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Outrage over COVID-19 vaccine inequities: Rich world hogs supplies and patents

Despite  the COVID-19 global mantra of ‘No one is safe until we are all safe’, the world's wealthy nations have not only hogged vaccine supplies coming on-stream but have also rejected patent waivers that would allow low-income countries the possibility of manufacturing their own stocks, writes MedicalBrief. Canada, alone, has procured enough vaccine to protect its population five times over.

The rejection by high-income countries of the intellectual property (IP) waiver that would allow low-income countries to produce COVID-19 vaccines is a step back in the campaign against global health inequities, write professors Ernest Aryeetey (Ghana) and Eivind Engebretsen, Åse Gornitzka, Peter Maassen and Svein Stølen (Norway) in The Lancet and University World News. It is intolerable for wealthy nations to claim an excessive share of global vaccine capacity.

The rights waiver proposed by India and South Africa is likely to be debated at a 17 December 2020 General Council meeting of the World Trade Organization. Despite massive support – from the World Health Organization, UNAIDS, and around 100 World Trade Organization states – at this stage, prospects look bleak.

Aside from the usual refusal to grant exceptions to protection of intellectual property rights, a sotto voce reason is that waiving intellectual property rights would in any case be meaningless for countries that are incapable of successfully producing or delivering a COVID-19 vaccine.

If that is the case, a long term solution would be to improve capacity in the poor world. Thus the academics urge support for a July 2020 call to massively strengthen African research, innovation and higher education, made jointly by two influential African and European organisations – the African Research Universities Alliance and the Guild of European Research-Intensive Universities.

Read The Lancet and University World News articles in full below.

‘No one is safe until we are all safe’, is a mantra of the global fight against SARS-CoV-2, writes MedicalBrief. This sounds good, and it is indeed true in a global pandemic.

But the words rang hollow in recent weeks as it became upsettingly obvious that the inequities COVID-19 has exposed and exacerbated also apply to vaccines. As a result, the rich world will be protected in the coming months and year, the poor world will not.

The worst example is Canada’s procurement of enough vaccine to protect its population five times over, according to Duke University data analysis. High-income countries have pre-bought most of the doses of COVID-19 vaccines that will be produced in 2021. The People’s Vaccine Alliance reports that only one in 10 people in some 70 low-income countries are likely to get vaccinated next year.

The proposed waiver is supported by around 100 of 164 WTO member states. The European Union opposes it along with the United States, United Kingdom, Australia, Brazil, Norway and others. The waiver is also supported by the World Health Organization, UNAIDS, and more than 300 civil society groups and researchers worldwide. So lots of support, but not from the wealthy nations that wield great influence at the WTO.

In a 9 December 2020 commentary, UNAIDS Executive Director Winnie Byanyima wrote that the UK had quite rightly been celebrating the development and administration of the first shots of one of the COVID-19 vaccines. It was a remarkable achievement. However, tragically echoing the early days of the response to AIDS, poorer countries would have to wait years to offer their people life-saving medicines.

“We must have a #PeoplesVaccine, not a profit vaccine,” she wrote. More encouragingly: “The campaign for a #PeoplesVaccine is gaining momentum,” Byanyima wrote.

In the US, more than 100 high-level leaders from public and civil society joined with politicians, economists and artists to sign a public letter calling on Joe Biden to support a People’s Vaccine. In the EU, a coalition of health trade unions, NGOs and activists, students and health experts launched a European Citizens’ Initiative for a people’s vaccine.

“Now is the time for pharmaceutical companies and governments to step up and ensure that a COVID-19 vaccine is available to everyone, everywhere, free at the point of use. Only then will the world begin to turn the tide on the COVID-19 crisis and ensure that everyone can stay safe and prosper,” said Byanyima.

Speaking at a MedicalBrief/Desmond Tutu Health Foundation/PPS webinar earlier this year, Dr Anthony Fauci, Director of the US National Institute of Allergy and Infectious Diseases (NIAID) told South African health practitioners that a COVID-19 vaccination's distribution should follow the same approach that the United States had followed with HIV antiretrovirals through its PEPFAR programme. Fauci said that former President George W Bush’s message to him had been that there was a moral obligation to ensure that life-saving interventions are universally and uniformly available, and not only to countries that can afford it.

“As a global community, we need to make sure that we don’t have just rich countries getting [vaccines]. That’s the reason why when we contract with companies, we talk about billions of doses, not hundreds of millions of doses. To me it’s a moral obligation.”

Link to the full UNAIDS commentary below.

The People’s Vaccine Alliance is a coalition of organisations including UNAIDS, Oxfam, Free the Vaccine, the Yunus Centre, Frontline AIDS and SumOfUs. It aims to: ensure that a vaccine is provided free to people; prevent monopolies on vaccine and treatment production; ensure vaccines are sold at affordable prices; and ensure fair allocation of vaccines.

On 9 December, Sarah Boseley wrote in The Guardian about the People’s Vaccine Alliance warning that deals done by rich countries would leave the poor at the mercy of a rampaging SARS-CoV-2. “Rich countries with 14% of the world’s population have secured 53% of the most promising vaccines,” the story reveals. Canada has bought more doses per head of population than any other – enough to vaccinate each Canadian five times, said the alliance,” the story reveals.

Supplies of the Pfizer-BioNTech vaccine would “almost all go to rich countries – 96% of doses have been bought by the West. The Moderna vaccine uses a similar technology, which also is claimed to have 95% efficacy, and is going exclusively to rich countries. The prices of both vaccines are high and access for low-income countries will be complicated by the ultra-low temperatures at which they need to be stored,” wrote Boseley.

“By contrast, the Oxford University-AstraZeneca vaccine, which has 70% efficacy, is stable at normal fridge temperatures and the price has been set deliberately how for global access. The manufacturers have said 64% of doses will go to people in the developing world.” Such a commitment was to be applauded – but one company could not alone supply the world. “At most Oxford-AstraZeneca can reach 18% of the world’s population next year.”

Campaigners, Boseley continued, want COVID vaccine manufacturers to share technology and intellectual property through the WHO COVID-19 Technology Access Pool. “That would allow billions more doses to be made at low prices for the developing world. AstraZeneca-Oxford, Moderna and Pfizer-BioNTech have received more than $5bn of public funding to develop their vaccines, they said, which means they have a responsibility to act in the global public interest.”

Link to The Guardian article below.

 

A step backwards in the fight against global vaccine inequities

Correspondence published in The Lancet on 9 December 2020

Ernest Aryeetey, Eivind Engebretsen, Åse Gornitzka, Peter Maassen and Svein Stølen*

The news that an effective vaccine against severe acute respiratory syndrome coronavirus will be introduced imminently was welcomed with great enthusiasm worldwide. The consensus is that access to vaccines for low-income countries is a global responsibility.

To make sure that all countries and their citizens will have equal access to a vaccine, Eswatini, India, Kenya, and South Africa proposed a waiver from certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights by the World Trade Organization (WTO).

Acceptance of the proposal would allow low-income countries to produce their own COVID-19 vaccine. However, various high-income countries rejected the proposal, arguing that they cannot support the proposed broad exceptions to protection of intellectual property rights, even in an exceptional crisis such as COVID-19.

Another argument, which is used more informally, is that the COVID-19 vaccine is difficult to produce, with demanding production lines and storage requirements. In short, waiving provisions of trade-related aspects of intellectual property rights would not make sense since basic scientific and technological conditions for producing and storing the vaccine are insufficiently fulfilled in low-income countries.

The conservative position that is taken by high-income countries is a step backwards in the campaign against global vaccine and immunisation inequities. To move forward, we can no longer accept the basic inequality resulting from the most resourceful nations of the world continuing to claim an unreasonably large share of the global production capacity, as in the case for COVID-19 vaccines.

Therefore, strengthening research institutions in low-income regions should be an absolute priority in cooperation agreements between high-income and low-income countries and regions.

Strengthening these institutions is particularly relevant for global education and science collaboration with Africa, which is mainly focused on primary and lower-secondary education (ie, age six to 15 years), largely marginalising scientific cooperation and building of scientific capacity.

To alter this traditional focus on primary and lower-secondary education, an alliance of 36 African and European research universities has launched an initiative to promote the prioritisation of research and innovation in the new strategic, multiannual agreement between the African Union and the European Union.

The initiative argues for major investments in African research universities to enhance their research and innovation productivity in key areas and improve career opportunities for African researchers on their own continent.

With this initiative, the participating universities give a clear message to all public authorities involved: if the necessary increase in the production and use of relevant knowledge and technology is to be realised throughout the whole continent, then strengthening research universities should be prioritised.

The challenges of vaccine and immunisation inequities clearly show the fundamental need for long-term investments in African universities as their continent's key institutions for knowledge.

* We declare no competing interests.

 

Vaccine inequities expose fault lines in North-South collaboration

University World News. Published on 10 December 2020

Ernest Aryeetey, Eivind Engebretsen, Åse Gornitzka, Peter Maassen and Svein Stølen

The gigantic global scientific efforts to develop a vaccine to mitigate the devastating impact of COVID-19 on societies have reached a point where the mass production and use of effective vaccines are a reality. But, in the subsequent race that is unfolding to produce and purchase vaccines, the gross global inequalities in the access to vaccinations, as well as in the science that makes that possible, have been exposed.

Currently, high-income countries have bought most of the doses of COVID-19 vaccines that will be produced in 2021. For example, Canada has obtained enough doses of various vaccines to vaccinate its entire population of 37.9 million people up to five times, which is at the top of the country list in terms of vaccines per capita, according to a data analysis compiled by Duke University.

In comparison, according to the People’s Vaccine Alliance, only one out of 10 people in nearly 70 low-income countries are likely to get vaccinated in 2021.

We raised our concerns about the vaccine and scientific inequities in a letter published on 9 December in The Lancet. We also offer a way forward: the strengthening of the research capacity at universities in low-income countries, especially in Africa, as a moral, economic and scientific imperative.

World Trade Organization waiver

It is in this context of global scientific inequity that we should look ahead at the General Council meeting of the WTO expected to take place on 17 December and consider the various arguments for and against a proposal for a waiver from certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement for the prevention, containment and treatment of COVID-19.

To make sure that all countries and their citizens would have equal access to approved vaccines, South Africa and India, supported by Eswatini and Kenya, have formally proposed the waiver to the WTO. Acceptance of the proposal would imply that all countries would be allowed to produce their own COVID-19 vaccine.

Currently, around 100 of the 164 WTO member states, the World Health Organization, UNAIDS and more than 300 civil society organisations worldwide support the proposed waiver. In addition, the proposal is supported by academics and researchers from around the world.

However, various high-income countries, including the United States, the United Kingdom, Australia, Brazil, the European Union and Norway, oppose the waiver proposal. The main formal argument expressed by these countries is that they do not want to allow for very broad exceptions to the existing WTO system when it comes to the protection of intellectual property rights, even in an exceptional crisis such as COVID-19.

Instead, they prefer voluntary agreements between individual countries and pharmaceutical companies, as has been the practice so far. The impact of this practice is obvious when we see that through voluntary agreements 96% of the candidate vaccine developed by Pfizer/BioNTech in 2021 and 100% of the Moderna vaccine have already been bought by high-income countries in bilateral agreements.

At the same time, the COVID-19 vaccine produced by the University of Oxford and AstraZeneca will be available on a non-profit basis, implying a low price, with 64% of the 2021 production estimated to be sold to low- and middle-income countries.

Still, taking into account the maximum production capacity of Oxford University-AstraZeneca, this implies, according to Dr Mohga Kamal Yanni from the People’s Vaccine Alliance, that: “Rich countries have enough doses to vaccinate everyone nearly three times over, whilst poor countries don’t even have enough to reach health workers and people at risk.”

Vaccine politics

The negotiations about the proposal are expected to continue at least until the 17 December meeting of the WTO’s General Council.

While the debates about waiving global intellectual property rights for COVID-19 medicines have hitherto dominated the COVID-19-related discussion about global vaccine inequality, another set of arguments used more informally is that the COVID-19 vaccine is difficult to produce, with demanding production lines and storage requirements.

Obviously, producing, distributing, storing and using billions of doses of vaccines require appropriate human, academic and technological capacity. Many low-income countries apparently do not have the required capacities for producing the COVID-19 vaccines, and from that perspective, waiving intellectual property rights to allow these countries to produce the vaccine for their own population would be almost meaningless in practice.

There are, for example, only a few countries in Africa that have the required scientific capacity to do research on, produce and store the COVID-19 vaccines (at least the Pfizer-BioNTech and Moderna ones, both being mRNA vaccines that are complicated to produce and need to be stored under very cold conditions).

Consequently, even if governments and pharmaceutical companies would reach the kind of voluntary arrangements the high-income countries prefer over a general patent waiver in the WTO, the lack of a high-quality academic community (and the required scientific capacities) would form an important additional barrier for any country to produce, store and use (first generation) COVID-19 vaccines.

Scientific inequality

Many countries in Africa are in this position as a result of structural national underfunding and political marginalisation. In this, low-income countries have generally followed the focus of bilateral and multilateral donors on primary and lower-secondary education (with children from six to 15 years).

As a consequence, most universities on the African continent are lagging behind the rest of the world, especially when it comes to their research capacity and productivity.

This is why we argued in our commentary in The Lancet, that the conservative position taken by high-income countries is a step back in the campaign against global vaccine and immunisation inequalities and forms a powerful reminder of the need to support and strengthen appropriate knowledge and technology developments in low-income countries.

This implies that, in accordance with the UN's Sustainable Development Goals, supporting the development of strong research institutions in the Global South that operate on the knowledge frontier and are equipped to absorb and adopt new technology should be an absolute priority in North-South cooperation agreements.

From our perspective, this is particularly relevant in the global knowledge sector collaboration with Africa. The traditional focus on primary and lower-secondary education implied, for higher education, science and innovation, that collaboration was limited to educational and administrative capacity building, short-term bilateral collaboration projects, especially in the areas of healthcare and agriculture, and scholarships for individual students.

The latter has given selected individuals important personal development and career opportunities but has also contributed to a massive brain drain from the African continent.

Strategically focused investments

Therefore the 36 member universities of the African Research Universities Alliance (ARUA), and the Guild of European Research-Intensive Universities have taken the initiative to convince the African Union and the European Union, and national governments in Europe and Africa, to develop a joint long-term strategy aimed at seriously strengthening African universities through focused investments (of at least €1 billion or US$1.2 billion per year) in their research capacity in five priority areas, that is, public health, the green deal, digital transformations, public governance, and inequality.

The 36 universities have drafted a detailed proposal arguing for the need to strengthen intra-African and joint African-European research activities, the research infrastructure at African universities, and joint doctoral education and postdoctoral programmes that ensure career opportunities for African research talents on their own continent.

With this initiative, the participating universities want to give a clear message to all public authorities involved: for African-European cooperation to become more strategic and mutually beneficial, measures to develop knowledge systems as a whole must be prioritised that include all levels, from kindergarten and primary school to university.

If the necessary increase in the production and use of advanced knowledge is to take place in more African countries, strengthening research universities on the African continent should be prioritised.

The challenges of vaccine and immunisation inequalities clearly illustrate the fundamental need for this type of long-term investment in African universities as the continent’s key knowledge institutions. This is not least necessary to avoid in the future that a relatively weak scientific and technology capacity is used as an argument for vaccines not being produced, for example on the African continent.

We cannot accept the basic inequality that arises when the most resourceful nations of the world take and continue to claim an unreasonably large share of the global pharmaceutical capacity, as in the case of the production and purchase of the COVID-19 vaccines.

Ernest Aryeetey is professor of economics of development, University of Ghana, and the secretary-general of the African Research Universities Alliance (ARUA). Eivind Engebretsen is a professor of medicine and the vice-dean of the faculty of medicine at the University of Oslo, Norway. Åse Gornitzka is a professor of public policy and public administration and the vice-rector of the University of Oslo. Peter Maassen is a professor of higher education research at the University of Oslo in Norway and extraordinary professor at the DSI-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Stellenbosch University, South Africa. Svein Stølen is a professor of chemistry and rector of the University of Oslo. They write in their personal capacity.

 

[link url="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32596-4/fulltext"]The Lancet – A step backwards in the fight against global vaccine inequities[/link]

 

[link url="https://www.universityworldnews.com/post.php?story=20201210055524317"]University World News – Vaccine inequities expose fault lines in North-South collaboration[/link]

 

[link url="https://www.unaids.org/en/resources/presscentre/featurestories/2020/december/20201209_we-must-have-a-peoples-vaccine"]UNAIDS commentary – We must have a #PeoplesVaccine, not a profit vaccine[/link]

 

[link url="https://peoplesvaccine.org"]The People’s Vaccine website[/link]

 

[link url="https://www.the-guild.eu/publications/arua-guild-concept-note-common-challenges.pdf"]African Research Universities Alliance and The Guild of European Research-Intensive Universities – Confronting our common challenges: A new approach to strengthening Africa's research, innovation and higher education capacity: Concept note[/link]

 

[link url="https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W669.pdf&Open=True"]WTO – Waiver from Certain Provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19 – Communication from India and South Africa[/link]


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[link url="https://www.medicalbrief.co.za/archives/fauci-wants-a-global-rollout-of-americas-right-on-schedule-vaccines/]Fauci wants a global rollout of America’s ‘right on schedule’ vaccines[/link]

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