The profit motive has prevented the Global South from getting the vaccines it desperately needs—and deserves – en anglais !
Berit Köhler and Jan van Aken advise the Rosa Luxemburg Foundation’s Geneva office on global health issues.
Translated by Gráinne Toomey and Ryan Eyers for Gegensatz Translation Collective.
Photo: Karen Nurses prepare vaccines at a health clinic in Haiti. Kasmauski, MCSP and Jhpiego, CC BY-NC 2.0
Since the beginning of the coronavirus pandemic, it has become more or less clear that only the development of an effective vaccine would provide a genuine possibility of containing the virus in the long term. When the prospect of developing such a vaccine became plausible, it understandably brought hope to many. Optimistic forecasts suggested a developmental period of a minimum of one to one and a half years, and there was universal agreement that the vaccine should then be made available for people on a global level.
The German chancellor, Angela Merkel, even went so far as to say that “Producing this vaccine and distributing it to all regions of the world is a global public good … We will have to explore new routes, both in development and—simultaneously—in the establishment of production capacity for the vaccine, and this will need to be done in as many global locations as possible.” She was by no means alone in making such a statement: all over the world, politicians and health experts asserted that solidarity between the Global North and the Global South would be essential, not only for developing the vaccine, but for making it available quickly worldwide.
The COVAX initiative, co-led by the World Health Organization, aimed to distribute the vaccine worldwide as equitably as possible. The plan had been to purchase vaccine doses for all countries centrally and then distribute them. The total of two billion vaccine doses that the initiative aimed to have distributed by the end of 2021 would have been enough to vaccinate health service workers and groups of people with the highest risk of contracting the virus—in particular the elderly.
What did the countries of the Global North do instead? While COVAX negotiations were still taking place, they signed their own contracts with pharmaceutical companies and leveraged their purchasing power to empty the market.
They are responsible for the fact that vaccine availability at the end of summer 2021 was as follows: in countries with lower incomes, 2.27 vaccine doses were available per 100 inhabitants; for countries with lower middle incomes, 30.55 doses were available; for those with upper-middle incomes, 106.29 doses; and for those with higher incomes (for instance Germany), 112.58 doses.
The EU alone signed purchase agreements for over 2.4 billion doses of the BioNTech Pfizer and 460 million doses of the Moderna vaccines—equating to more than six doses of mRNA vaccine alone per inhabitant—in addition to doses produced by AstraZeneca und Johnson & Johnson.
While countries in the Global North began to discuss administering a third vaccine dose as a booster shot, in the countries of the Global South, not even healthcare workers had yet been vaccinated. What made this situation particularly grotesque was that large-scale studies that had helped to secure approval for the vaccines had been conducted in Global South countries.
All that remains of the promises made at the beginning of the pandemic are donations of money and vaccines by wealthy countries and private individuals that can be distributed throughout Global South countries. 640 million vaccine doses were supposed to have been sent to these countries by August 2021, but only a quarter of this total ultimately arrived.
Equitable Distribution Is Possible, but Unwanted
As early as October 2020, South Africa and India had tabled a proposal at the World Trade Organization (WTO) for waiving the TRIPS (Trade-related Intellectual Property Rights) agreement in relation to the pandemic. This would mean that member countries of the WTO are exempt from obligations concerning the protection of patents and related rights for medication, vaccines, diagnostics, and protective equipment for combating coronavirus for as long as the pandemic persists. The reasoning behind the proposal was that vaccine production so far would not be sufficient, and that more production facilities should be built. The idea was not only to distribute the existing pie differently, but to share the recipe and build more bakeries. By September 2021, more than 100 countries and a huge number of civil society organizations had already voiced their support for the waiver. German pharma companies were some of the most tenacious opponents of this course of action.
A question submitted by Die Linke in the German federal parliament led to the following response from the government: “Proper protection of intellectual property rights provides a considerable incentive for vaccine research and development and is an important legal requirement for the contractual cooperation and licensing agreements between pharmaceutical companies and with manufacturers in order to increase production capacity for vaccine manufacture … The federal government does not view voluntary license awarding to manufacturers as an issue. Initiatives such as ACT-Accelerator and COVAX by the WHO are providing equitable and rapid access worldwide to highly innovative vaccines.”
Opponents of the waiver argued that suspending patents would lead to a shortage of vaccine doses. They also suggested that pharma companies would no longer produce vaccines in the case of future pandemics if patents were suspended and the investment was no longer worth it.
In response to the first argument: when the waiver was proposed in October 2020, experts estimated that equipping and retrofitting existing production facilities in order to produce the vaccine would take four to six months. So, while this does take time, not getting started at all is hardly a solution. A wide range of drugs, including coronavirus vaccines, is now being manufactured in Bangladesh, South Africa, and India, but not even the medication produced in these countries remains there. Only six percent of the Johnson & Johnson vaccines produced in South Africa are not exported.
As for the second argument: big pharma is reluctant to develop vaccines. Doing so is too risky, laborious, and time-consuming, and the obstacles for safety and approval, as well as the amount of capital that must be invested, prove too high. During the pandemic, however, the majority of funds have been provided by governments, and there are governmental purchase guarantees in place. Globally, around 5.9 billion US dollars has been invested (2.2 billion in the US, and 1.5 billion in Germany), with 98 percent of these funds coming from public resources. Pharma companies have not publicly disclosed how much they have invested in vaccine development. The aforementioned public monies are in circulation without any contractual securitized assets, price maintenance, delivery guarantees, transparency regulations, or liability regulations. In the current year, revenue generated by the vaccine made up 43 percent of total turnover at Pfizer, while net profit rose by 59 percent. During the first six months of 2021, BioNTech generated a surplus of almost four billion euro after posting losses in the previous year.
Politics, Not Profits, Should Guide Decisions
Coronavirus vaccines are a cash cow and their patents are stubbornly protected to ensure that companies can continue to absorb their full profit potential in future. The business goal of pharma companies certainly has nothing to do with making vaccines available on the global level, or with providing a right to healthcare. Appeals to these corporations to act in a socially responsible manner in light of the exceptional circumstances of the current pandemic—circumstances that in future could potentially become the rule—have fallen on deaf ears.
Only political action—not commercial dealings—can decide whether people in the Global South will receive vaccinations, or whether millions of them will die.
To avoid the manufacture of medication, vaccines, and medical devices essentially becoming a license to print money, a form of production is required that is separate from the market. Non-profit consumer protection organization Public Citizen has conducted a study to investigate what is needed to produce eight billion vaccine doses within a year and has envisioned the following model. Coordinated by the WHO and UN, 14 regional production facilities that can produce eight billion vaccine doses within one year should be set up in various global locations. Together with the production capacity that already exists, this would be sufficient to vaccinate 80 percent of the global population. According to the study, costs for establishing and operating this production network and the production of vaccines would be between 10 to 23 billion US dollars. Die Linke has also proposed a similarly structured model, calling for the establishment of publicly owned vaccine manufacturing centres (known as “basic vaccine manufacturing hubs”) that can produce vaccines for between 20 to 30 million citizens; these hubs would be maintained on a permanent basis, and not only during pandemics. The costs for Germany would amount to 120 million euro, plus an additional 10 million annually for maintenance during idle time. For this model to be put into operation, the first step is for patents to be waived and for a comprehensive transfer of technology to take place.
In the words of South African human rights activist Mark Heywood, “If we fail as civil society on COVID-19 it will take us many decades to recover. We need to be out there and we need to be winning the argument about the way the world has to look and what the values and the priorities of the world are!”