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Road To Hell Paved With Good Intentions

By Jomo Kwame Sundaram

Access to COVID-19 vaccines for many developing countries and most of their people will have to wait as the powerful and better off secure earlier access regardless of need or urgency. More profits, by manufacturing scarcity, will surely cause even more loss of both lives and livelihoods.

Good intentions not enough

To induce private efforts to develop and distribute vaccines, the WHO initiated COVAX to ensure more equitable access to COVID-19 vaccines. However, interest by vaccine companies has been limited, while some governments – especially from better-off upper middle-income countries – pursue other options.

Credit: UNICEF/Nahom Tesfaye

COVAX has been co-led with GAVI, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI). Buoyed by their earlier success with advance market commitments (AMC), they have extended the same approach in very different circumstances.

AMC was originally conceived to induce the development of vaccines for ‘neglected diseases’. Such infectious diseases remain threats in poor countries and among poor people. Hence, prospective sales revenue was believed to be too small for needed investments by profit-seeking vaccine companies.

By guaranteeing and subsidising sales, the AMC effectively promises the vaccine developer to make the research and development effort profitable, typically with early payments and subsidies to enhance the inducement.

No one size fits all

In the Covid-19 pandemic context, however, the COVAX AMC is not a ‘white knight’ coming to the rescue of an orphaned, typically tropical disease. Instead, it competes with other buyers, mostly of greater means.

Jomo Kwame Sundaram

To put it bluntly, the Covid-19 pandemic context is quite different from the ‘neglected diseases’ problem which the AMC was conceived to address, i.e., contemporary Western R&D efforts presumed to be driven primarily, if not exclusively by the prospect of profits.

The highly infectious ‘aerosol-borne’ virus quickly achieved a global reach. Apparently more likely to be lethal with advancing age, mass vulnerability to infection ensured a broad, inclusive, international market for Covid-19 vaccines from the outset.

Recognising the extent and impact of the pandemic threat, vaccine developers expect to sell their vaccines very profitably. They made advance sales to many rich-country governments, rather than, or even while committing to COVAX. Unsurprisingly in these circumstances, the COVAX AMC approach has not worked well, let alone equitably.

The companies did not require AMC advance purchases to start their efforts. Expecting the WHO to protect their interests, participating developing country governments, mainly of upper-middle income economies, have generally not worked together to push for further price moderation.

COVAX subverted

Advance Covid-19 vaccine purchases by many rich country governments are not only greatly in excess of their population requirements, but also not made in a transparent manner conducive to improving equity.

Unsure of the efficacy and effectiveness of the often still experimental vaccines, some booked, paid for and now demand far more than needed by their populations. Thus, COVAX has been subverted by rich country government actions.

Ironically, instead of protecting and promoting the interests of the poor, the public interest and the common good, the COVAX AMC has served to set floor prices. Arguably, COVAX has ensured profits for vaccine companies without addressing the ‘only money talks’ problem and competitive ‘vaccine nationalism’.

To ensure a ‘people’s vaccine’ available to all, Acharya and Reddy have proposed public financing to develop or buy over vaccine formulas. This can ensure patentable and other relevant information is freely shared, enabling generic vaccine producers to greatly increase supply at much lower prices.

As rich country governments have already paid much to accelerate vaccine development, they can more easily secure and share the thus far undisclosed information needed to greatly and affordably scale up generic vaccine output.

As vaccine developers do not really expect much revenue from selling vaccines to the poor, such ‘generosity’ would cost them little, while earning them and the enabling governments priceless appreciation and goodwill in the process.

Way out

The best way forward now involves approving the TRIPS waiver at the WTO, which the Trump administration, the EU and some allies, such as Brazil, have stubbornly blocked.

The TRIPS waiver – sought by developing countries led by South Africa, India and Pakistan – seeks to temporarily suspend several TRIPS provisions on patents, design and protection of undisclosed information.

The Biden administration has shown renewed commitment to multilateralism by re-joining the World Health Organization (WHO). It can demonstrate leadership by not only lifting the US embargo on exports of vaccines, vital medicines and equipment, but also advocating strongly for the TRIPS waiver proposal at the WTO.

US taxpayers have already spent many billions to accelerate private vaccine development and distribution. Vaccines for the world can be greatly increased, at little additional cost, by working with the rest of the world, as Chinese researchers did by sharing the virus’ genome sequence with the world within a fortnight of its discovery over a year ago.

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