Ramifications of a global vaccination drive

When US joined a push to set aside patents for shots, it entered a roiling debate over how to ensure poor countries get enough vaccine

In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century. But wealthy countries have captured an overwhelming share of the benefit. Only 0.3% of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9% of the world’s population. Vaccine manufacturers assert that a fix is at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 mn doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.

But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70% of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses. The problem is that many raw materials and key equipment remain in short supply. And the global need for vaccines might prove far greater than currently estimated, given that the coronavirus presents a moving target: If dangerous new variants emerge, requiring booster shots and reformulated vaccines, demand could dramatically increase, intensifying the imperative for every country to lock up supply for its own people.

The only way around the zero-sum competition for doses is to greatly expand the global supply of vaccines. On that point, nearly everyone agrees.

But what is the fastest way to make that happen? On that question, divisions remain stark, undermining collective efforts to end the pandemic. Some health experts argue that the only way to avert catastrophe is to force drug giants to relax their grip on their secrets and enlist many more manufacturers in making vaccines. In place of the existing arrangement — in which drug companies set up partnerships on their terms, while setting the prices of their vaccines — world leaders could compel or persuade the industry to cooperate with more companies to yield additional doses at rates affordable to poor countries. Those advocating such intervention have focused on two primary approaches: waiving patents to allow many more manufacturers to copy existing vaccines, and requiring the pharmaceutical companies to transfer their technology — that is, help other manufacturers learn to replicate their products.

The World Trade Organization — the de facto referee in international trade disputes — is the venue for negotiations on how to proceed. But the institution operates by consensus, and so far, there is none. The Biden administration recently joined more than 100 countries in asking the W.T.O. to partially set aside vaccine patents. But the European Union has signalled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor. Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganising the fire department amid an inferno. “We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.” Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and havenots. The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the COVID-19 Prevention Network.

“The model of charity is, I think, an unacceptable model.” In this fractious atmosphere, the W.T.O.’s leaders are crafting their proceedings less as a push to formally change the rules than as a negotiation that will persuade national governments and the global pharmaceutical industry to agree on a unified plan — ideally in the next few months. The Europeans are banking on the notion that the vaccine makers, fearing patent waivers, will eventually agree to the transfers, especially if the world’s richest countries throw money their way to make sharing know-how more palatable.

Many public health experts say that patent waivers will have no meaningful effect unless vaccine makers also share their manufacturing methods. Waivers are akin to publishing a complex recipe; tech transfer is like sending a master chef to someone’s kitchen to teach them how to cook the dish. “If you’re to manufacture vaccines, you need several things to work at the same time,” the W.T.O. director-general, Ngozi Okonjo-Iweala, told journalists recently. “If there is no transfer of technology, it won’t work.” Even with waivers, technology transfers and expanded access to raw materials, experts say it would take about six months for more drug makers to start churning out vaccines. The only short-term fix, they and European leaders say, is for wealthy countries — especially the United States — to donate and export more of their stock to the rest of the world. The European Union allowed the export of hundreds of millions of doses, as many as it kept at home, while the United States held fast to its supply.

But boosting donations and exports entails risk. India shipped out more than 60 million doses this year, including donations, before halting vaccine exports a month ago. Now, as a wave of death ravages the largely unvaccinated Indian population, the government is drawing fire at home for having let go of doses. The details of any plan to boost vaccinations worldwide may matter less than revamping the incentives that have produced the status quo. Wealthy countries, especially in the West, have monopolised most of the supply of vaccines not through happenstance, but as a result of economic and political realities. Companies like Pfizer and Moderna have logged billions of dollars in revenue by selling most of their doses to deep-pocketed governments in N America and Europe. The deals left too few doses available for Covax, a multilateral partnership created to funnel vaccines to low- and middle-income nations at relatively low prices. While the partnership has been hampered by problems — recently India’s blocking exports amid its own crisis — the snapping up of doses by rich countries was a blow.

“We as high-income countries made sure the market was lopsided,” said Mark Eccleston-Turner, an expert on international law and infectious diseases at Keele University in England. “The fundamental problem is that the system is broken, but it’s broken in our favor.” Changing that calculus may depend on persuading wealthy countries that allowing the pandemic to rage on in much of the world poses universal risks by allowing variants to take hold, forcing the world into an endless cycle of pharmaceutical catch-up. “It needs to be global leaders functioning as a unit, to say that vaccine is a form of global security,” said Dr. Rebecca Weintraub, a global health expert at Harvard Medical School. She suggested that the G7, the group of leading economies, could lead such a campaign and finance it when the members convene in England next month.