National access to effective vaccines against COVID-19 is being decided by a country’s financial and diplomatic clout rather than its actual health needs, according to leading academics and officials from Africa, Asia, the Caribbean and South America.
As a result, the planet has been divided between the rich North with rapid mass access to the vaccine and the Global South without.
In response, a completely new mindset is required to address the political issue of producing and distributing vaccines against COVID-19 in a fair, affordable way – one that views the virus and its impacts as more than just another disease and sees the pandemic for what it is, a global crisis in a globalised world.
Accordingly, efforts to address the current and future health crises should include greater collaboration among governments in low- and middle-income countries to increase their own scientific and technological capacity and produce more equitable access to intellectual property rights and cutting-edge research at the global level.
In addition, wealthier countries and big pharmaceutical companies should agree to more democratic access to the cures that they fund and produce in cases of international emergency.
“If we consider access to life-saving vaccines as an indicator of basic human rights, we have a planet divided between rich and poor countries, which poses a risk for all humanity,” said Roberto Lopez, who leads Acción Internacional para la Salud, a South American network of organisations seeking universal access to crucial medicines.
“Access should be based on epidemiological criteria, rather than on how much money one has,” Lopez said.
Lopez was speaking at an international webinar, the first in the Alliance for African Partnership Public Dialogue Series, co-hosted by various centres at the Michigan State University (MSU), including the MSU African Studies Center, MSU Asian Studies Center and MSU Center for Latin American and Caribbean Studies as well as the university’s Institute for Global Health. University World News (UWN) is the media partner for the series.
Lopez further criticised current efforts by big pharmaceutical companies, such as AstraZeneca, to transfer technology and production to sites beyond Europe and North America as woefully inadequate.
And, amid a global shortage in which demand for vaccines continues to significantly outstrip supply, he decried how access had become politicised to the detriment of less powerful states.
“Vaccines are being used as a political tool to consolidate international agreements and alliances,” he told the webinar titled “The impact of COVID-19 vaccine inequities in the Global South”.
Meanwhile, a World Health Organization (WHO) goal that every government in the world should have at least started vaccinating their domestic populations within 100 days from the beginning of this year was unlikely to be met, said Dr Richard Mihigo, who coordinates the international body’s immunisation and vaccine-preventable disease programme at its Regional Office for Africa.
The 100-day challenge, which ends on 7 April, was launched in January in an effort to close the gap in vaccine accessibility between high- and low-income countries.
However, as the deadline approaches, 36 countries covered by COVAX, the WHO’s initiative to provide global access to vaccines against the coronavirus, have still not embarked on national vaccination programmes. Of these, the majority (26) are lower-middle-income or low-income countries.
In Africa, vaccination programmes only started from the end of February; in Ghana, about two months after they started being rolled out in wealthier parts of the world, Mihigo told the webinar.
76% of doses were given in 10 rich countries
Of the 536 million vaccine doses that had been injected worldwide at the end of March, 76% were delivered in 10 high-income countries, including the United States, and only 27 million in Africa – about 5% of the total.
The 100-day campaign, which, according to Lopez, represented an international cry for help on the part of the WHO, had fallen on “deaf ears”, he said.
Indeed, economic dependence on the wealthier countries among the world’s poorer states was described as a significant factor potentially inhibiting middle- and low-income countries from accessing vaccines.
For example, in the Caribbean, the close ties that most of the island nations have established with Cuba and Venezuela pose “geopolitical challenges” given that the US, which decries such diplomacy, is a major trade partner in the region, according to Dr Douglas Slater, assistant secretary-general for human and social development, Caribbean Community (CARICOM).
At the same time, while international institutions have proved reluctant to provide Caribbean states considered to be ‘middle-income’ with concessional financing to address their social challenges, much less the impacts of the pandemic, it has been Cuba that has stepped in with a commitment to meet the region’s vaccine needs with a new cure it is producing.
Appropriately, the name of the Cuban vaccine is soberana in Spanish, which means ‘sovereign’, as in sovereignty – ostensibly a nod to the country’s pride in its world-renowned national health system in a terrain of research generally dominated by institutions in the Global North.
Indonesia also has developed its own cures as part of a national programme to offer its population free vaccines, Professor Ova Emilia of the faculty of medicine, public health and nursing at Gadjah Mada University told the webinar.
With the support of the ministries of health, and research and technology, six vaccine development programmes have been established at four universities and two research institutions in Indonesia. Each has worked on a different biological platform.
Two seed vaccines have been produced, which will now be tested in clinical trials; and the government has stepped in to regroup the development efforts to make them more efficient.
However, Emilia noted that, even with the substantial government support and some nascent private-sector interest, industry has been reluctant to collaborate with the initiative before clear results emerge, adopting a ‘wait and see’ approach.
As a result, the effort to develop a working vaccine has remained largely driven by the government alone, which has led to operational limitations and delays, said Emilia.
‘Failure’ of private sector criticised
In this regard, the failure of the private sector and in particular the global pharmaceutical industry to look beyond parochial corporate interests was viewed as a major contributor to inequitable access to affordable vaccines by the speakers at the MSU-UWN webinar.
This is particularly so, given that scientific advances underpinning the present production of vaccines by large pharmaceutical companies have been made on the back of research conducted among a global scientific community over many years, according to Amit Kumar, consul general of India in Chicago.
“It is the knowledge and skills held by scientists, researchers, public health experts and universities that has enabled the cross-country collaborations and the enormous public funding that has facilitated the development of vaccines in record time,” he said.
“Clearly the development of over 19 vaccines was not solely due to the intellectual property held by a single company alone.”
The British-Swedish pharmaceutical and biotechnology multinational, AstraZeneca, which emphasised its global commitment to no-profit access to its vaccinations at the meeting, acknowledged the role of governments as funding partners.
Dr Tonya Villafana, global franchise head, infection, at the firm described its work with multilateral bodies in support of a “fair allocation” of doses; and its efforts to boost supplies through production deals with a number of manufacturers around the world, including in India.
At the same time, large pharmaceutical companies and the governments of a number of wealthy countries have continually refused to respond positively to calls that have been made at the WHO since the beginning of the pandemic to share the research underpinning their vaccine development programmes and the intellectual property rights (IPR) to the cures they have produced.
Rather, they have described such pleas as “senseless” and “dangerous”, and as posing a threat to the prospects of research into new medications, said Lopez.
Drive to lift IPR restrictions
In response, and as many poorer countries have struggled to lay hands on supplies of the various cures, South Africa and India have led a drive to lift IPR restrictions on vaccine production in order to promote equitable access to remedies for the virus.
Brajendra Navnit, India’s permanent representative to the World Trade Organization (WTO), noted in January that the progress made by the WHO’s COVID-19 Technology Access Pool initiative, which promotes voluntary contribution of intellectual property, technology and data to support the global sharing and large-scale manufacture of medical products to combat the virus, had been inadequate.
Decrying the secrecy surrounding the initiative’s efforts, he also said that the limited scope of its so-called ‘flexibilities option’, under which individual countries were obliged to seek exemptions for pharmaceutical products on a case-by-case basis, encouraged “nationalism rather than true international collaboration”.
The process was also described as extremely time-consuming by Kumar, who noted the urgency of taking action to combat the spread of the virus, particularly given the rising number of COVID-19 variants. “The time to take action is now. If we don’t take action, we will simply run out of time,” he said.
“We are dealing with a pandemic and not a disease, and therefore we need to move beyond the traditional ways of thinking … Given the globalised world in which we live, a virus anywhere is a threat everywhere.”
In this context, India has urged adoption of a global waiver under the WTO’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement, not only in the interests of everyone’s health, but also, according to Navnit, to “re-establish [the] WTO’s credibility”.
‘Stronger multilateral leadership needed’
The point was reinforced at the recent webinar, with Lopez noting that, despite the best efforts of the COVAX mechanism, only stronger multilateral leadership to produce cooperation among the various stakeholders and a broad exemption on patents could produce the necessary global equity of access to the vaccine.
In the meantime, he said, “the WHO pool [for vaccine supply] is an empty pool”.
Looking to the future, there was also a call for greater solidarity among those countries which are at the margins of the global research community in order to increase their scientific and technological capacity to respond to emergencies such as the present pandemic.
“We need to explore opportunities in the Global South for research and development among ourselves,” said Slater, noting the capacity for technological advances and vaccine production in India, Cuba and Brazil.
“But we have to work together, because we cannot and should not always depend on the Global North, as we have seen. That is not to say we should not work with them, but we have to try to be as self-sufficient as possible,” he said.
The four-part Alliance for African Partnership (AAP) Public Dialogue Series will next explore topics on agriculture, race and economic development.