A week before Christmas, Canada had a gift for the world: a few million doses of the most coveted substance money can buy right now. The country is planning to donate surplus vaccine supplies to poorer nations that are at risk of being left empty-handed in the race to distribute the vaccine, a government representative said in a video call.
Attendees at the meeting included members of the World Health Organization, the vaccine alliance Gavi, the heads of three major pharmaceutical companies and health experts from around the world.
The mood was hopeful. Britain had just launched its vaccination program. The end of the pandemic seemed to be within reach.
Then a journalist asked if Canada, which has secured more vaccine per capita than any other country in the world, planned to deliver those doses immediately. Or would it first do so after a large percentage of Canadians have been immunized? At what point would the country be willing to give up some of its abundance of vaccine?
The representative paused. People have to understand, she said hesitantly, that we are experiencing extraordinary times. She didn’t want to commit herself to a timeline.
It sent a clear message, especially to poorer countries. And it contained two warnings. First: Wealthy nations like Canada are perfectly willing to share their vaccines, but on terms set by the rich. Second: Once again, it might not be the people who most urgently need a remedy who get it first, but rather those who are willing to pay the most for it.
The coronavirus isn’t the first recent pandemic that has exposed inequality between the rich and the poor. During the deadliest phase of the HIV pandemic in the mid-2000s, 2 million people were dying per year, most of them in southern Africa. It took many years for life-saving drugs to make their way to the continent. One of the reasons: The Western pharmaceutical companies that developed the medications are eager for profits, and those drugs frequently cost as much as 10,000 a year per patient 20 years ago.
H1N1 followed in 2009. A swine flu vaccine was available just seven months after the first outbreak. But rich countries bought up the drug. The pandemic had already ended by the time poorer countries got access to the vaccine.
Things were supposed to be fairer this time. The international community established Covax, a consortium of private and government funders to distribute the vaccine. Under the tutelage of WHO, the Gavi vaccine alliance and the research alliance Coalition for Epidemic Preparedness Innovations (CEPI), Covax began its work in April 2020. The aim is to deliver 2 billion vaccine doses by the end of 2021. Almost every country on the planet has joined the initiative, with the United States as the most recent addition. “No one is safe, unless everyone is safe,” reads the initiative’s slogan.
But nine months later, there are few signs of solidarity. According to the Duke Global Health Institute, 16 percent of the world’s population has secured 60 percent of the available vaccines. Instead of relying solely on Covax, the European Union, Britain and Canada have ordered large quantities directly from manufacturers, thus blocking the market for now. Prices are rising. And now that the vaccination campaigns in Europe, the U.S. and elsewhere are being met with setbacks, few are particularly concerned about sharing at the moment.
Britain’s government plans to offer every adult a first dose of the vaccine by the autumn. Germany is aiming to have vaccinated almost two-thirds of its population by then. In Israel, which is vaccinating its people faster than any other country, the first teenagers are already getting their jabs. At the same time, countries like Ukraine, Mozambique or Colombia may have to wait until 2023 before enough vaccine is available for the blanket vaccination of their populations.
Meanwhile, frustration is growing, also at the World Health Organization. It is correct for governments to first vaccinate doctors, caregivers and the elderly, WHO Director-General Tedros Adhanom Ghebreyesus said in an emotional speech in mid-January. “It’s not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries.” He added that more than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. “Just 25 doses have been given in one lowest-income country,” he said. “Not 25 million, not 25,000, just 25.”
The WHO head spoke openly about what many are thinking in Africa and everywhere else where there is neither the money nor the power to get the vaccine. “I need to be blunt,” Tedros, who is Ethiopian, railed. “The world is on the brink of a catastrophic moral failure.”
Officials at WHO fear the world could break into two vaccine blocs. On the one side, a small elite from countries that immunize their populations to a wide extent. These countries could boost their economies, open theaters and schools and international tourism could be boosted because these governments agree on travel corridors among themselves.
The other side would include large parts of Latin America, Africa and Asia, where the majority of humanity lives and where the pandemic would continue to rage.
But a delayed vaccination campaign in poor regions also poses dangers for rich countries. For one, the risk of additional mutations would loom for years to come, such as those recently discovered in Britain and South Africa – with the worst-case possibility of a mutation rendering existing vaccines useless. Additionally, the global economy would recover more slowly because supply chains in developing and emerging countries would occasionally be disrupted.
In a new study commissioned by the International Chamber of Commerce, economists have warned that inequitable distribution of the vaccines could cause between $1.8 trillion and $3.8 trillion in damage to the global economy – and that’s assuming that developing countries are able to vaccinate half their populations by the end of the year. In the worst-case scenario developed by the researchers, the populations of wealthy nations would be fully vaccinated by the middle of this year, but if poorer countries are excluded, the damage to the global economy could exceed $9 trillion. In other words, it would be worth everyone’s while to distribute the vaccine around the world as quickly and as equitably as possible.
But earlier this week, the European Commission declared that in the future, pharmaceutical companies would only be able to export vaccines from the EU with the approval of Brussels, unless they were humanitarian supplies. Shortly before that, pharmaceutical company AstraZeneca announced it would only be able to deliver 31 million doses of its vaccine to the EU by the end of March instead of 80 million. People all across the EU are angry that progress on vaccination has been so slow.
“There is enormous pressure on governments,” says Krishna Udayakumar, director of the Duke Global Health Innovation Center, an American research institution. He says it is reasonable that the EU wants to ensure their own population can be covered and that they can be at the front of the line. “But at the same time, leaders need to realize what consequences their actions will have” for their countries.
His team warned months ago that wealthy countries now view the Covax initiative as little more than a bailout fund for countries that can’t otherwise afford the vaccines. But if countries like the U.S. or Germany reserve large quantities of vaccine, there is a risk that not much will be left over for Covax. “The problem is that they’re giving with one hand and taking with the other,” says Udayakumar.
What is happening right now is precisely what Covax had hoped to prevent. Instead of working together, countries are competing against each other to get vaccines. But they would have been better off pooling their market power, which would have resulted in lower prices and lower risk for each individual government. Poorer countries, meanwhile, would have gained access to discounted vaccines thanks to the subsidies from the richer ones. Ninety-two eligible countries are part of the Covax program.
But it is still unclear when the first vaccines will reach people in these countries. Covax hasn’t distributed a single dose so far. Richard Mihigo, one of the leaders of WHO’s vaccination efforts in Africa, says rich countries bought up almost all the vaccine while they were busy arranging funding for Covax.
Another problem is that the vaccine from AstraZeneca and Oxford University that Covas is primarily relying on has not yet received a recommendation from WHO and is therefore not available yet. The initiative did just sign an agreement with the German-American consortium BioNTech and Pfizer for up to 40 million vaccine doses. But it is not yet certain when those can be delivered. And even if a date is set, they will probably play only a minor role in global distribution because the Pfizer/BioNTech vaccine has to be stored at minus 70 degrees Celsius, making it impractical for large parts of the world.
A spokesman for the vaccination alliance Gavi, which is coordinating the purchase of the Covax vaccines, has pleaded for understanding for the huge task the world has set for itself: the distribution of 2 billion vaccine doses to 190 countries within a year. “Nothing like this has ever been attempted before in such a short time frame and we are working round the clock to ensure it is a success.”
But vaccination experts like Kate Elder have a different view. “The slowness of the Covax facility flies in the face of global health,” she says. Elder is a leading figure at Doctors without Borders’ Access Campaign, an initiative working to increase access to affordable medicines.
“We’re hearing a lot of concerns from governments that depend on Covax,” Elder says, adding that there has been a lack of clear timelines and liability issues haven’t been clarified to the extent necessary. “There are many governments that were concerned about sending tremendous sums of public funding to Covax and also to Gavi as their down payment and not really having anything guaranteed in receipt.” She is calling for agreements with pharmaceutical companies to be made public, and also says it needs to be clear where, when and how the vaccines will be delivered.
Meanwhile, many countries that can afford to buy vaccines through their own channels are already doing so. South Africa is awaiting delivery of doses of the AstraZeneca vaccine that are being produced in India. Reports in the media suggest that the country is paying almost twice as much as the EU per dose. The Seychelles has begun a vaccination campaign with vaccines that have been donated by the United Arab Emirates. The African Union has also ordered $270 million worth of vaccines from Pfizer, AstraZeneca and Johnson & Johnson.
According to Elder, poor countries are now facing a supply shortage that has been created artificially because of Covax’s structural failures – and they will now have to take what they can get on the world market, in some cases at higher prices.
Economists have warned that inequitable distribution of vaccines could cause up to $3.8 trillion in damage to the global economy.
This has prompted India and South Africa to call on the World Trade Organization to suspend intellectual property rights on medicines that can be used to fight COVID-19 during the pandemic. That would allow generic manufacturers in emerging countries to produce the drugs that were created in Western research laboratories without a license – and probably much more cheaply than in industrialized countries. In their formal submission to the body, they argued that the coronavirus has created a “global emergency.” At a time when countries are closing schools and factories, when democratic rights are being suspended, why should patent protection be sacrosanct?
Nearly 100 countries have signed on to the proposal. But the U.S., the EU, UK, Norway, Switzerland, Japan, Canada, Australia and Brazil are all blocking the drive. They claim that it’s not the patents that are the problem, but there are no factories available for increased production. And that companies like AstraZeneca and Johnson & Johnson are already foregoing profits.
In May, the head of the pharmaceutical company Pfizer, Albert Bourla, said that the protection of patents was the reason why investors provided money to develop diagnostics, drugs and vaccines. What Bourla didn’t mention, however, is that research on many of the vaccines, including his company’s, has been supported with billions in public funding. Experts like Anne Jung of the aid organization medico international, are critical of the fact that the companies have not been contractually obliged to share the results of their research in return.
Many industrial nations prefer their own solution, one that provides governments with more control – through donations like those proposed by Canada and France, for example. The European Commission also supports those proposals, at least in theory. One of the few countries that have so far pledged to donate alongside their own national vaccination campaign is Norway.
The vaccine stinginess could come back to haunt us because others will be happy to fill the vacuum left by the West. “We are seeing growing desperation on part of some lower middle-income countries,” says Duke Global Health Innovation Center’s Udayakumar. “Their populations are demanding protection rather sooner than later. But the only access these countries will get is often through vaccines where we don’t have a sufficient level of publicly available data on efficacy and safety.”
Countries like China and Russia are often the only ones supplying developing nations. India, which is home to some of the world’s largest vaccine factories, recently gave more than 3 million doses of vaccine to its South Asian neighbors. Prime Minister Narendra Modi said his country was prepared to “protect humanity.”
But India is acting no more out of pure altruistic interests than Russia or China. All three countries have recognized that vaccine diplomacy is no charity project. For them, it presents a one-time opportunity to increase their own influence and political weight in the world for decades to come.