I am sorry to tell you that you’re not getting a COVID-19 vaccine appointment for a while. Actually, you’re not getting a vaccine until 2022 or perhaps 2023. We only have a few doses for Connecticut, fewer for New Haven, and can only provide a COVID-19 vaccine to 25% of Americans this year if we’re lucky. Sorry. Better luck next pandemic. Sounds like a joke, right? You know there is plenty of vaccine out there, so this must just be a terrible attempt at humor. Right?
For many low- and middle-income countries, this is no joke. In fact, the United Nations-led COVAX facility, a global initiative aimed at equitable access to COVID-19 vaccines, has said that it can only provide 27% coverage for low-income countries this year. How did this happen? Well, first many rich countries bought up vaccine supplies with pre-orders of vaccines in development earlier in 2020, with some countries able to cover their entire populations several times over while poor nations could not even secure a single dose.
A broad coalition of hundreds of non-governmental organizations, multilateral agencies, world leaders, researchers, clinicians and legal experts has been calling for a people’s vaccine for close to a year now, asking for “a global guarantee which ensures that, when a safe and effective vaccine is developed, it is produced rapidly at scale and made available for all people, in all countries, free of charge.” However, rich countries, powerful figures like Bill Gates and, most importantly, the pharmaceutical industry itself have other ideas. In fact, it’s an old idea: the market will provide. Companies will eventually get around to making enough vaccine for everyone, they’ll get around to making agreements, one by one, with local manufacturers and contract for additional production in middle-income countries like India and South Africa. Until then, you’ll have to wait.
This is déjà vu all over again. I was around for the battles to get AIDS drugs to the Global South. Who said it couldn’t be done back in the late 1990s, early 2000s? Bill Gates. The pharmaceutical industry. Rich countries around the world. But it got done because some low- and middle-income countries, like Brazil and Thailand, didn’t take no for an answer and started making their own antiretroviral medicines. In the meantime, a coalition of advocates, clinicians and scientists rose up to challenge the orthodoxy of global health and development – one that said it was better to have Africans wait for an AIDS vaccine, or cast aspersions on the residents of an entire continent in suggesting “Africans couldn’t tell time,” and couldn’t possibly adhere to taking their AIDS medications like the rest of us.
Then, as now, the call from many of us has been to use the production capacity of the rest of the world to ensure access to these critical medical interventions for everyone. For AIDS drugs, the production was a simpler task, and many companies ended up making generic equivalents of key antiretrovirals once the resistance of the big men and women of global health was overcome. For COVID-19 vaccines, more difficult to make, the task is more complicated, and production on the scale needed to cover everyone will require tech transfer from the companies; the subsidization of the construction of new facilities to make the vaccines, their precursor molecules and other commodities necessary for manufacture; as well as the sharing of resources, expertise and intellectual property (IP).
This last item sends Bill Gates, the pharmaceutical industry and many rich-country governments into a frenzy. They claim that relaxing IP protections in a global health emergency isn’t the answer. The Director General of the World Health Organization disagrees, as do many other experts. But this is about control and who is in charge. With relaxation of intellectual property restrictions across the board on COVID-19, instead of the one-by-one voluntary licenses being struck between originator companies and others around the world, we could plan and work together, without this hurdle. Companies would be paid to participate in a collective effort, a Marshall Plan for vaccines, even though American taxpayers invested billions in the vaccines in 2020. Without a coordinated, global strategy to publicly scale up vaccines now, we will simply be held hostage to the market, its motives and its timeline, and then have to wait for years in line for a vaccine, depending on where we live on this planet.
Gregg Gonsalves, Ph.D., is an assistant professor of epidemiology (microbial diseases) at the Yale School of Public Health, associate (adjunct) professor of law at Yale Law School, and Co-Director of the Global Health Justice Partnership at Yale.
This commentary is the first of a six-part series produced by the Yale School of Public Health highlighting important issues related to COVID-19 and public health.