FEATURED IMAGE: Alena Shekhovtcova, via Pexels | IMAGE DESCRIPTION: An empty ampoule, with the“COVID-19 Vaccine”, stands amongst other ampoules strewn on the table, in front of a neon pink light; the floor is neon blue
Fuelled by capitalistic, profit-driven Big Pharma and philanthropic billionaire Bill Gates, and enabled by wealthy countries, is an ongoing human right’s violation in the Global South. The vaccine apartheid is the latest manifestation of extractivist, profit-over-people capitalism. But how did it happen? And what can we do about it?
What is the vaccine apartheid?
Equality Labs defines the vaccine apartheid as “the intentional deprivation of vaccine supplies, patents, and aid to the Global South for the purpose of profit by big pharma and Global North countries”. Put another way, it’s the international race to secure the most vaccines. A race in which the Global North inevitably comes out on top, while the Global South suffers. All while Big Pharma—that is, big pharmaceutical companies—make obscene profits. How bad is the situation? Here are some numbers. 83% of vaccines administered worldwide have gone to high- and upper-middle-income countries. Only a mere 0.2% has gone to low-income countries.
Meanwhile, Big Pharma is profiting off deaths from the pandemic. The People’s Vaccine Alliance is a growing movement of organisations, leaders, and experts. They calculated that Pfitzer, Johnson & Johnson, and AstraZeneca have paid out $26 billion in dividends and stock buybacks to their shareholders. An amount that, they contended, is enough to vaccinate 1.3 billion people. (The same as the population of Africa.) Now, no one is saying that we shouldn’t compensate research and development that led to the vaccine. It should, and to be fair, some bigger pharmaceutical companies are attempting to close the gap. But Big Pharma, along with a host of other players and factors, is a big part of the reason why the gap is so wide, to begin with.
Rich countries are hoarding vaccines
As it turns out, not only are rich countries getting priority access to the vaccine, they’re also hoarding vaccines. According to the People’s Vaccine Alliance, rich countries have bought enough doses to vaccinate their entire populations three times over, if approved. Representing only 14% of the world’s population, they’ve bought up 53% of the most promising vaccines so far. And rich countries have acquired all of Moderna’s doses and 90% of Pfitzer’s doses. (Both of which are the most effective vaccines, standing at 95% efficacy.)
I hate that I have to say this. But even if we vaccinate everyone in rich countries, we won’t be COVID-free. As is already happening, the virus will continue to mutate. Giving rise to various different strands, prolonging the global pandemic. In fact, two-thirds of epidemiologists, from some of the world’s leading academic institutions, warn that mutations could render current vaccines ineffective in a year or less, according to new research from Oxfam. As Dr. Gavin Yamey from Duke reminds us, rich countries hoarding vaccines will drag the pandemic on for as long as seven more years. “We need to start thinking of ourselves as an interconnected global community,” he says. But even though we’re interconnected, what’s happening now demonstrates that there are stark inequalities. (Which, for clarity, have always been there.)
Anyway, this shouldn’t be the line of argument that convinces you that rich countries hoarding vaccines is bad. Rich countries shouldn’t want to share vaccines out of self-preservation. They should want to share vaccines because a vaccine is a human right. In the same way that food, water, and shelter are basic human rights. And more important than that: they should have to share because rich countries are only rich because poor countries exist. A result, no doubt, of extractivist capitalism.
And it would be disingenuous to pretend otherwise. As activist Deesha Menon puts it, we ought to be “sick n tired of rich people & countries acting like their wealth is not built off the backs of exploitation, wage theft, global slave trade, and hoarding.” Rich countries’ richness exists “because of inequalities perpetuated by global racial capitalism that have privileged countries in the ‘Global North’ at the expense of countries like India”. And “capitalism has made us feel entitled to steal [translation: hoard vaccines] from people whom we’ve made individualise our safety, wealth, and healing [translation: from countries like India, whom we’re feeling safe, and vaccinated, at the expense of].”
FEATURED IMAGE: People’s Vaccine | IMAGE DESCRIPTION: A text image; on the left, the words “RICH NATIONS ARE VACCINATING ONE PERSON EVERY SECOND” in white on yellow text, with a clock icon below, and the hands replaced with a syringe; on the right, the words “WHILE THE MAJORITY OF THE POOREST NATIONS ARE YET TO GIVE A SINGLE DOSE” in white on teal text
We need to talk about India
India is but one of the countries of the Global South that’s received the short end of the stick. (Not just now, because of the vaccine apartheid, but also historically, as above.) But you’ve probably seen the COVID situation in India on your social media by now.
If not, here’s an excerpt from Arundhati Roy for The Guardian. “Hospital beds are unavailable. Doctors and medical staff are at breaking point. Friends call with stories about wards with no staff and more dead patients than live ones. People are dying in hospital corridors, on roads and in their homes. Crematoriums in Delhi have run out of firewood. The forest department has had to give special permission for the felling of city trees. Desperate people are using whatever kindling they can find. Parks and car parks are being turned into cremation grounds. It’s as if there’s an invisible UFO parked in our skies, sucking the air out of our lungs. An air raid of a kind we’ve never known.”
“Oxygen is the new currency on India’s morbid new stock exchange. Senior politicians, journalists, lawyers – India’s elite – are on Twitter pleading for hospital beds and oxygen cylinders. The hidden market for cylinders is booming. Oxygen saturation machines and drugs are hard to come by.” Most heartbreakingly, she writes: “None of this conveys the full depth and range of the trauma, the chaos and, above all, the indignity that people are being subjected to.” The situation is so dire that India today accounts for 1 in 3 new COVID cases, because of the second wave. And the worst part is that the numbers are an underestimation. We can’t be sure of the real numbers, because there aren’t enough COVID tests to know.
Certainly, as Roy makes chillingly and starkly clear, India’s present situation is a combination of factors. Many of them are internal. A perfect storm of a corrupt government, (resultant) unprepared infrastructure, privatised healthcare, and massive inequality. All of these are, of course, on their own more complex, and are hard to summarise. (Roy’s essay and Vidya Krishnan’s essay for The Atlantic are compulsory reading in this regard.) But it is the (lack of) system that has failed the people of India. And they shouldn’t have to pay with their lives.
And in any case, these internal factors aside, India, along with the rest of the Global South, is a victim of the vaccine apartheid, of Big Pharma, and of philanthropic billionaires. (Well, one philanthropic billionaire, at least.) How?
The IP rights debate
One way to ease the situation in the Global South is to lift barriers to the production of vaccines. Currently, at the centre of the debate is one particular barrier: intellectual property (IP) rights. India and South Africa are amongst the countries pressing for the World Trade Organization (WTO) to waive an international IP agreement. That agreement protects pharmaceutical trade secrets (that is, about how to manufacture effective vaccines). Wealthy nations like the US, the UK, and the EU have blocked the plan. Big Pharma too, has been against the waiver.
Why not waiver IP rights?
First, they argue that there’s a very practical reason. That divulging trade secrets wouldn’t actually increase global vaccine supply. It comes down to, they say, logistical challenges. Like not having access to raw materials, and not having efficient distribution methods in the Global South. (There is irony, of course, in this because global racial capitalism has extracted raw materials for centuries from the Global South. And why doesn’t the Global South have efficient distribution methods to begin with?)
A second reason why they argue against the waiver is this. That IP rights are important within the pharmaceutical industry. Big Pharma says that it would harm innovation and entrepreneurship. One analyst for an investment bank says this: “It would be intensively counterproductive, in the extreme, because what it would say to the industry is: ‘Don’t work on anything that we really care about, because if you do, we’re just going to take it away from you.’”
But is it really about “innovation and entrepreneurship”, or is it about money? Dr. Aaron Kesselheim from Harvard Medical School explains that this sort of protectiveness over and resistance against IP rights is characteristic of the industry. An industry, like any other industry, that is interested in protecting its profits and protecting its business model. In a revealing letter to Katherine Tai, Joe Biden’s trade representative, the Biotechnology Innovation Organization, warned against giving “license to other countries — some of them our economic competitors — to hollow out our world-leading biotechnology base, export jobs abroad and undermine incentives to invest in such technologies in the future.”
Accordingly, one of the fears of the industry is that the patent waiver for COVID vaccines could set a precedent for other medicines—which is how they make money. (As it turns out, the industry spends very little on research and development. And if they do, it’s rarely on vaccines, which aren’t very profitable and take a long time to develop.)
What then, if not the waiver?
Generally, those against the waiver suggest that Big Pharma should be pressured into donating vaccines to the Global South, sell at cost, or very cheaply. And to be fair, Pfizer’s chief executive Albert Bourla said on LinkedIn that Pfizer would immediately donate over $70 million worth of medicines to India and that he’s trying to fast-track the vaccine approval process in the country. Moderna said that it would not enforce its COVID patents. But these aren’t equal to donating vaccines or selling affordably. And can we take Pfizer’s and Moderna’s word?
AstraZeneca, which manufactures the vaccine developed by Oxford, has committed to making theirs available on a non-profit basis to the developing world. It’s much cheaper than the others and only requires regular refrigeration storage, which makes theirs much easier to distribute worldwide. So far, this seems promising, and the People’s Vaccine Alliance agrees too. But, they note, it can “only reach 18% of the world’s population next year at most”, and “demonstrates that one company alone cannot hope to supply the whole world”.
What about the other side?
They say that the waiver is important because it will prevent WTO member countries (including the US, the UK, and the EU) from enforcing patents, trade secrets, or pharmaceutical monopolies under the body’s agreement on trade-related IP rights (TRIPS). This means that drug companies and innovators in other countries can make or import cheap generic copies of the COVID vaccine without worrying about Big Pharma suing them. The waiver would also extend to therapeutics and medical supplies, crucial too to the COVID fight.
There are a lot of people who are for the waiver, including much of the global research community, major NGOs, leaders and public health experts. In a May 2020 open letter, over 140 political and civil society leaders called upon governments and companies to begin pooling their IP. They wrote “Now is not the time to leave this massive and moral task to market forces”. Additionally, in October 2020, Eswatini, India, Kenya and South Africa declared in a statement to the WTO, “COVID-19 reveals the deep structural inequality in access to medicines globally, and a root cause is IP that sustains and dominates industry’s interests at the cost of lives.”
The next logical question…
… might be: can innovators create COVID vaccines without the highly-specialised, specific information? Without the secret recipe? Tahir Amin, founder of the Initiative for Medicines, Access & Knowledge, a nonprofit with a mission to create a more just and equitable medicines system for all, says that there are “companies that feel they can go it alone”—that is, without a secret recipe—and that what they need is to not “have to look over their shoulder and feel like they are going to take someone’s intellectual property.” This is true, as Sharon Lerner and Lee Fang note for The Intercept: “Factory owners around the globe, from Bangladesh to Canada, have said they stand ready to retrofit facilities and move forward with vaccine production if given the chance.”
Biolyse Pharma, based in Ontario, Canada, best-suited to make copies of the Johnson & Johnson vaccine, said that they could produce as many as 20 million vaccines a year. Incepta, based in Bangladesh, India, can apparently make from 600 to 800 million vaccines a year. Other firms in South Korea and Pakistan have also reportedly expressed interest in vaccine production. So the truth is, there are companies out there waiting for the green light to make these vaccines. And Dean Baker, economist and co-founder of the Center for Economic and Policy Research, adds: “Even if we say, ‘OK, this is highly specialised knowledge’… the idea that it wouldn’t benefit everyone to share that knowledge is kind of crazy. The industry’s argument—we’re just stuck—that makes zero sense.” So are we really just stuck?
A note on the tech transfers…
Before we answer that question, it does appear that for some vaccines, you do need specialised information. Sharing this information, otherwise known as technology transfer, is especially important for the messenger RNA (mRNA) vaccines: Pfizer and Moderna. These also happen to be the vaccines that are most effective, and have the additional advantage of a simpler production process than some other vaccines, and can be quickly adapted to respond to emerging variants. And yet, despite all this, Pfizer and Moderna simply don’t wish to share. Some say that this is the real barrier to mass production, not the IP rights.
In April this year, the WHO actually established the mRNA technology transfer hub. The hub invited these companies to share their know-how, process training and IP rights so that the countries suffering because of the vaccine apartheid can produce their own vaccines. According to the coordinator of the WHO’s Initiative for Vaccine Research, the hub received 50 expressions of interest. Though of course, the biggest players, Moderna and Pfizer, haven’t said a word. Edward Hammond, an independent consultant working on vaccine manufacturing, said recently: “It’s useless to focus on [retrofitting and building facilities to make vaccines] if BioNTech and Pfizer and Moderna are not going to surrender the information on how to do it.”
So are we really just stuck?
We need to talk about Bill Gates
One of the key reasons why we’re stuck is because powerful people in the industry keeping us here. And one of them is Bill Gates, who has a say in global health because he’s a billionaire.
To give you an idea of Gates’s stand on the issue, he shared that we should defend IP rights. We shouldn’t share the technology with the Global South. He maintains that it’s a “safety” issue, that there aren’t factories on standby to produce safe vaccines. Even though, as explained, there are production facilities that have expressed interest and capabilities. And if it’s a safety issue, can’t Big Pharma just share best practices, and provide resources to help create safe facilities?
The truth? Even if they could, Gates wouldn’t want to. Because he is one to accept business-as-usual as is. “Typically in global health,” he said, “it takes a decade between when the vaccine comes into the rich world and when it gets into the poor countries.” The matter-of-factness in that statement should register as cruel.
But it isn’t surprising that Gates responds in this way. He’s impeded global access to the vaccines since last year, as Alexander Zaitchik explains in this exposé for The New Republic. (Also compulsory reading.)
Bill Gates vs. the world
The story starts in February 2020, even before the WHO officially declared the pandemic. Hundreds of public health and infectious disease experts gathered at Geneva. Together they decided that the world would collaborate against the global pandemic. That we would share information, maintain open communication, in service of global health. They did not, however, put down on paper, that we should or would waiver IP rights. Instead, they assumed that cooperation would prevail. “That pharmaceutical companies and their allied governments would allow intellectual property concerns to slow things down,” Zaitchik writes, “does not seem to have occurred to them.”
In the early days of the pandemic, though, everyone seemed to be on board with a cooperative global pandemic response. The WHO wanted to concretise the cooperative model. So they came up with a plan to create a voluntary IP pool inside the WHO. The idea was that everyone would work together, instead of competing in a race. Together, we would come up with a vaccine that would be widely available, along with its requisite technologies. The idea came into being in late May, with the launch of the WHO COVID-19 Technology Access Pool (C-TAP). But by then, Zaitchik explains, it was too late. By then, “the optimism and sense of possibility that defined the early days were long gone.”
It turns out that since March, Gates had been planning to organise research, development, manufacture and distribution of treatments and vaccines, his way. “Crucially, and in contrast to the C-TAP, [his] Accelerator enshrined Gates’s long-standing commitment to respecting exclusive intellectual property claims.” He unveiled his Accelerator, the Access to Covid-19 Tools Accelerator (ACT-Accelerator) in April at the WHO. “The biggest and most consequential arm, COVAX, proposed to subsidize vaccine deals with poor countries through donations by, and sales to, richer ones.” Notably: “The goal was always limited: It aimed to provide vaccines for up to 20 percent of the population in low-to-middle-income countries. After that, governments would largely have to compete on the global market like everyone else.”
The ACT-Accelerator, a Gates operation
As Zaitchik explains, though it’s housed within the WHO, the Gates organisation “designed, managed, and staffed” the ACT-Accelerator. It thus also carries through on Gates’s values and philanthropic approach. “Companies partnering with COVAX are allowed to set their own tiered prices. They are subject to almost no transparency requirements and to toothless contractual nods to “equitable access” that have never been enforced. Crucially, the companies retain exclusive rights to their intellectual property.”
James Love, founder and director of Knowledge Ecology International, explains that, expectedly, “Gates wanted exclusive rights maintained. He acted fast to stop the push for sharing the knowledge needed to make the products—the know-how, the data, the cell lines, the tech transfer, the transparency that is critically important in a dozen ways. The pooling approach represented by C-TAP included all of that. Instead of backing those early discussions, he raced ahead and signaled support for business-as-usual on intellectual property by announcing the ACT-Accelerator in March.”
Unsurprisingly, Big Pharma has stood behind this Gates operation. How do we know this? In May 2020, the WHO unveiled the C-TAP with a “Solidarity Call to Action” to share all IP related to COVID-19. Big Pharma’s global trade association, the International Federation of Pharmaceutical Manufacturers & Associations, responded indirectly… with a livestreamed media event. Featuring the heads of AstraZeneca, Johnson & Johnson, Pfizer, and Bill Gates, journalists of course asked about their response to the C-TAP launch. Pfizer’s Boula denounced the pooling of IP as “dangerous” and “nonsense”. Instead, all the executives affirmed and supported Gates and his ACT-Accelerator.
So are we really just stuck?
The answer? We are. But why? We’re stuck because of the collusion of Big Pharma and Bill Gates. Enabled by wealthy countries who have stepped back to allow them to call the shots. The result of all this is the vaccine apartheid. As Zaitchik points out, “the ACT-Accelerator has failed to meet its goal of providing discounted vaccines to the ‘priority fifth’ of low-income populations. The drug companies and rich nations that had so much praise for the initiative a year ago have retreated into bilateral deals that leave little for anybody else.”
That the Global South has been left to fend for itself while rich nations hoard vaccines and Big Pharma and Bill Gates continue to go on about IP rights should not be surprising. For one, Gates’s position is “consistent with a lifelong ideological commitment to knowledge monopolies”. (Zaitchik’s exposé goes in-depth about that.) And his recent statements to the media reveal that he believes “poor countries should be grateful to wait for the leftovers”. And Big Pharma, like Gates, refuses to budge from the status quo.
As Hadas Thier writes for Jacobin Magazine: “Neither pharmaceutical companies, who stand to lose billions if they forfeit monopoly control over vaccine production, nor self-appointed billionaire philanthropists, who themselves made their fortunes off of intellectual property laws, will make this right. It is against their interests to do so.” We will not win the fight against COVID-19 if we don’t fight business-as-usual. The global vaccine apartheid will prevail if we don’t fight business-as-usual. The virus will continue to mutate and spread if we don’t fight business-as-usual.
What now?
We must wake up to the fact that, as Menon points out, even having a debate about this is violent, when so many are dying. Making this conversation about what makes economic sense, about the profits of Big Pharma, is even worse. So is celebrating Gates’s philanthropy, and obsessing over his recent divorce. (Literally, who cares?)
We must start by showing solidarity with the Global South. As writer-activist Fariha Róisín makes clear, this is especially important because so much of our world today extracts from and exploits India and South Asia. A recent viral post on Instagram puts it this way. “You cannot profit off or consume a culture without showing up for the real, gasping human beings upholding that culture. This is when they need you the most.” There are many ways you can help. (Resources here, here and here.)
FEATURED IMAGE: @theslowfactory | IMAGE DESCRIPTION: A graphic of a cartographic image of India, in muted yellow, on a grey background, with the text “Mutual Aid & Resources” and “Head to indiacovidmutualaid.carrd.co” next to the image
It’s not our fault that Big Pharma and Bill Gates are making the vaccine apartheid a seemingly inevitable, inescapable reality. But what we can do? Push for governments opposing the proposal to waiver IP rights to change their position. According to the People’s Vaccine Alliance (take action page here), that’s the governments of Australia, Canada, Chile, the EU, Japan, Norway, Singapore, Switzerland, and the UK. The US is a particularly important player, which is why Biden was under increasing pressure and as of 6 May, 2021, the Biden administration is backing the waiving of IP protections for the COVID vaccine.
Thier argues that Biden could end the pandemic if he wants to. “The United States government has both the power and the legal right to do so. The first step would be to stop stonewalling the patent waiver at the WTO. The Biden administration could also provide compulsory licenses of publicly funded vaccines to drug manufacturers that have the capacity to produce the vaccine.” Thier notes that most COVID vaccines use stabilised spike protein technology. Public funding from the US went into this. And the US National Institutes of Health claims joint ownership to the Moderna vaccine.
Further, the US government can also facilitate technology transfer and IP sharing through C-TAP. And it can invest much more resources into scaling up vaccine production everywhere. “What stands in the way is the Biden administration’s commitment to the pharmaceutical industry, their lobbies, and their profits.” We need to step up the pressure on wealthy governments now—and everyone can do this.
UPDATE: As of 6 May, 2021, the Biden administration is backing the waiving of IP protections for the COVID vaccine.