Canada and European Union countries that have already bought out large portions of the global vaccine supply.
“As we say, no one is safe until everyone is safe,” De Gama said.