[Ip-health] Popular Science: We’ve barely made a dent in vaccinating the world against COVID-19 - Getting the vaccine to every country won’t be easy, but it can be done.

Thiru Balasubramaniam thiru at keionline.org
Sat Feb 20 23:06:32 PST 2021



We’ve barely made a dent in vaccinating the world against COVID-19

Getting the vaccine to every country won’t be easy, but it can be done.

Kat Eschner
February 17, 2021

As COVID-19 vaccinations become more accessible in wealthy countries, most
developing nations are still waiting for their first doses to arrive. Slow
rates of global vaccinations could give the virus more time to mutate,
experts say, and compound the economic and social crises already caused by
the pandemic.

A number of issues prevent people around the world from getting vaccinated
but two stand out: Only a small number of companies know how to manufacture
the vaccines that have been approved for use (or will be soon) and only
some parts of the world have the technology to produce vaccines of this
kind. However, both of these issues could be overcome, and the U.S. could
play a lead role.

“As of last week, only 55 people were vaccinated in low-income countries,”
says Niko Lusiani, a Washington-based economic policy and corporate
accountability lobbyist at Peoples Vaccine Alliance, an international
coalition of organizations campaigning for the production of a
freely-available COVID-19 vaccine for all. (Members include Oxfam, UNAIDS
and Amnesty International.) Those lone 55 individuals are a very tiny
fraction of the 2.5 billion people that make up the total population of all
low-income countries. Those poorer nations have no access to any COVID-19
vaccine at this point, Lusiani says. And in middle- and high-income
countries, slow vaccine production timelines and shaky rollouts mean that
vaccination is proceeding slowly in every corner of the world.

Meanwhile, SARS-CoV-2, the virus that causes COVID-19, still has a huge
reservoir of unvaccinated or partially-vaccinated people to infect. The
longer the virus has to circulate around the world’s population, the more
chances it has to mutate and potentially defeat our vaccines.

“Scaling manufacturing of the vaccine is the most important challenge of
our time,” says Thiru Balasubramaniam, a Geneva-based public health
specialist at Knowledge Ecology International (KEI), an NGO. “Especially
the first half of this year,” he says.

Since more vaccines have entered late-stage trials and gotten approved,
developed countries have become more protective of the doses. For example,
the United States has bought up the lion’s share of the Pfizer and Moderna
vaccines and the European Union has recently placed new export tariffs on

Even if we manage to get everyone vaccinated, Lusiani says, the delayed
start and continually problematic rollout will likely result in huge
economic and social impacts. A recent report by the International Chamber
of Commerce found that about $9.2 trillion USD stands to be lost from the
global economy if developed nations, largely in the West, buy up all the
vaccine doses. Half of that loss will be to developed nations. “The
research shows that no economy can recover fully from the COVID-19 pandemic
until vaccines are equally accessible in all countries,” the report

So how can the world make vaccine distribution more equal? Since early last
year, developing countries have been pushing for international governing
bodies to use some of the tools at their disposal to ensure that everybody
has access to COVID-19 vaccinations.

However, developed nations have stymied these efforts and those by the
World Health Organization and World Trade Organization to ensure equitable
vaccine access, says Carlos Correa, an executive of the South Centre, an
intergovernmental organization of developing countries.

How vaccines get allocated has a lot to do with the patents companies like
Moderna and Pfizer place on them. Back in 1995, the World Trade
Organization created a legal agreement called TRIPS (the Trade-Related
Aspects of Intellectual Property Rights) which mandated that all WTO member
countries must have a patent on all pharmaceuticals created in their

Previously, any pharmaceutical drug could be left without a patent, meaning
that the information about its constituent ingredients and how it was made
could be freely distributed. (Famously Jonas Salk chose to release the
polio vaccine he developed in 1955 without a patent to allow other
countries to more easily develop and distribute it.)

Under the TRIPS agreement, countries must also respect the intellectual
property, such as patents, of other WTO members. Those that don’t comply
face economic and trade reprisals that many—especially developing
nations—can ill afford.

However, Article 73 of the TRIPS Agreement notes that member states can act
outside its bounds “in time of war or other emergency in international
relations”, which the current pandemic presumably falls under. This
exception could create a pathway for vaccine info-sharing within the
Agreement’s bounds. So could a waiver submitted last year by
representatives of South Africa and India that would create an exception to
the TRIPS Agreement for COVID-19 therapies.

Either of these measures would create a framework for any countries with
vaccine production infrastructure to produce COVID-19 vaccines. But they
have been rejected by developed countries so far, says Correa, who has
written extensively on the TRIPS Agreement.

Another obstacle standing in the way of developing nations getting access
to the virus is the fact that the technological capacity to produce
vaccines, including the new Pfizer and Moderna mRNA vaccines, is extensive.
Retooling existing vaccine production infrastructure with the technology to
produce COVID-19 vaccines “may be complex, but it’s not impossible,” Correa

After all, many countries throughout the world already have vaccine
production facilities, although the exact level of global capacity is hard
to identify. KEI, is working on a publicly-visible Excel document auditing
capacity around the globe. But, of course, that capacity won’t matter
unless the information about the vaccine’s recipe and the technology
required to make it is also available.

There’s plenty of evidence that the companies that developed the vaccines
aren’t the only ones able to produce them. Contract manufacturers in the US
and Europe have produced Moderna’s vaccine, the Associated Press reports,
and the Serum Institute of India is a contracted producer for AstraZeneca’s

[Related: Read about what you can do right now to protect yourself from the
new COVID-19 variants]

Last spring, the World Health Organization launched a voluntary initiative
for pooling COVID-19 treatment technology and know-how, called the COVID-19
Technology Access Pool (C-TAP). A number of countries signed on to the
agreement, but many others—including the United States—abstained.

Pharmaceutical companies, while invited to share their resources, also
declined. Albert Bourla, chief executive of Pfizer, called the idea
“nonsense” and “dangerous.” His company agreed late last month that it
would provide a meager 40 million doses of its vaccine, at an undisclosed
price, to COVAX, the public-private partnership overseeing distribution of
COVID-19 vaccines around the globe.

Lusiani says C-TAP is waiting for companies to participate. “More
importantly, perhaps, it’s waiting for governments in the rich world to
participate.” Meanwhile, poor countries are doing what they can to purchase
vaccines on their own.

The bottom line, according to KEI’s Balasubramaniam, is that more political
will is needed to bring COVID-19 vaccines to the world in any kind of
timely fashion. Wealthy countries have the money to make direct deals with
vaccine manufacturers; they also have the most sway in international
political bodies like WHO and the WTO. That disproportionate influence
could have severe consequences for the planet’s COVID-19 recovery, Carnegie
Mellon University bioethicist Danielle Wenner told Popular Science last
fall. At that time, she warned of the potential repercussions that could
arise if rich countries hoarded the vaccine.

The United States throwing its weight behind a TRIPS Agreement workaround
and the C-TAP project would make a huge difference, everybody interviewed
for this story agreed. There are signs that the new administration plans to
act on at least some fronts—Anthony Fauci, when asked in January whether he
supports the U.S. joining C-TAP, responded “Yes, yes, yes”—but it remains
unclear how the Biden administration, which only recently reiterated its
commitment to the World Health Organization, is going to help end the
pandemic everywhere.

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

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