Bissau, Republic of Guinea-Bissau - January 6, 2020: Street scene in the city of Bissau with cars in a road, Guinea Bissau

Bioethics Forum Essay

Covid Vaccine Patent Waivers are for Health Sovereignty

On May 5, U.S. trade representative Katherine Tai surprised the world with a tweet stating that “the U.S. supports the waiver of IP protections on Covid-19 vaccines to help end the pandemic and we’ll actively participate in @WTO negotiations to make that happen.”  The next day, Vladimir Putin expressed Russia’s support for the waiver.  And a week later, China also stated its support. That all three superpower rivals support Covid vaccine patent waivers puts them awkwardly on the same side against notable non-supporters, including European Union countries, the United Kingdom, Japan, South Korea, the vaccine makers, and Bill Gates. And, maybe for the first time, the Gates Foundation, a major funder and architect of the global Covid response, diverged from Mr. Gates’s views and publicly expressed its support for a narrow waiver.   

While we do not know what led up to Tai’s tweet, from early 2020 a global movement has been growing for Covid “global public goods,” including vaccines (a people’s vaccine, and the European Citizens’ Initiative No Profit on Pandemic). Initially spearheaded by civil society organizations and the head of UNAIDS, it has been gaining support from celebrities, academics, scientists, former politicians, and others worldwide.  The nightmare situation the earliest advocates were worried about–well before there were any effective vaccines–has come true. As of now, 80% to 90% of Covid vaccinations have been given in high-income countries, starkly dividing the world into the richest haves versus the rest. Only 1% to 2% of global vaccine supply has been administered in African countries as of May 2021. Current manufacturers, even with increased partnerships, cannot produce enough vaccines for the rest of the world for years to come. This means deaths in low- and middle-income countries (LMICs) will continue rising, their economies and other dimensions of social life will continue suffering, and new variants could arise potentially undermining what has been achieved everywhere.

The public goods movement has been growing in parallel to the establishment of the COVAX facility, which has been shepherding the fundraising, development, manufacturing, and global distribution of covid vaccines all within a patent-protecting and profit-incentivizing framework.  The initial aim was to have countries sign up with COVAX and pay in advance for doses covering up to 50% of their population. LMICs that could not finance purchases would be covered by other COVAX members and funders to receive doses for up to 20% of their population according to fair allocation schedule. This model has largely been undermined by rich countries as they sidestepped COVAX and made bilateral agreements directly and often with multiple vaccine manufacturers, buying up most of the doses available now and for years to come.  So far, COVAX has purchased 1.1 billion doses and distributed about 70 million doses largely to LMICs. Various reports state COVAX has a funding gap of $6 to $12 billion for its distribution plan for 2021. And its existing distribution schedule became severely constrained when a major supplier in India was banned from exporting vaccines.

 Another strategy for increasing the global supply of Covid vaccines worldwide is to make the formulas and manufacturing know-how freely and openly available by temporarily removing patent protections. Given the global emergency, the idea is to get as many manufacturers as possible producing Covid vaccines as quickly as possible. So, last October, the governments of India and South Africa, two key players in increasing the global access to HIV drugs in the late 1990s, jointly put forward a proposal at the WTO for a temporary waiver from the 1994 TRIPS agreement for vaccines, as well as therapeutics, diagnostics, and other medical tools for Covid-19.  It is now being cosponsored by over 100 countries. Importantly, the U.K. and Germany, home to some of the Covid vaccine producers, as well as other of the world’s richest countries, have stated their opposition to such a waiver.  Up till now, countries home to major pharmaceutical companies, especially the U.S., have vehemently defended IP protections at the WTO, even during other health emergencies.

Tai’s tweet sent out during a WTO meeting, was likely well-timed.  It gave the world’s seven richest countries about one month to negotiate an agreement among themselves before their leaders meet in person from June 11 to 13 in the U.K. The move also helped begin to restore the U.S. as a global leader. Yet, even with U.S., Russia, and China support, the likelihood of the WTO waiver proposal going through is very low, as all member countries have to support it.  But the U.S. support opens up space for creating something better than the current situation, which has been called vaccine apartheid. And, indeed, on May 21, at a Global Health Summit jointly organized by the EU and G20, billions of vaccine doses and additional financial funding for LMICs were pledged by CEOs of pharma companies, EU national leaders, and others.

The most prominent critique of the patent waiver proposal is that IP protection is not the real problem to greater global access to covid vaccines. Instead, it is  manufacturing capacity, technology transfer, import tariffs, and other logistical issues, including the lack of raw materials, a point repeatedly expressed by Charles Michel, president of the European Council, and by heads of pharmaceutical companies and trade organizations. But waiver advocates have not argued that patents are the only or main challenge to providing more vaccines everywhere, but rather that the waiver is a necessary step in ramping up worldwide manufacturing.  Even in the best-case scenario of a patent waiver, it would still take at least months to get manufacturers worldwide online. Some have already offered to help but have been rebuffed or ignored by patent holders.

Moreover, underlying the waiver proposal is the attempt to break dependency by LMICs on rich countries for vaccines and other health care goods. First, rich countries have not only undermined COVAX by not funding it and by buying up available vaccines, they are also ignoring its fair allocation framework by distributing their “excess” vaccines to specific countries in line with their own national and strategic interests.  And, second, even before Covid, many LMICs were importing most of their pharmaceuticals, diagnostic tools, and other health care goods. The waiver is a potential way of sidestepping rich countries’ vaccine stratagems and helping their populations survive this pandemic as well as building up local vaccine manufacturing capacity for the future. That is, more than 100 LMICs want to bolster their national health sovereignty. There are already efforts under way in the E.U. to assess and reduce its dependency on third parties for health care goods and services and increase its autonomy in future public health emergencies.  While rich countries increase their self-reliance, the continued pleas for and rhetoric of donating excess Covid vaccines to LMICs obfuscates the more fundamental claim being made for health sovereignty by leaders of the vast majority of the human population.

A temporary patent waiver would likely save more lives in LMICs as the number of doses produced by current manufacturers will not be sufficient to cover the world’s population for years.  And the technology transfer would allow a number of LMICs to establish domestic vaccine manufacturing, as well as help other countries break free from the dependence on the generosity and national interests of the world’s richest countries.  Such a world would be better than what we are currently living in.

Sridhar Venkatapuram (@sridhartweet) is an associate professor of global health and philosophy at King’s College London, and Chair of the International Resource Group for Global Health Justice (IRG-GHJ). Anna C. Zielinska is an associate professor of moral, legal, and political philosophy at the University of Lorraine, in Nancy, France, and at Sciences Po Paris. She is a member of the IRG-GHJ.

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