The horror of what is unfolding in India has shocked the world. Covid patients lying in the streets and in cars gasping for air with relatives crying for oxygen has brought the brutality of this pandemic home to us, once again. This time in countries with poor health systems, where millions are without access to the most basic health care. Who would have thought that we would see black markets on oxygen develop, just 16 months back? The cries of these victims have forced countries with more control of the Covid-pandemic to send help.
But the twisted and sad irony is this: while thousands upon thousands die every day in India from Covid-19, their own factories produce vaccines in the millions that are shipped right out of the country. To us who can pay for them. Indian health authorities themselves have only been able to vaccinate 2 percent of their own population. Our big pharma produces from their factories. But we know that India could produce far more, and be able to vaccinate millions upon millions worldwide, and their own people.
They are not permitted to do so, however. They are stopped by the regulations of the World Trade Organization, WTO. The patenting rules are preventing them from using the technology. The battle on this issue in the WTO has been going on for at least 9 months. The rich world has blocked any change. Earlier this month, however, the United States announced a groundbreaking reversal. The Covid-vaccines should no longer be protected by patents reserved for the giants of the pharmaceutical industry. They want an exception to these WTO regulations.
This turnaround by the Biden administration could actually be the world’s most important life-saving decision in decades. Now it is for other affluent countries to follow suit. There still is resistance from France, Germany and others, but with the US pushing, and with the support of Norway, the chair of the committee on this issue (the TRIPS-committee), there may be a good chance that the turnaround can become world policy.
Market and profit ahead of access for all?
Because the biggest problem in fighting the pandemic now is the scarcity of vaccines globally. This is caused by limited production capacity. Such a decision by the WTO will provide increased production of vaccines, as vaccine technology will become available to companies all over the world. It will expand production capacity globally, and with that, vaccines will be cheaper. Cheaper vaccines globally also mean that many more developing countries will be able to vaccinate their own population.
The regulations today permit companies to patent their vaccine inventions and thus also monopolize the production and sale of their products. This ensures return on their investments and, in addition, generates significant profits. This time, however, big pharma has received enormous amounts of subsidies from governments, both in the research and development of vaccines. It would not be right if they were to reap the benefits of this support alone. On the contrary, this should imply that they accept exceptions to the rules this time. In this unique situation access for all must come before profit for the few.
This has also happened once before, for HIV and AIDS ARVs. Now we are facing a global pandemic of historic proportions. Exceptions are even more justified this time. South Africa and India, supported by China and about 100 other countries, have proposed an exception to the WTO-rules for months, while the United States and Western European countries blocked it. Apart from research and development, the argument has also been that the Covid-vaccines are more demanding to produce than other medicines, including ARVs for HIV and AIDS. Clearly, much more needs to be done both in technology transfer and developing additional capacity in other developing countries with pharmaceutical industries.
But Indian manufacturers are already delivering and can scale up significantly. And with an exception to the patenting rules, the incentives will change: Many more companies worldwide will do their utmost to join the league of competent vaccine producers. We are also likely to see new ways of partnering between companies in sharing technology and building capacity. The incentives will certainly increase the number of manufacturers globally.
Aid is not enough
We have seen the challenges with relying on aid only with the recent assistance being sent to India. Delivering support when a pandemic is unfolding is like fighting a tidal wave. Aid will never be enough. With the Covax-initiative a giant transfer of Covid-19 vaccines to developing countries is taking place. This is very good. It is linked to the Access to Covid-19 Tools Accelerator (ACT-A), a so-called vaccine accelerator, co-chaired by Norway and South Africa. But the Covax initiative is not getting enough funds and is far from reaching its target for 2021.
Even if it did, the target for this year represents only 20% of needed vaccine coverage globally. And even that goal is very far away. Still, 80% of the population in the developing world is left without vaccines. The Biden administration has made solid contributions, but for the initiative in total, around $20 billion more is still needed this year alone. With the large aid cuts now taking place in so many countries, it will be very difficult, if not impossible, to bring in the billions and billions of dollars needed. In other words, investing in aid alone will not help us combat the global pandemic.
That is why patent regulations are so important. The exemption now proposed by the US is also more limited. It applies to vaccines only, and not medicines against Covid-19. Hopefully, this will make it possible to achieve consensus in the WTO. The World Health Organization is waiting for this decision. They know that the battle against covid cannot be won without it. Neither the market alone nor assistance alone can provide vaccines for everyone. It is only by combining the two we can make it happen. Only then can the poorest avoid ending up at the back of the world's longest queue. And only then can we avoid that new and dangerous mutations finding their way back to us.