We quarantine, we mask, we worry. Right now, the Holy Grail for ending the COVID-19 pandemic — and finally returning our lives to normal — is filled with vials and vials of vaccine. Older folks and other at-risk workers are first up in the scramble to be immunized, and our new president is promising to beef up production so it can get out to all Americans over the coming months.
But if there is one key lesson to be learned from this past year, it is that we will only be able to crush the pandemic anywhere when it can be done everywhere. “Everywhere” has to include the 84% of the world’s population that lives in low- and middle-income countries. Many of their governments already struggle to provide basic health services, with budgets further stretched by the economic crisis. In those places, access to COVID vaccines is a far-off dream, for reasons that are not new. As of mid-February, more than 130 countries had not vaccinated a single person.
Those of us who were involved in the early response to the scourge of AIDS in Africa see eerie parallels. The first drug treatment, AZT, was approved by the U.S. Food and Drug Administration in 1987 and, like the other more effective treatments that followed, it was too costly for low-income countries to adopt. I worked with a health program in Mozambique in the late 1990’s, and it was only after an Indian pharmaceutical company, CIPLA, began producing generic versions of the triple-drug therapy in 2001 that we were able to support affordable and effective drug treatment for people living with HIV and AIDS. As a result of that delay of more than a dozen years — during which HIV spread unchecked in countries unable to afford drug treatment — some 15 million Africans died of AIDS.
Who bears responsibility for the gap between critical needs and effective responses to new biological threats? The pharmaceutical sector of rich countries holds the patents and thus controls key products needed to address this devastating new virus. Enter the WTO, the World Trade Organization. This international body is the rule-maker (and enforcer) for buying and selling goods and services internationally. One of the major aims of the WTO is to protect corporate intellectual property (IP) rights, as laid out in its Trade-Related Intellectual Property Rights (TRIPS) provisions.
Protecting patents sounds like a reasonable approach in normal times, with the aim of incentivizing the development of new products and processes, including masks, ventilator valves and laboratory reagents for test kits as well as drugs and vaccines. But these are not normal times. With nearly two-and-a-half million deaths from COVID worldwide in just one year, with global economic crises that have devastated many national economies, the concept of “normal” needs urgent rethinking.
The WTO has been presented with an immediate solution that would allow expansion of the medical products needed to bring the pandemic under control. South Africa, India, and 55 other countries have requested that the WTO issue a temporary IP waiver for pandemic-related products. The waiver would allow generic COVID-19 diagnostics, vaccines, and treatments to be produced by any country without the constraints of the pharmaceutical companies holding the patents on the products. So it would, in effect, disallow the consideration of patents on COVID-19-related materiel for the duration of the pandemic — until such time as global herd immunity is achieved. The waiver would be an emergency measure in response to this global crisis and would allow a massive increase in vaccine production and distribution.
But serious obstacles stand in the way of this approach. Although the WTO’s complex rules of trade can be cumbersome to sort out, concerns of those opposing the proposal are fairly straightforward. The US and several other industrialized countries have so far been adamant that dropping patent protections would mean unacceptable reduction of profits for pharmaceutical corporations. They argue that options already exist for individual countries to apply for a type of waiver — without, however, acknowledging that the applications are time-consuming and resource-intensive, with uncertain outcomes. That recommended process is rather like trying to revise fire escape standards in the middle of a fire.
Opponents also suggest that the poorer countries of the world don’t have the capacity to develop these products — which, if true, should then obviate any concerns about generics being developed. They also suggest that the WHO-supported effort known as COVAX, a vaccine fund for low-income countries to which wealthy countries can contribute, should fill in the gap. But even if pledges for support are met, COVAX is only expected to provide around 20% of the vaccine required by countries in need.
So the biggest obstacle to enacting the TRIPS waiver is, predictably, the corporate bottom line. It’s a serious barrier, despite the already substantial profit margins of pharmaceutical companies. In just one example, it’s estimated that profit from Pfizer vaccine sales will be around four billion dollars — and that’s after their costs for research and development. Not often mentioned is that several of the other likely-to-be-approved vaccines were developed with substantial support from the federal government. Can these companies not spare some of their gains for people in desperate need of relief from the pandemic?
None of us will be safe until the entire world is safe.
The U.S. could be a leader by, at a minimum, supporting the proposed TRIPS waiver. So far, the administration has not indicated it’s willing to take that stand. Our new president needs to hear that we don’t want a repeat of the deadly debacle that occurred in rollout of AIDS drugs. And the U.S. could go much further than that by spearheading an international initiative to assure global access to COVID vaccines. There is a precedent. The President’s Emergency Program for AIDS Relief, PEPFAR, established in 2003 by then-president Bush, is estimated to have saved over 18 million men, women and children from death due to AIDS.
Whatever the mechanism we use, the goal must be giving people everywhere a fair chance to be protected from COVID infection. Because none of us will truly be safe until the entire world is safe.