Analysis

How to End Vaccine Apartheid

The United States has failed on its boast to be an “arsenal of vaccines.”

By , a writer and journalist based in Goa, India.
Women stand in a queue as they wait to receive a dose of the Covishield vaccine against COVID-19 at a primary health center in Siliguri, India, on Aug. 2.
Women stand in a queue as they wait to receive a dose of the Covishield vaccine against COVID-19 at a primary health center in Siliguri, India, on Aug. 2. DIPTENDU DUTTA/AFP via Getty Images

In May, U.S. President Joe Biden declared the United States could become the world’s “arsenal of vaccines.” Later that month, his administration backed the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver, which would suspend intellectual property protections for pharmaceutical companies, allowing vaccines to be produced cheaply and in bulk. Amnesty International hailed the move as an important first step: “By reversing the prior administration’s position,” declared the group’s executive director, Paul O’Brien, “President Biden has made clear that the U.S. prioritizes people’s lives over pharmaceutical company profits.”

Six months later, the TRIPS waiver is dead in the water. Negotiations over the proposal were slated to begin in June, but the process never got underway, with steady opposition from the European Union as well as pharmaceutical companies. Instead of a universal waiver, leaders of the European Commission, the EU’s executive branch, are pushing for options, such as limiting export restrictions and encouraging voluntary licensing—half measures meant to protect patent monopolies. As a result, no official TRIPS declaration has been finalized, even as millions of people get infected and tens of thousands die in countries throughout the global south.

At last month’s G-20 summit in Rome, world leaders skirted over the nightmare unfolding in developing nations, including my home country: India. They made more promises and, based on magical mathematics, agreed on a goal to vaccinate at least 70 percent of the world’s population by the middle of next year. It’s unclear how they can succeed. With COVID-19’s global death toll surpassing a staggering 5 million deaths—a figure rising every day as billions of people are denied access to lifesaving vaccines—these leaders took almost no concrete action to tackle the intensifying pandemic.

In May, U.S. President Joe Biden declared the United States could become the world’s “arsenal of vaccines.” Later that month, his administration backed the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver, which would suspend intellectual property protections for pharmaceutical companies, allowing vaccines to be produced cheaply and in bulk. Amnesty International hailed the move as an important first step: “By reversing the prior administration’s position,” declared the group’s executive director, Paul O’Brien, “President Biden has made clear that the U.S. prioritizes people’s lives over pharmaceutical company profits.”

Six months later, the TRIPS waiver is dead in the water. Negotiations over the proposal were slated to begin in June, but the process never got underway, with steady opposition from the European Union as well as pharmaceutical companies. Instead of a universal waiver, leaders of the European Commission, the EU’s executive branch, are pushing for options, such as limiting export restrictions and encouraging voluntary licensing—half measures meant to protect patent monopolies. As a result, no official TRIPS declaration has been finalized, even as millions of people get infected and tens of thousands die in countries throughout the global south.

At last month’s G-20 summit in Rome, world leaders skirted over the nightmare unfolding in developing nations, including my home country: India. They made more promises and, based on magical mathematics, agreed on a goal to vaccinate at least 70 percent of the world’s population by the middle of next year. It’s unclear how they can succeed. With COVID-19’s global death toll surpassing a staggering 5 million deaths—a figure rising every day as billions of people are denied access to lifesaving vaccines—these leaders took almost no concrete action to tackle the intensifying pandemic.

There is now reasonable fear we might be stuck in a “forever pandemic,” characterized by vaccine surpluses in some nations, where people against vaccines reject freely available shots, and massive shortages in other countries, where therapeutically destitute populations face wave after wave of infections from a preventable disease. 

Last spring, poorer nations around the world waited for promised COVID-19 vaccine delivery shipments from COVAX, the ambitious global collaboration set up to give every country equitable access to shots. Two American epidemiologists, Seth Berkley and Richard Hatchett, were behind this initiative. Berkley heads Gavi, an alliance devoted to increasing the equitable and sustainable distribution of vaccines, and Hatchett is the CEO of the Coalition for Epidemic Preparedness Innovations, which finances vaccine development. The two men conceived of COVAX, a global procurement plan endorsed by the World Health Organization (WHO), to support the development and manufacturing of COVID-19 vaccines as well as negotiate pricing. Their main goal was to ensure all participating countries got equal vaccine access regardless of their income levels.

COVAX was a vision of genuine global solidarity. Launched in April 2020, its initial aim was to make 2 billion vaccine doses available by the end of 2021—enough to protect health workers and high-risk groups. COVAX has since announced it won’t meet that goal. “Countries have received supplies months late or with little notice, throwing vaccination campaigns into chaos and sometimes delaying people’s second doses,” said a report by the Bureau of Investigative Journalism and STAT, a health-oriented news site. “In some cases, short-date vaccines were returned or thrown away after governments were unable to distribute them in time. Countries and regions with the financial means to do so then scrambled to make deals with vaccine manufacturers directly, but found themselves at the back of the queue.”

How did we get to this impasse?

Put simply, COVAX was flawed from the start. The platform had just one primary supplier: India. More than a third of all humanity now relies on India for its COVID-19 vaccine needs. So far, more than 70 nations have received a total of 60 million COVID-19 vaccines from India. But in March, amid its own COVID-19 crisis, India stopped exporting vaccines and focused instead on protecting its own population.

In creating COVAX, global health tsars essentially caused a bottleneck in COVID-19 vaccine supplies. Developing nations could, as a practical matter, only get vaccines via COVAX while Western governments could sign massive bilateral deals with pharmaceutical companies, buying up all available vaccines. (Canada purchased five times the doses it needed.) Vaccine hoarding by the rich left COVAX with a limited ability to either procure vaccines in bulk or negotiate better prices. That left much of the world at the mercy of just one supplier: the Serum Institute of India (SII).

The SII, with a long history of supplying vaccines to global programs, makes COVID-19 vaccines at $3 per dose—about a tenth of the price that Moderna and Pfizer vaccines cost. A strategic review commissioned by the WHO noted that by the end of September, COVAX had delivered more than 319 million vaccines, roughly 16 percent of the original year-end goal of 2 billion doses. Many of the doses that were delivered, however, were so close to expiring they could not be used. In Malawi and East Timor, COVAX vaccines had to be destroyed, and South Sudan and the Democratic Republic of the Congo returned doses.

When India stopped exporting vaccines in the midst of its own devastating second wave of infections, African nations found themselves abandoned. They had to place late orders directly from manufacturers, all of whom preferred bulk orders from Western nations willing to outbid poorer ones.

Now, the United States, after failing its promise to deliver doses equitably, is foisting the Herculean responsibility to vaccinate the world onto India. As the Washington Post noted in September, pressure on India to resume exports “comes as wealthy nations, including the United States, move to offer coronavirus booster shots to their own vaccinated residents.” Mike Ryan, executive director of the WHO’s emergency program, equated this to “handing out extra life jackets to some while leaving others to drown.” WHO chief Tedros Adhanom Ghebreyesus has called it a “catastrophic moral failure.”

The United States has vaccinated nearly 64 percent of its adults while India has vaccinated only 24 percent. Under such circumstances, Western governments’ demand that India supplies vaccines to the developing world is immoral. To do so while administering boosters to their own citizens is obscene.

A report by Airfinity—a private firm providing COVID-19 vaccine production, stockpiling, expiry, and delivery predictions—warns that without redistribution, G-7 nations could waste 241 million doses by the end of 2021. The United States’ four national pharmacy chains—Walgreens, CVS Pharmacy, Walmart, and Rite Aid—alone have reported more than 1 million wasted doses each, according to the Centers for Disease Control and Prevention.

Over the past 18 months, the West has repeatedly failed countries across the developing world—and the millions of unvaccinated people there are an indictment of Western nations as well as WHO and COVAX. “The thing about styling yourself as a savior is that people might expect you to do some saving,” said Achal Prabhala, coordinator of the accessibsa project, which campaigns for access to medicines. Prabhala points out that COVAX imagined it would be sufficient for one company, AstraZeneca, to license one vaccine to one company in India—and that would somehow take care of half the world. Having put all its eggs in one basket, it is no surprise COVAX has shipped just 435 million of the 2 billion doses it promised this year.

 If the first year of the pandemic was about global solidarity, the second has been about greed, racism, and medical apartheid. The leaders of Western countries have organized global health around the principle of charity, as if that’s equal to justice. Perhaps summarizing the global mood, in April, the New Republic published a detailed profile titled, “How Bill Gates Impeded Global Access to Covid Vaccines,” for his role in tying up life-saving vaccines in the name of protecting intellectual property.

Africa continues to have the lowest vaccine coverage—just 4 percent of its population is fully vaccinated—and some of the highest fatality rates. In very low-income countries, less than 1 percent of the population is fully vaccinated. Airfinity estimates the immediate redistribution of vaccines could potentially avert nearly 1 million deaths from COVID-19 by the middle of next year. But deaths are likely to continue rising as more transmissible variants spread.

Only two nations can disrupt the world’s vaccine gridlock: the United States and Germany, which both produce taxpayer-funded vaccines (Johnson & Johnson, Moderna, and BioNTech). Unless taxpayer-funded vaccines are free for use where they’re desperately needed—with each continent allowed to make vaccines for itself—this pandemic will not end. After all, global health security cannot be left to the whims of a handful of pharmaceutical corporations, philanthropists, and politicians. For the pandemic to end, the TRIPS waiver, almost has to pass—for two reasons. First, it will immediately remove legal obstacles to accessing non-vaccine COVID-19 products, such as pills and diagnostic materials, for example. And second, it will remove a significant layer of red tape around licensing and provide legal stability for developing nations. The answer to COVAX’s failures is not a different version of COVAX. Centralized vaccine supplies simply do not work in an emergency—regardless of whether the central supplier is in India or the United States or anywhere else. Instead of aiming to be the world’s “arsenal of vaccines,” the United States and its allies could instead focus on making the technology behind vaccines openly accessible to the world. Millions of lives can still be saved by faster vaccine redistribution and a TRIPS waiver. The wealthy West cannot continue to dawdle while millions of less privileged people die.

Vidya Krishnan is a writer and journalist based in Goa, India. Her first book, Phantom Plague: How Tuberculosis Shaped History, will be published by PublicAffairs in February 2022.

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