WHO chief Dr Tedros Ghebreyesus Adhanom described the vaccine inequality gap this week as "growing every single day, and becoming more grotesque every day".
“Countries that are now vaccinating younger, healthy people at low risk of disease are doing so at the cost of the lives of health workers, older people and other at-risk groups in other countries,” Tedros said.
He warned too that unequal sharing of doses risks the emergence of new resistant variants among unvaccinated populations.
“The inequitable distribution of vaccines is not just a moral outrage. It’s also economically and epidemiologically self-defeating,” he said.
Though wealthy countries have poured funds into the Covax scheme to procure vaccines for low- and middle-income countries, the cash is taking time to translate into doses into arms because the same richer countries have priority-ordered so many vaccines for themselves.
Vaccine ingredients and manufacturing capacities are limited, though growing, leaving the world to vie over the doses that are available.
A glance at the vaccine export data the EU has collected since February gives an idea of who is at the front of the queue: 10.9 million does to the UK, 6.6 million to Canada, 5.4 million to Japan, 4.4 million to Mexico, 1.5 million to Saudi Arabia, 1.5 million to Singapore.
“Those who pay a lot, get a lot,” a politician who has closely observed the process remarked on Wednesday.
As a solution, India and South Africa have led a demand for the medical patents for Covid-19 vaccines and treatments to be waived, to allow producers all around the world to step in and start manufacturing as well. If produced in places where costs are lower, the vaccines would be more affordable too, they argue.
The call has the support of about 100 national governments, medical charities like Médecins sans Frontières, and 250 national parliamentarians and members of the European Parliament who called for the extraordinary step.
“It will lift IP monopolies, remove legal uncertainty, and provide the freedom to operate to enable collaboration to increase and speed up the availability, accessibility and affordability of Covid-19 vaccines, tests, and treatments globally,” the parliamentarians wrote in an open letter.
Tedros has also thrown his weight behind the idea, saying the world should be on a “war footing” to beat back the virus.
But the proposal is opposed by wealthy countries including Britain, Switzerland, EU countries and the United States. The World Trade Organisation has discussed eight times whether to waive the rules of its Trade-Related Aspects of Intellectual Property (Trips), but the opposition of the rich countries has prevented the required consensus.
The pharmaceutical industry opposes the move on the basis that funding for research and development relies on the incentive of patent protections, which allow investors to recoup their costs and make a return for a certain time period after discoveries are made. Such protections also make it easier to collaborate with others such as in public-private partnerships, it is argued.
It’s common to hear from politicians in Brussels that merely waiving patents would not be enough to create an increase in production because the procedure is too complex. To put it simply: it’s not enough to release the recipe, the chefs need to be taught the technique. This would require the pharmaceutical companies to support the process.
In a bid to forge consensus, the new chief of the World Trade Organisation has argued for a “a third way”, in which intellectual property remains protected and pharmaceutical companies agree to transfer technology through licensing agreements.
Some have already forged the way. The much-maligned AstraZeneca is currently the only company to have licensed its technology to other countries, allowing for production around the world, as well as committing to sell its vaccine at cost without making a profit. This was part of its deal with Oxford University, whose researchers determined at the outset as they began working on the vaccine that it should be licensed freely and sold at or near cost.
For Bruno Bulic, a pharmaceutical analyst at Baader Helvea, an under-appreciated aspect of the question is time.
“In my opinion, waiving patents will not solve the issue right now, for the reason that it will be technically difficult to rapidly reproduce the whole production chain for newcomers,” he told The Irish Times. “Large-scale RNA production, for instance, was not and is still not routine work.”
The companies that are currently making the vaccines began ramping up their production 12 months ago, and some are still only getting off the ground.
“It would take other players probably twice as long,” Bulic estimates. “By that time, the pandemic might be gone.”