Failure to provide global access to Covid vaccines risks fresh outbreaks through travel or the emergence of new variants, writes Dr Aisling McMahon, Department of Law
The approval of several vaccines against COVID-19 has brought significant hope. However, there are issues with vaccine supplies and vast inequalities around access globally which must be addressed. In December 2020, the People's Vaccine Alliance highlighted that only one in 10 people in nearly 70 lower income countries will obtain access to Covid-19 vaccines in 2021. In contrast, many richer countries have purchased enough doses to vaccinate their populations several times over.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) described these inequalities as a putting the world on the brink of "catastrophic moral failure". Furthermore, Dr Mike Ryan, Executive Director, WHO Health Emergencies Programme said of frontline health-workers in lower income countries that "they're right down at the end of the queue right now and they're looking up to the top of the queue and the people at the top of the queue are fighting about where they are in the queue. That's what it looks like; fighting over the cake when they don't even have access to the crumbs."
Given the devastating global impact of Covid-19, why is there such a queue for vaccines? Who is controlling it? And is there a better way forward?
Intellectual property and vaccine access
Intellectual property rights, such as patents, play a key role in this context, because they give the rightsholder (often pharmaceutical companies) the right to stop others using their patented invention (e.g. elements of a vaccine). Rightsholders can dictate who gains access to the vaccine first and at what price.
Such companies also control who can produce vaccines and depending on whether they license their technologies and share know-how to enable others to produce vaccines, this can directly affect supplies available. Under the current model, companies control the queue, even where the research supporting the development of many Covid-19 vaccines was assisted by significant public funding.
Countries and regions like the EU, have raced to agree often opaque deals with companies for preferential vaccine access. Many countries agreed to such deals in addition to participating in the COVAX system, maximising vaccine doses for countries that can afford it but leaving lower-income countries at the end of the queue. Such deals or so-called 'vaccine nationalism’ are understandable at a national/regional level seeking access to bring Covid-19 to an end in that state or region. However, vaccine nationalism is highly problematic from a global health justice perspective, and self-defeating if our goal is to save lives, end Covid-19 and return to normality.
This is because global access to vaccines is needed to end the pandemic. Failure to provide global access risks outbreaks re-emerging in countries through travel. Prolonging Covid-19 prevalence anywhere risks new variants of Covid-19 emerging which current vaccines may not work against thereby jeopardising ending the pandemic.
Aside from these reasons for change, the current system is also not effectively delivering vaccines for developed countries as fast as could be possible. We are already seeing shortfalls in promised supplies, as demonstrated by the significant recent disputes over shortfalls in supplies of the AstraZeneca’s vaccine in the EU.
These issues could be improved by pharmaceutical companies working to share intellectual property rights, know-how and data for Covid-19 vaccines enabling others to assist in production to increase supplies of vaccines. Some companies have recently embarked on agreements to increase manufacturing capacity, for example, Pfizer/BioNTech recently agreed a deal with Sanofi to support the manufacture of 125 million doses of their vaccine in Europe. Novartis has also agreed to support production of the Pfizer/BioNTech vaccine. But more action is urgently needed, as many companies do not share technologies and the know-how needed to maximise global vaccine production capacity.
Governments must intervene to tackle this and the global inequalities around Covid-19 vaccine access. One mechanism to do so is the WHO’s COVID-19 Technology Access Pool (CTAP) which facilitates sharing of intellectual property rights, data and know-how over Covid-19 health-technologies including vaccines to enable full technology-transfer and could be used to increase the scale and speed of supplies globally. However, to datem it has been supported by just 40 countries, including five EU countries. More support is urgently needed for CTAP, and it is vital that countries like Ireland endorse it.
It is in all our interests that there is global equitable access to vaccines to end the pandemic, and countries must take action to achieve this
Moreover, in 2020, South Africa and India proposed a waiver to the World Trade Organisation’s international intellectual property system to suspend intellectual property rights for the duration of the pandemic to help address access issues. This proposal is still under discussion within the WTO, but lacks the support of higher-income countries, and must also be reconsidered by countries.
Covid-19 is one of the greatest health crises of our time. It is in all our interests that there is global equitable access to vaccines to end the pandemic, and countries must take action to achieve this. We must listen to Dr Tedros Adhanom Ghebreyesus when he says: “The pandemic will not be over anywhere until it is over everywhere. This is the reality of an interconnected world, and that reality can be met only by a reaffirmation of solidarity and an inclusive public-health order that distributes vaccines globally, quickly, and equitably."