Developed nations have a moral duty to waive patents on vaccines

As I write this month's column, coronavirus cases are once again on the rise. The seven-day rolling average of infections has climbed above 5,000 in the State for the first time since January. The Omicron variant saw the European Union recommend the suspension of travel to and from several southern African countries where it has become prominent, despite being discovered independently in several European countries with no demonstrable link to southern Africa.

This is a reminder of our privileged position in the global north, with a surplus of vaccines available. As we roll out the third wave of booster jabs, countries such as South Africa, which led calls for a patent waiver to speed up vaccine production, have been able to vaccinate only 28 per cent of their population. Elsewhere in the region, that percentage often drops to single figures.

Of course, this winter coronavirus is not the only respiratory virus that we will be vaccinating against. This is traditionally flu season in the northern hemisphere.

There were just 21,266 flu cases confirmed by Australian laboratories this season, compared to an average of 113,861 in the previous five years

In the southern hemisphere, however, winter has just ended. One interesting finding from Australia is that vaccination, alongside social distancing and similar restrictions to combat coronavirus spread, has had a dramatic effect on flu cases.

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In July two people died of flu in Australia, the first in more than a year. The five-year average for Australian flu deaths is 404. There were just 21,266 flu cases confirmed by Australian laboratories this season, compared to an average of 113,861 in the previous five years.

Airborne disease

Public health measures have been so effective in restricting airborne disease transmission that there have been no confirmed cases of two of the four major strains of flu anywhere in the world for more than 18 months. There are two families of the flu virus, influenzas A and B. Influenza A is divided into subtypes based on their surface proteins (H1N1 and H3N2) which are then divided into clades. Influenza B is divided into two lineages, Victoria and Yamagata. An entire clade of H3N2 (3c3.A) was last detected in March 2020, while no cases of B/Yamagata have been confirmed since last April.

It may be too soon to declare these strains extinct, but the reduction in their prevalence is certainly remarkable. The World Health Organisation (WHO) has only ever declared two diseases extinct: the cattle disease rinderpest, and one human disease, smallpox. Both were the result of massive vaccination drives and global campaigning.

In 1796 Edward Jenner developed the first vaccine by taking material from cowpox lesions on a cow maid (vaccine comes from vaccus, the Latin for cow)

In 1796 Edward Jenner developed the first vaccine by taking material from cowpox lesions on a cow maid (vaccine comes from vaccus, the Latin for cow) and injecting it into an eight-year-old boy. Several weeks later, he injected the boy with live smallpox, with no ensuing infection.

Inoculation

This approach would not receive ethical approval today, but it did demonstrate that cowpox could protect against smallpox and offered an alternative to the more dangerous method of inoculation, originating in China, by exposure to a mild version of smallpox.

By the late 19th century, vaccination meant Ireland was recording only a handful of smallpox deaths each year. In the early 1870s a smallpox pandemic killed about 4,000 people here. England, with about four times the population, recorded more than 40,000 smallpox deaths in the same period. Other countries with less stringent vaccination regimes were even more badly affected and saw double or treble those rates.

Tropical countries

The technical and sanitary challenges posed by using a culture drawn from animal samples and stored in glycerol meant that vaccination was particularly difficult in tropical countries.

However, in the 1950s, Leslie Collier at the Lister Institute developed a freeze-dried vaccine. In the following decade, Benjamin Rubin of Wyeth Laboratories designed the bifurcated needle, which allowed for reliable and cheap vaccination using the Lister vaccine with minimal training.

These developments, and the decision to waive patents and royalties on the needle and vaccine, enabled the WHO to launch its 1966-1977 campaign to eradicate smallpox globally.

Coming shortly after a failed effort to eradicate malaria, the team led by Donald Henderson had to overcome scepticism that eradication was possible. But after 14 years of careful searching and contact tracing, millions of vaccines delivered using a "ring" approach to target resources effectively, and $300 million, smallpox was finally declared eradicated in 1980.

The news that public health measures have a significant impact on respiratory virus spread is very welcome, but the lesson from history is that developed nations have a moral duty and practical rationale for waiving patents to vaccinate more quickly the global south.