The covid-19 pandemic has affected the whole world but it has had a disproportionate effect in different countries and regions. Global organizations like the World Health Organisation (WHO) have been at the forefront in coordinating the response to the pandemic. The whole world has seen differential effects of the vaccine rollout reaching different parts of the world, with the richer countries getting a lion’s share of the vaccines available while the poor countries are left fighting for scraps off the table.
The pandemic, for as long as it goes on, becomes more and more likely to create more resistant mutations that can give rise to further waves of the pandemic. The virus cannot be eradicated in only select parts of the world while allowing it to rage on elsewhere. This is because there is no guarantee that the current vaccines will protect the inoculated against new strains that can develop in the future. So it makes sense that countries should unite and fight to eradicate the virus across the globe in an equitable fashion.
The COVID-19 Vaccines Global Access facility (COVAX) is an initiative by the WHO which was established for the distribution of the vaccine throughout the world in an equitable manner. The plan is to distribute the vaccine into phases. In the first phase, countries will get vaccines according to the proportion of the population, enough to vaccinate 3% of the population most vulnerable to contracting the disease like the frontline workers treating patients. Then the vaccine will be made available to 20% of the population who are at the highest risk such as the elderly and people with comorbidities.
In the second phase, the vaccine should be given to people according to how the disease is spreading after the first phase and how the country’s healthcare system is able to cope with it. Eventually, the global population would be vaccinated. 190 countries had joined this program by January 2021. The USA, after Biden was elected, joined the program in February. The plan is that higher- and middle-income countries will be paying for their vaccine doses while the lowest-income countries would be given the vaccines for free. As this is a worldwide global health problem where eradication is absolutely necessary, this is quite a fair way of vaccine rollout.
Sadly that is not what is happening. There is a new form of inequality that is being observed which can be termed as “vaccine inequality”. Under COVAX, countries can also make bilateral agreements with vaccine manufacturers to directly buy vaccines outside of the program for their own country. This meant that as soon as regulatory approval was given to vaccines, richer countries rushed in to place massive pre-orders for the vaccines that are to be produced. In terms of numbers, for example, richer countries comprising only 14% of the world population had already pre-ordered 80% of the estimated entire production of Pfizer’s vaccine for 2021.
On 18th January 2021, the WHO chief, Tedros Adhanom Ghebreyesus, stated “I need to be blunt: the world is on the brink of a catastrophic moral failure and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries”. He further stated, “Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals going around COVAX; driving up prices and attempting to jump to the front of the queue. This is wrong.” Tedros reported that while 39 million doses have been administered in nearly 50 rich countries, only 25 doses have been given in one low-income nation. Canada has pre-ordered enough vaccines for them to be able to vaccinate each individual citizen six times, while in UK and USA there are about four vaccines per person. In the EU and Australia, there are two vaccines per person.
Vaccine companies are also making the vaccines available to richer countries that are able to purchase higher quantities and that pre-ordered at an early stage at lower prices. For example, European Union members will pay $2.16 for individual AstraZeneca shots while South Africa will have to pay $5.25 (about two and a half times more) for the same. Richer countries with much more spending power can afford to make pre-orders on vaccines that have less than a hundred percent guarantee of working. As a result, vaccine companies looking to fund their own manufacturing will be agreeable to make these deals with these countries. Now, after the vaccine has been released and proven to be effective, the company will have less incentive to offer the vaccine at a lower price. The variation in prices of the vaccines available is exorbitantly large: from $2.19 to $44.
One of the first vaccines that showed a lot of promise during development was created by Oxford University’s Jenner Institute which is a publicly funded laboratory. At first, they pledged to make the vaccine available free of cost for any manufacturer. This would have resulted in the vaccine being provided to people at a low cost. But then a few weeks later Oxford, counseled by the Bill and Melinda Gates Foundation, which had made a significant donation to the lab, announced that it had signed an exclusive deal with AstraZeneca. This gave the pharmaceutical giant the sole right to produce the vaccine with no guarantees that it will continue to provide it at a nominal cost. The terms of the deal will also allow Oxford to make plenty of profits in the coming years. AstraZeneca has committed to making zero profits off any COVID-19 vaccines for the duration of the pandemic, but it has come to light that it has given itself the power to declare the pandemic to be over as early as July 2021. This will mean that after July 2021 the company will be free to charge governments and individuals prices as high as they wish for their vaccines.
The companies that are manufacturing vaccines have received an unprecedented amount of public funding and therefore, it is perceived by many global organizations like the WHO and Doctors Without Borders that the public has a right to get these vaccines at a nominal rate. For example, six of the most popular vaccines: AstraZeneca/Oxford University, Johnson&Johnson/BiologicalE, Pfizer/BioNTech, GlaxoSmithKline/Sanofi Pasteur, Novavax/Serum Institute of India, and Moderna/Lonza has been given about $12 billion dollars of public funding that has gone into the research and development of the vaccines. But the deals that the companies are now making with governments are shrouded in secrecy, regarding the terms of payments and such other integral details. The companies are also not willing to disclose the cost of making each vaccine, so it is difficult to gauge how much they are profiting from them.
There was a possible alternative manner of navigating the situation to ensure greater equity. In October 2020, India and South Africa had put forward a proposal calling on the World Trade Organization to allow for the suspension of intellectual property rules with regards to pandemic-related pharmaceuticals including future vaccines. This would have allowed manufacturers in the developing world to be able to manufacture the generic versions of the vaccine themselves without infringing on WTO rules. The member countries could have chosen not to enforce patents related to covid-19 drugs, vaccines, masks, ventilators, etc. This proposal was favored by nearly 100 countries but it was opposed by the United States, the European Union, Britain, Norway, Switzerland, Japan, Canada, Australia, and Brazil. But because of the greater lobbying power of these rich countries, as well as multinational pharmaceutical companies, this proposal was not approved.
Reportedly, Bill Gates too had thrown his support against the proposal. Gates had argued that approving the proposal would not have made any difference because it would have taken a lot of resources to make generic versions of these vaccines because of their complicated nature. But Doctors Without Borders stated that Pfizer and Moderna vaccines can be produced much more easily provided that they share their knowledge. There are tens of thousands of factories in the developing world that can scale up production rapidly if only the companies share the technical know-how.
Another possibility that could have been was the Covid-19 Technology Access Pool (CTAP) proposed by Costa Rica and supported by the WHO. It creates a common knowledge pool of tests, medicines, and vaccines which will be available for free or at affordable licensing cost for all members. But the richer countries have refused to join in and only 40 developing countries have joined. Thus, it has not proven to be effective but it shows what could have been if things had taken a different path.
The pandemic, being a global health disaster, had a lot of potential to show us a new way forward of dealing with public health issues. Strong institutional support and global cooperation could have allowed for equitable vaccination which would have been beneficial for all. But the pharmaceutical industry successfully lobbied for higher profits and continued to keep the world on its incompetent, unjust, and inequitable path.
Shikhar is a first year Masters student of Economics at Ashoka University.