Sunday, July 18, 2021

The Travesty of Vaccine Nationalism

 Few have ever claimed that this capitalist system is fair and the vaccine gap between the global rich and poor is a prime example of its inherent inequality. The coronavirus pandemic has created nine new billionaires, six are linked to the successful mRNA vaccines.

It’s like a famine in which “the richest guys grab the baker,” said Strive Masiyiwa, the African Union’s envoy for vaccine acquisition. 

“This was a deliberate global architecture of unfairness,” Masiyiwa told a Milkin Institute conference. “We have no access to vaccines either as donations or available for us to purchase. Am I surprised? No, because this is where we were with the HIV pandemic. Eight years after therapeutics were available in the West, we did not receive them and we lost 10 million people.”

Inequity is everywhere. Haiti received its first delivery July 15 after months of promises — 500,000 doses for a population over 11 million. 

Canada has procured more than 10 doses for every resident yet Sierra Leone’s vaccination rate was just 1% on June 20.

Christian Happi, a professor at Nigeria’s Redeemer’s University and a member of CEPI’s scientific advisory committee, explained, global health experts soon came to realize that rich countries “could sign a piece of paper saying they believe in equity, but as soon as the chips are down, they will do whatever they want.” 

 European and American officials deeply involved in bankrolling and distributing the vaccines against coronavirus have told  Associated Press there was no thought of how to handle the situation globally. Instead, they jostled for their own domestic use.

There was a global purchase plan to provide vaccines for poorer countries, but it was so flawed and underfunded that it couldn’t compete in the cutthroat competition to buy. Intellectual property rights vied with global public health for priority. Rich countries expanded vaccinations to younger and younger people, ignored the repeated pleas of health officials to donate their doses instead and debated booster shots - – even as poor countries couldn’t vaccinate the most susceptible.

 Wealthy nations expected a return on their investment in the development of the vaccine.

On April 30, 2020, AstraZeneca took sole responsibility for the global production and distribution of the Oxford vaccine and pledged to sell it for “a few dollars a dose.” Over the next few weeks, the U.S. and Britain secured agreements totalling 400 million doses from AstraZeneca. They were home to the pharmaceutical companies with the most promising vaccine candidates, the world’s most advanced production facilities, and the money to fund both,

On May 15, 2020, Trump announced Operation Warp Speed. The idea of including clauses to ensure that vaccines would go to anyone besides Americans wasn’t even considered.  The U.S. repeatedly invoked the Defense Production Act — 18 times under the Trump Administration and at least once under Biden. The moves barred exports of crucial raw materials as factories were ramping up production of the as-yet-unapproved vaccines — and eventually, of the vaccines themselves. It meant those materials would run low in much of the rest of the world. 

COVAX had the backing of the World Health Organization, CEPI, vaccines alliance Gavi and the powerful Gates Foundation. What it did not have was cash, and without cash it could secure no contracts.

 “Operation Warp Speed signed the first public deals and that started a chain reaction,” said Gian Gandhi, UNICEF’s COVAX coordinator for supply. “It was a like a rush on the banks, but to buy up the expected supply.”

Many global health authorities hadn’t fully grasped the extent of pandemic nationalism and found it unimaginable that the country would block vaccines when the world was counting on them.  The World Health Organization created a technology-sharing platform to expand vaccine production. It foundered as not a single company agreed to share its blueprints, even for a fee — and no government pushed them to. The U.S. and other countries could have pushed companies harder to share their knowledge, if only for the duration of the pandemic.

The one organization that could have pushed for more technology sharing was the Gates Foundation, whose money to WHO nearly matches that of the U.S. government. Instead, Bill Gates defended stringent intellectual property rights as the best way to speed innovation. His foundation poured money and influence into the Access to COVID-19 Tools Accelerator, which also failed. Initially resistant, the Gates Foundation has changed its position in favor of sharing.

Dr. Clemence Auer, the EU’s lead negotiator for vaccine contracts last summer, said the question of compelling pharmaceutical companies to suspend their vaccine intellectual property rights to increase the worldwide supply of coronavirus vaccines never even came up. 

“We had a mandate to buy vaccines, not to talk about intellectual property, ” Auer said.“The global community should have had this discussion back in 2020 but that didn’t happen,” he said. “Maybe we should have done it last year, but now it’s too late. It is spilled milk.”

"...The governments that had resources went and bought the supplies,” CEPI chief executive Dr. Richard Hatchett told the AP. “COVAX was not in a position to do that.” Months later, when COVAX finally had the money to sign deals for global supplies, they were at the end of the line. The lack of capital available to vaccine makers to boost their capacity outside the small number of existing manufacturing hubs was also “a lost opportunity,” Hatchett said. “We approached the international financing institutions, including the World Bank and the International Finance Corporation about making those investments and they were not willing to do that,” he said. CEPI ended up investing about $1.5 billion, far less than what a major financial institution might have been able to commit.

COVAX finally delivered vaccines on Feb. 24, to Ghana, a load of 600,000 AstraZeneca doses manufactured by the Serum Institute of India and transported by UNICEF planes. By that date, 27% of the population in Britain had been vaccinated, 13% in the U.S., 5% in Europe — and 0.23% in Africa.

Winnie Byanyima, head of UNAIDS says the world has learned little in the decades since the AIDS pandemic was brought under control in the United States, only to kill millions in Africa because treatments were unaffordable: 

“Medicines should be a global public good, not just like a luxury handbag you buy on the market.”

A  push to lift intellectual property restrictions on vaccines and medicines has gone nowhere in the World Trade Organization.

Dr. Ingrid Katz, an infectious disease researcher at the Center for Global Health at Massachusetts General Hospital, said the key question is whether vaccines and essential medications are a commodity or a right.

"If it’s going to be a commodity, we’re going to keep walking down this road every time we have something like this,” she said. 

And if it is all going to rely on the generosity of rich countries, a lot of people are going to die. Four million have died already.

“It speaks volumes about where we are as a globe when you have the source of decision-making sitting with very few people who have a lot of wealth and are essentially making life and death decisions for the rest of the globe,” Dr Katz said. 

Vaccine inequity: Inside the cutthroat race to secure doses (

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