Vaccine access not for all?

The race to develop safe and effective vaccines for COVID-19 feels existential. But even if all goes according to plans, it's clear that - at least for the foreseeable future - there will be far greater demand for these vaccines than supply. We've already seen the ugly scramble for personal protective equipment, COVID-19 testing kits, therapeutics and treatments, which pitted countries against one another, and in the U.S., forced states into competition.

India and South Africa have put forward a novel proposal to replace our current competition-driven approach with cooperation. At a meeting on Oct. 15, they will be asking the World Trade Organization ( WTO) to temporarily relax its rules to allow for more international collaboration in the manufacture of the vaccines and medicines - even without authorization from the companies that created them. Theirs is an ambitious gambit, but one that deserves support.

Even though no one knows when or if a vaccine candidate will succeed as safe and effective, the U.S. and a few other wealthy governments have already paid to reserve millions of doses. Oxfam estimates that 51 percent of the doses to be produced based on current capacity have already been reserved for countries with just 13 percent of the global population. If the rest of the world depends on the same manufacturing facilities, they will have to wait for them to deliver on their preorders and hope that more doses can be produced before too many more die or become seriously ill.

A dozen pharmaceutical companies have voluntarily pledged to enable "timely availability" and "affordability for lower income countries." Astra Zeneca and Novavax have struck deals with a manufacturer in India to allow millions of doses to be made and sold to India and other lower income countries at a fraction of the cost they expect to charge elsewhere. But these limited pledges fall far short of the open, non-exclusive licensing that could transform the situation.

Without a more open approach to intellectual property, the COVID-19 vaccine, and other products that could help us better respond to the pandemic, will likely remain out of reach for most of the world. As we grapple with the fallout of over 1 million deaths worldwide, hundreds of millions of children still out of school and battered economies, ensuring equitable access to a COVID-19 vaccine is not just a public health challenge, it's a fundamental human rights concern.

To be sure, vaccination will not be a silver bullet: many of the candidates in the final stages of trials may not provide lasting immunity, and rising vaccine hesitancy might complicate efforts. Social distancing, widespread testing, contact tracing, bolstering weak healthcare systems, and protecting health workers will continue to be critical. Nonetheless, since mass vaccination is the safest path toward protecting people from infection, severe illness and death, it makes sense to try to ensure availability of as many doses as possible, as quickly as possible.

Pharmaceutical companies have typically maintained control over the intellectual property behind their discoveries, determining prices and deciding who can produce their product. The access to medicines movement has for decades argued that these profit-driven practices are unsavory even in normal times, and demanded more transparent pricing. Those objections seem even more salient in these extraordinary times.

Governments have poured billions of dollars of public money - at least US $19 billion as of mid-September according to estimates shared by Policy Cures Research - into efforts to develop vaccines. But this funding has come with few strings attached. Companies will still control the manufacturing decisions governing both availability and affordability of any vaccine. Without decisive action, our fates could be left in these companies' hands.

Some efforts are already being made to help low- and middle-income countries get vaccines. The World Health Organization (WHO), Gavi-the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations are together backing a new vaccine procurement mechanism called the COVAX Facility. It plans to pool resources and negotiate deals of its own with pharmaceutical companies.

But COVAX has only raised $700 million of its $2 billion start-up costs, fails to challenge hoarding by its own participants, and doesn't commit to pooling and sharing intellectual property, or to require pricing transparency, and so these vaccines may not be affordable to much of the world.

In Brazil and South Africa, civil society spent years challenging the high costs of medicines, especially those used in the treatment of HIV or AIDS. Eventually, both governments succumbed to public pressure and issued "compulsory licenses" which authorize producers to make patented products without the consent of the patent holder. The companies hit back with lawsuits. Those battles sparked a rethinking of the global approach to the enforcement of intellectual property rules. The WTO adopted rules to allow governments and companies to produce certain products without the permission of the original patent holders.

Due to the COVID-19 pandemic, Canada, Chile, Ecuador, France, and Germany have all taken steps that permit compulsory licenses. That option, while effective, is ad hoc.

Bruno Stagno-Ugarte