[Ip-health] AP: Vaccine inequity: Inside the cutthroat race to secure dose

Thiru Balasubramaniam thiru at keionline.org
Tue Jul 20 01:39:51 PDT 2021


Vaccine inequity: Inside the cutthroat race to secure doses
July 18, 2021

No one disputes that the world is unfair. But no one expected a vaccine gap
between the global rich and poor that was this bad, this far into the

Inequity is everywhere: Inoculations go begging in the United States while
Haiti, a short plane ride away, received its first delivery July 15 after
months of promises — 500,000 doses for a population over 11 million. Canada
has procured more than 10 doses for every resident; Sierra Leone’s
vaccination rate just cracked 1% on June 20.

It’s like a famine in which “the richest guys grab the baker,” said Strive
Masiyiwa, the African Union’s envoy for vaccine acquisition.

In fact, European and American officials deeply involved in bankrolling and
distributing the vaccines against coronavirus have told The Associated
Press there was no thought of how to handle the situation globally.
Instead, they jostled for their own domestic use.

But there are more specific reasons why vaccines have and have not reached
the haves and have-nots.

COVID-19 unexpectedly devastated wealthy countries first — and some of them
were among the few places that make the vaccines. Export restrictions kept
the doses within their borders.

There was a global purchase plan to provide vaccines for poorer countries,
but it was so flawed and underfunded that it couldn’t compete in the
cutthroat competition to buy. Intellectual property rights vied with global
public health for priority. Rich countries expanded vaccinations to younger
and younger people, ignored the repeated pleas of health officials to
donate their doses instead and debated booster shots - – even as poor
countries couldn’t vaccinate the most susceptible.

The disparity was in some ways inevitable; wealthy nations expected a
return on their investment of taxpayer money. But the scale of the
inequity, the stockpiling of unused vaccines, the lack of a viable global
plan to solve a global problem has shocked health officials, though it
wasn’t the first time.

“This was a deliberate global architecture of unfairness,” Masiyiwa told a
Milkin Institute conference.

“We have no access to vaccines either as donations or available for us to
purchase. Am I surprised? No, because this is where we were with the HIV
pandemic. Eight years after therapeutics were available in the West, we did
not receive them and we lost 10 million people.”

“It’s simple math,” he said. “We have no access. We have no vaccine


On Jan. 30, 2020, WHO declared the coronavirus outbreak in China to be a
global emergency. It would be months before the word “pandemic” became

But that same day, the Coalition for Epidemic Preparedness and Innovations,
or CEPI, was planning for the worst. CEPI announced “a call for proven
vaccine technologies applicable for large scale manufacturing,” according
to minutes from its scientific advisory group. CEPI said it would be
critical “to support the strategy for global access” early in the game.

CEPI quickly invested in two promising coronavirus vaccines being developed
by Moderna and CureVac.

“We said very early on that it would be important to have a platform where
all countries could draw vaccines from, where there’s accountability and
transparency,” said Christian Happi, a professor at Nigeria’s Redeemer’s
University and a member of CEPI’s scientific advisory committee. “But the
whole idea was that we thought rich countries would fund it for the
developing world.”

Happi said officials never expected the pandemic would strike first and
hardest in Europe and the U.S. Or that their assessment of preparedness in
the world’s most advanced economies would prove horrifically optimistic.

Global health experts would soon come to realize that rich countries “could
sign a piece of paper saying they believe in equity, but as soon as the
chips are down, they will do whatever they want,” he said.

On March 16, five days after WHO first described COVID-19 as a “pandemic,”
the novel mRNA vaccine developed by Moderna was injected into a trial
participant for the first time.


At the same time, the U.S. repeatedly invoked the Defense Production Act —
18 times under the Trump Administration and at least once under Biden. The
moves barred exports of crucial raw materials as factories were ramping up
production of the as-yet-unapproved vaccines — and eventually, of the
vaccines themselves.

But it also meant those materials would run low in much of the rest of the
world. The U.S. stranglehold would lift only in spring 2021, and only

Operation Warp Speed supercharged the global race to secure vaccines, but
it would still take another two weeks until COVAX — the COVID-19 Vaccines
Global Access Facility — was formally announced as the entity to ensure
equity, with the Serum Institute of India as the core supplier for the
developing world.

COVAX had the backing of the World Health Organization, CEPI, vaccines
alliance Gavi and the powerful Gates Foundation. What it did not have was
cash, and without cash it could secure no contracts.

“Operation Warp Speed signed the first public deals and that started a
chain reaction,” said Gian Gandhi, UNICEF’s COVAX coordinator for supply.
“It was a like a rush on the banks, but to buy up the expected supply.”

Some involved in the COVAX project flagged India as a potential problem
early on, according to minutes of meetings in late spring and early summer
of 2020.

India’s government had blocked exports of protective gear, but many global
health authorities who hadn’t fully grasped the extent of pandemic
nationalism found it unimaginable that the country would block vaccines
when the world was counting on them. Also, India had so far been spared the
waves of death that were sweeping across Europe and the Americas.


A separate plan put forward by the government of Costa Rica and the World
Health Organization to create a technology-sharing platform to expand
vaccine production foundered. Not a single company agreed to share its
blueprints, even for a fee — and no government pushed them behind the
scenes, according to multiple people involved in the project.

On the global scale, the one organization that could have pushed for more
technology sharing was the Gates Foundation, whose money to WHO nearly
matches that of the U.S. government.

Instead, Bill Gates defended stringent intellectual property rights as the
best way to speed innovation. His foundation poured money and influence
into the Access to COVID-19 Tools Accelerator, which also failed to
generate the money or influence needed to ramp up production outside
already existing hubs.


But by the time it was clear the mRNA doses were a viable alternative, even
in poor countries with limited cold chain, the available supply had been
snapped up in Europe, the United States and Canada. And India, in the
throes of its own COVID-19 surge, diverted its vaccines for its own use.

According to the People’s Vaccine Alliance, a grouping of human rights
organizations advocating for broader sharing of vaccines and their
underlying technology, the coronavirus has created nine new billionaires.
The top six are linked to the successful mRNA vaccines.

For Byanyima, of UNAIDS, this is a travesty and a sign that the world has
learned little in the decades since the AIDS pandemic was brought under
control in the United States, only to kill millions in Africa because
treatments were unaffordable: “Medicines should be a global public good,
not just like a luxury handbag you buy on the market.”


For the pharmaceutical industry, mRNA is the ultimate confirmation that
hard work and risk-taking is rewarded. And those companies keep tight hold
on the keys to their successful vaccines.

When Moderna and Pfizer created new production lines, it was in the insular
European and American manufacturing networks that had as much stake as
anyone in both ensuring that the injections meet the highest standards and
keeping promises not to abuse intellectual property.

Many public health officials have pushed for technology transfer during the
pandemic. Initially resistant, the Gates Foundation has changed its
position in favor of sharing.

Dr. Clemence Auer, the EU’s lead negotiator for vaccine contracts last
summer, said the question of compelling pharmaceutical companies to suspend
their vaccine intellectual property rights to increase the worldwide supply
of coronavirus vaccines never even came up.

“We had a mandate to buy vaccines, not to talk about intellectual property,
” Auer said.

“The global community should have had this discussion back in 2020 but that
didn’t happen,” he said. “Maybe we should have done it last year, but now
it’s too late. It is spilled milk.”

CEPI includes equity clauses in the vaccines that it invests in, among them
the successful Moderna candidate, but has yet to invoke them during the
pandemic. Some include requirements to make a vaccine available to
populations in need at affordable prices, as is the case in CEPI’s Moderna
contract. But Moderna was first available exclusively in wealthy countries
and even now only limited amounts are going outside Europe and the United

A separate push to lift intellectual property restrictions on vaccines and
medicines has also gone nowhere in the World Trade Organization.

And WHO is reticent to criticize donor nations or the pharmaceutical
companies. The U.N. health agency works by consensus and needs them for
other aspects of global health — and for its own continued existence. The
Biden administration has reversed Trump’s decision to defund and leave WHO,
but the damage has been done.


A recent meeting of WHO’s vaccine allocation group disbanded with nothing
accomplished, because there was no vaccine to allocate. “Zero doses of
AstraZeneca vaccine, zero doses of Pfizer vaccine, zero doses of J&J
vaccine,” said Dr. Bruce Aylward, a senior advisor at the organization.

“Every single one of our suppliers is unable to supply during this period
because others are making demands on those products, others who are
vaccinating very young populations that are not at risk,” Aylward said.


Maria Cheng reported from London, and Aniruddha Ghosal from New Delhi.
Other contributors include Sally Ho in Seattle; Zeke Miller in Washington;
Danica Coto in San Juan, Puerto Rico; and Stacey Plaisance in New Orleans.


Follow AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic
and https://apnews.com/hub/coronavirus-vaccine

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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