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Should drug companies have the power to control vaccine access for the world’s poor?

Introduction by Croakey: The World Trade Organization will next week consider a temporary waiver on drug company vaccine monopolies so poorer countries can access and produce COVID-19 vaccines.

The waiver is being sought to the TRIPS treaty, the Trade-Related Aspects of Intellectual Property Rights, which creates barriers for low-income nations to access vital medicines, while patents and other protections prevent smaller companies and nations from manufacturing large quantities of lower-cost vaccines.

This week an alliance of health, human rights and fair-trade organisations rallied outside Pfizer Australia’s office in Sydney, calling for the pharmaceuticals giant to put the COVID-19 vaccination needs of millions of people in low and lower-middle income countries ahead of its revenue targets.

The organisations included Amnesty International, Australian Fair Trade and Investment Network, Médecins Sans Frontières Australia, Oxfam Australia, and Union Aid Abroad.

Global access to vaccines is skewed towards high income countries, and the target set by the WHO taskforce in July to vaccinate 40 percent of people in every low and lower-middle income country by the end of this year now seems an impossible dream.

In the article below Jennifer Tierney, Médecins Sans Frontières Australia Executive Director (pictured) calls for global solidarity on vaccine access and for wealthy countries with surplus vaccines, like Australia, to urgent redistribute vaccines to countries in need.


Jennifer Tierney writes:

As a medical humanitarian organisation, Médecins Sans Frontières/Doctors Without Borders (MSF) teams have for decades observed systematic failures that put profits before people’s lives when it comes to the provision of essential drugs and other medical tools.

Over 20 years ago, using money awarded to us from the Nobel Peace Prize, we launched the Access to Essential Medicines Campaign to advocate to change a system where drugs were either too expensive or not available for those who needed them.

The campaign was established against the backdrop of the HIV/AIDS epidemic when life-saving drugs were priced out of reach in low-income nations. MSF medical staff also lacked effective treatments for people with diseases such as tuberculosis and malaria, because pharmaceutical corporations didn’t consider it profitable enough to develop drugs for people who couldn’t afford to pay high prices.

Fast forward to late 2019 as COVID-19 upended our lives and the global health system. Surely, we could hope in a global pandemic – where everyone everywhere was at risk from the same virus – that a paradigm shift might occur? Was this the crisis that was needed to focus attention on, and fix, our broken global system?

Unfortunately no. Nearly two years into the pandemic and just 5.5% of citizens in low-income countries have had their first COVID-19 shot while 64% of people in high-income countries have. In Australia the contrast is even starker – with more than 80% of people double dosed compared to 1.7% in Papua New Guinea.

Dr Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization (WHO), has consistently championed the call for equity of access to vaccines and other medical tools.

“I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers,” he said in September.

A manufactured crisis

This inequality, which is stalling progress against COVID-19, was not inevitable. It is a manufactured crisis brought about by the decisions of pharmaceutical companies and wealthy governments.

Rather than take concrete measures to ensure global access to COVID-19 vaccines, states with the power to do so have largely left decisions around availability, accessibility and affordability in the hands of business.

Despite receiving billions of dollars in government funding to develop COVID-19 vaccines, most pharmaceutical companies have insisted on maintaining control over production, which stunts the global supply and distribution of vaccines.

By refusing to waive intellectual property rights or share their technologies, most western vaccine developers have blocked other companies from manufacturing much-needed doses. Intellectual property rights also mean companies can set the price of vaccines and many have chosen to sell them at high prices, and over time have increased the price.  Pfizer/BioNTech and Moderna’s predicted 2021-22 revenue from sales of their vaccines totals more than $83 billion.

The WHO has set up several initiatives to encourage technology sharing and boost supply of vaccines, drugs and other medical tools but pharmaceutical companies have refused to join. These include the COVID-19 Technology Access Pool (C-TAP) and the mRNA technology transfer hub in South Africa.

Pharmaceutical companies have restricted global supply and prioritised distribution to rich countries. Pfizer/BioNtech’s delivered nine times more vaccines to Sweden than to all the low-income countries combined, while nine out of 10 Moderna doses have gone to high-income countries. In the meantime, COVAX, the global procurement mechanism that was supposed to deliver COVID-19 vaccines equally across the world, has struggled to secure the doses it was promised.

High-income countries have sat on stockpiles of vaccines, ordering far more than they need. By MSF’s estimates there will be 870 million excess doses held by countries including Australia, Canada, Denmark, France, the Netherlands, Norway, Sweden, Germany, the UK and the US by the end of 2021.

If surplus doses were to be redistributed to where they are most needed quickly, an estimated one million deaths could be averted by the middle of 2022.

MSF has consistently been pushing for countries and pharmaceutical companies to take a global perspective and follow WHO’s Equitable Allocation Framework so that all frontline health workers and other high-risk groups are vaccinated first, no matter where they live.

Only after these groups have been vaccinated, should low-risk people be vaccinated. Not only does this contribute towards ending the pandemic sooner and reduce the risk of new variants emerging, but it also helps to lift pressure off over-burdened health facilities.

So, what needs to change?

Immediate steps

Wealthy countries with surplus vaccines must start redistributing vaccines to COVAX as soon as possible. MSF also urges the Australian Government to respond to the call by WHO Director-General Dr Tedros Adhanom Ghebreyesus not to administer booster doses (except for over-65s and the immunocompromised) until the end of the year.

Pharmaceutical companies must prioritise increasing the availability of vaccines in less wealthy regions by devoting a significant share of their 2021/22 production runs to the COVAX facility that is providing vaccines to low- and middle-income countries.

Governments, including Australia, must actively support the TRIPS waiver at the World Trade Organization, an initiative supported by 118 countries designed to facilitate intellectual property and technology sharing of COVID-19 drugs, vaccines and diagnostics.

To achieve a fair rollout vaccine developers must suspend their intellectual property rights by issuing global, open and non-exclusive licences or by participating in C-TAP or the WHO mRNA vaccine technology transfer hub. They must share their knowledge and technology and train qualified manufacturers committed to ramping up production of COVID-19 vaccines.

How to fix the broken system

Action is needed to create mid- and long-term solutions to ensure manufacturing and supply capacity for vaccines, drugs and diagnostics is not only increased but diversified to support a more sustainable global supply system. Public funding shouldn’t be handed over without strings attached.

In future, public and philanthropic funders should ensure vaccines, medicines and diagnostics are developed, produced and provided as global public goods, free from private monopolies. Enforceable conditions must be attached to all research and development funding schemes to ensure non-exclusive licensing and technology transfer to low- and middle-income countries.

And finally, governments that contribute public funds for research for future outbreaks must require pharma corporations to open their books and show the public all research and development and production costs. The public pays for medical research through their taxes and, therefore, deserves transparency on how public money is used.

During the pandemic no company has fully disclosed the actual costs of production, their sources of external funding, or prices they have been charging in different countries. This needs to change.

We need global solidarity for this pandemic and for the future pandemics we will inevitably face. Pharmaceutical corporations should not decide who gets access to life-saving drugs and vaccines. Let’s learn some of the hard lessons now – so we can do better next time.

Jennifer Tierney is the Executive Director of Médecins Sans Frontières Australia.


See Croakey‘s archive of stories on vaccination.

 

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