As Disparities Grow, So Does the Risk of New Variants

Normally, the world produces four billion vaccine doses annually, explains Alain Alsalhani, a vaccines pharmacist for Médecins Sans Frontières’ (MSF) Access Campaign. To meet the global demand for Covid-19 vaccines, it must up that to 14 billion.

The UK, the United States, Japan, and the European Union (EU) had reserved much of this capacity by September, securing a possible 4.2 billion doses of frontrunner Covid-19 vaccines, although some of these jabs remain in clinical trials.

Today, some richer countries have capitalised on that lead. The United States had administered about 150 million doses of Covid-19 vaccines as of 1 April, or a quarter of immunisations given globally. The entire continent of Africa—home to nearly 20 percent of the world population—has made do with just 11 million vaccines. The US and the UK are projected to vaccinate enough people to stop widespread transmission of SARS-CoV-2 by about July, just as South Africa is expected to begin ramping-up general vaccination.

Meanwhile, World Health Organisation initiatives to help the world’s poorest nations will cover just 3.3 percent of people in 145 participating nations by mid-2021.

In an interconnected world, disparities in vaccination rates give the virus room to mutate and increase the risk of new variants with the potential to spread faster or outsmart current vaccines. As Columbia University clinical epidemiology professor Quarraisha Abdool Karim puts it, ‘As nations start to expand their vaccination programmes, we are once again reminded about our interdependence.’

Showdown at the WTO

In October, South Africa and India proposed that the World Trade Organisation (WTO) waive certain intellectual property protections relating to not just patents but also manufacturing know-how for a limited time – just long enough to allow the world to bring Covid-19 under control. The waiver would apply to medical commodities, such as vaccines, ventilators, and even laboratory supplies needed to fight the pandemic.

International trade law already allows countries to override some patent protections to protect the public health, but these provisions remain difficult for much of the Global South to use in practice, not least because those who do have historically faced trade pressure from countries such as the United States.

Today, almost 60 countries—mostly in the Global South—have officially sponsored the waiver proposal. Proponents say that granting the waiver would allow more producers to begin manufacturing Covid-19 medical commodities, including vaccines, increasing supplies and affordability.

But many wealthy, vaccine-producing countries that secured early access to Covid-19 vaccines—including the UK, US, Canada, and Japan—oppose the waiver. This is despite the Canadian government’s moves to expand its own ability to override patent protections early in its Covid-19 outbreak.

The waiver is also facing pushback by a minority of Global South countries, notably Brazil and Chile, whose WTO delegation was one of several to demand evidence that waiving intellectual property rights would actually bolster vaccine production.

The newly-appointed head of the WTO, Ngozi Okonjo-Iweala, has proposed another way, dependent on companies voluntarily licensing patented goods – something that has yet to materialise, despite previous attempts by the World Health Organisation to encourage the same. Meanwhile, Japan, the US, Australia seem confident they can partner with India to find at least a partial solution to vaccine shortages multilaterally and outside the WTO.

Patents Are Only One Part of the Puzzle

Those opposing the waiver often argue that relaxing intellectual property protections around immunisations isn’t enough to allow nations that don’t currently produce vaccines to suddenly erect multimillion-dollar factories and develop expertise.

In part, they’re right. About 80 percent of global vaccine sales normally come from just five large multinational corporations with facilities in North America, Europe, and Australia, according to a scoping presented by South Africa’s public-private vaccine partnership, Biovac, to Parliament. South Africa is one of just a handful of countries in Africa with any vaccine manufacturing capacity, and it’s taken Biovac almost 20 years to begin producing a vaccine on local soil.

‘Raising capital is one of the challenges we faced when we started up,’ Biovac CEO Morena Makhoana explains. ‘The second challenge that we had but subsequently overcame is convincing large multinationals to partner with a South African company.’

To expand the world’s ability to produce Covid-19 vaccines, firms that can make the jabs will have to partner with new producers, transferring complicated technology that isn’t in the public domain, Alsalhani adds.

Early in the pandemic, Oxford University engaged in a technology transfer with the Serum Institute of India to enable it to produce its Covid-19 vaccine. Today, low- and middle-income countries rely almost solely on the Serum Institute for access to the Oxford University vaccine.

However, even the Serum Institute is struggling to meet local and international demand for the jabs and has said it will fail to meet expected stocks for Covax. Attempts by the UK government to explore purchasing vaccines from Serum has led academics to accuse it of competing with poorer countries already in the queue.

Success in obtaining a WTO waiver, although an important step, is likely not enough on its own to guarantee technology transfer, Alsalhani warns.

‘Some people pushing the waiver would argue that governments could [use it to] go as far as stripping companies of their knowledge,’ he says. ‘I don’t think this is realistic. I don’t think the French government would, for example, go to Sanofi’s manufacturing site and take hold of the documentation and then escort people under police protection to India to do a technology transfer – because that’s what we would be talking about.’

Public Money, Public Good?

Instead, Alsalhani says that countries that invested billions of dollars in vaccine research and development—like the US, UK, and Germany—should impose conditions on that funding to compel companies to engage in technology transfers.

‘The Moderna vaccine was 100 percent funded for its research and development by the United States government for about $1 billion,’ Achal Prabhala, a fellow at the Shuttleworth Foundation and the coordinator of the access to medicine project accessibsa, pointed out during a recent webinar. ‘If after a year, Moderna had found that the vaccine didn’t work and it threw in the towel, they would not have lost a single dollar.

‘The US and [other funding governments]—despite having the ability to own some of these vaccines—did not impose any conditions whatsoever on companies, even for their own access except to secure the doses they required,’ he added. ‘What they definitely did not do was allow the technology itself to be replicated.’

He adds: ‘If you were to commission someone to build you a house, you would own that house, wouldn’t you?’

Europe Desperately Needs More Vaccine Suppliers, Too

Traditionally, it can take anywhere from three to five years and as much as $600 million to build plants to produce certain types of vaccine solutions. Figures like this often fuel the industry’s argument that it’s impossible to create new vaccine manufacturing capacity quickly.

But Alsalhani says that it may take just a matter of months to repurpose some kinds of sterile pharmaceutical production plants to make the type of Covid-19 mRNA vaccines that Moderna and Pfizer have produced – if companies are willing to transfer the technology. New plants like these may not be able to make millions of Covid-19 doses, but they could make several hundreds of thousands. At the moment, even that kind of number would be enough to more than double the vaccinated populations of some countries.

And this isn’t a problem confined to the other side of the world. If patent protections were eased or licenses granted and technology transfers followed, increased vaccine production—albeit relatively small—could also benefit the EU where most countries have only managed to vaccinate one in 10 people. Prabhala says some of this scarcity could have been avoided if publicly-funded vaccines were treated as a public good.

‘We’ve always thought of access to medicines or vaccines as a poor country problem,’ he says. ‘The idea that Europe is now suffering, to a lesser extent perhaps, the same problems that many other countries is a sign of the times.

‘[It] harkens back to policies that allowed for publicly-funded research to be privatised and used for commercial profit as if that was somehow the best solution available to create new pharmaceutical products,’ he adds. ‘It could have been deliberately avoided.’