The world is racing for a COVID-19 vaccine — and rich countries are jumping to the front of the line. This summer of “vaccine nationalism” may come back to haunt us.
The United States, the European Union, and the United Kingdom have bought up the first 2.6 billion doses of vaccines currently in development. The US government has given more than $11 billion to eight pharmaceutical companies in “Operation Warp Speed,” most of it for vaccine development and manufacturing, and bought more than 1.2 billion doses. The European Union and the United Kingdom this month followed the US lead, signing deals with drug companies to secure more than 1.4 billion doses. By buying doses of the most promising contenders in such large numbers, countries are hedging their bets on which vaccines will be approved first, and how many doses their immunity may require.
The deals bypass global cooperation agreements and leapfrog over advocates’ demands for public transparency — about when most of the world will be able to get COVID-19 vaccines and at what price — and for knowledge- and technology-sharing agreements between rich countries and poorer ones. Instead what’s happening, advocates say, is that drug manufacturers will prop up their revenues in the short term, and shore up their profits in the long term, at the cost of timely universal access.
“So a few wealthy people who own the technology, and who have capital to invest, are able to decide who lives and who dies,” said Winnie Byanyima, executive director of UNAIDS, headquartered in Geneva.
This is a story, she said, with lessons that already should have been learned. In the late 1990s, AIDS was exploding around the world. The outbreak was especially bad in sub-Saharan Africa — in 1998, there were 5,500 funerals a day for AIDS victims across the continent — but people couldn’t afford the cost of treatment, which could exceed $10,000. Drug companies refused to budge on pricing or sharing intellectual property, insisting the model of high prices and proprietary protections was what made the industry willing to spend millions on research and development. That model ruled the day until an Indian manufacturer began selling generic versions of HIV drugs, turning the tide of the epidemic. But 39 drug companies sued South Africa for buying those generics. They finally dropped their lawsuit in 2001, paving the way for generic drugs, but by then, over 8 million more people had died.
Byanyima wants the world to handle COVID-19 better. Together with Oxfam International, a global anti-poverty organization, UNAIDS is leading a movement for “a people’s vaccine.” Its supporters are campaigning for free access for everyone not only to the vaccine itself, but to the knowledge and technology it takes to produce it. So far, more than 140 world leaders have echoed the call, including Joseph Stiglitz, a Nobel laureate for economics; Dr. John Nkengasong, head of the Africa CDC, which coordinates the continent’s COVID response; and Pope Francis.
Some pharmaceutical companies say that they’re already doing their part. Sanofi, a drug maker based in Paris, said in an email that it would provide vaccine doses to a global pool, administered by the Global Vaccine Alliance. But the company would not specify how many doses it would make available, at what price, or when.
GlaxoSmithKline, which is producing a “booster” for Sanofi’s vaccine, said it does not expect to make a profit on this work, but if it does, it will invest “any short-term profit” in COVID research and epidemic preparedness. The Sanofi-GSK partnership received $2 billion in US funding in July.
The Gates Foundation is spending $150 million to manufacture 100 million doses of vaccines developed by AstraZeneca and Novavax for India and other countries deemed “lower-middle-income,” at a maximum price of $3 per dose. Both drug companies have separately signed agreements with the same Indian manufacturer to make 1 billion doses available for low- and middle-income countries, but it’s unclear how many of those doses India will claim and how many will be left for the rest of the world. Much of that remainder may already be spoken for by US, UK, and EU deals.
At the moment, it’s unclear how long it will take to fulfill rich countries’ vaccine orders. (Companies receiving US funding either did not reply or declined to answer.) And all of these agreements exclude the knowledge-sharing advocates say is crucial to timely intervention. Unlike HIV/AIDS drugs, which are fairly easy to copy, vaccines are complicated biological materials. Experts say loosening patents or licenses won’t be enough. Unless drug companies openly share technology, know-how, and data, generic manufacturers won’t be able to do much.
The Coronavirus Technology Access Pool, spearheaded by the World Health Organization, is designed for that purpose, but drug companies are focusing elsewhere — and the consequences could be catastrophic. “If knowledge is not shared now, at the very first moment . . . it may take years for generic producers to get on track. We may see not see sub-Saharan Africans being vaccinated for three or four years,” said Chema Vera, interim executive director of Oxfam International.
The pandemic is already wreaking havoc on global economies, and Oxfam estimates that it could push another half-billion people into poverty, erasing more than a decade of gains, and leave more than half of the world’s population impoverished. The compounding effect of a years-long delay in vaccine access, Verma said, “would be simply astonishing.”
If vaccine nationalism sentences poor countries to deepening poverty and even more disease, it also doesn’t protect rich countries. “No vaccine is 100 percent effective. The effectiveness comes from vaccinating the majority, and we’re not going to get that with COVID,” said Mogha Kamal-Yanni, a global health consultant who’s working on the policy side of the “people’s vaccine” effort.
Unless poor countries are vaccinated, Yanni said, rich countries aren’t really protected. Human beings move around too much, and our economies are too interdependent, for us to “get back to normal” without universal vaccine access.
The solution, advocates say, is getting tougher with pharmaceutical companies. “Drug companies are drug companies, but it’s our money, public money, that is going into the development of these vaccines, and there should be demands made,” said Ellen ’t Hoen, a lawyer and public health advocate who has worked on pharmaceutical and intellectual property policies and access for more than 30 years.
Tom Wilbur, a spokesman for PhRMA, the trade group for the pharmaceutical industry, defended proprietary protections as a key ingredient in industry innovation. “In fact, many of the existing medicines and investigational medicines being tested for COVID-19 exist today because of [intellectual property] and other incentives that drove the research and development,” he said in an email.
Byanyima disagrees, saying the fact that drug companies needed public funding to get this far with a COVID vaccine shows that “the system of proprietary protection has collapsed. It was always unjust because it locked people out and privileged profits over lives,” she said, “If drug companies had been left on their own, we wouldn’t be near a breakthrough.”
Ndileka Mandela knows the issues from all sides: She was a nurse in South Africa in the early days of the AIDS epidemic, and then a representative for a pharmaceutical company, and, most recently, a COVID-19 survivor. Her aunt — daughter of Nelson Mandela, the anti-apartheid hero, Nobel laureate and South Africa’s first Black president — died last month with COVID-19.
As complicated as the vaccine debate might seem, she insists that the way forward is simple.
“This is a pandemic,” she said. “For once in our lives, let us forgo the profit and save humanity.”
Jina Moore, a journalist based in East Africa, has written about health, human rights, and politics from more than 30 countries. Follow her on Twitter @itsjina.