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Interview: Health, Not Wealth, Should Determine Access to a Covid-19 Vaccine

How Opaque Vaccine Deals Could Undermine a Global Recovery from the Pandemic

People in Brooklyn, New York wait in line to receive free food from a food pantry in May 2020, as unemployment claims rose during the Covid-19 outbreak. © 2020 Andrew Lichtenstein/Corbis via Getty Images

More than 1 million people around the world have lost their lives to Covid-19. At least another 38 million people have been infected; many have fallen severely ill. With nearly every country in the world having reported Covid-19 cases, the social and economic consequences of the pandemic have been devastating and far reaching. A Covid-19 vaccine will be critical to ending the pandemic and saving lives. The race to develop such a vaccine is on. But who will ultimately be able to access and afford it? Birgit Schwarz talks to Human Rights Watch senior counsel for business and human rights, Aruna Kashyap, and senior researcher on children’s rights, Margaret Wurth, about the need for more transparency and the equitable allocation of vaccines on the basis of health needs, not money.

Who is involved in the development of a Covid-19 vaccine?

AK: The World Health Organization (WHO) keeps a list of companies and other entities that are currently involved in research and development of Covid-19 vaccines. Nearly 200 vaccine candidates are in the pipeline. But as of October 19, according to the WHO, only 10 vaccine candidates were in the final stages of clinical trials. High-income countries such as the US, Germany, the UK, Norway, South Korea, Saudi Arabia, and Canada, together with the European Commission, are investing enormous amounts of public money into Covid-19 vaccine research and development, mostly by funding private companies and other entities who are leading the research. By mid-September, more than US$19 billion had gone into funding vaccines.

What do governments expect in return?

AK: Governments which have the resources to do so are negotiating bilateral deals for their own countries with companies and other entities to reserve high quantities of future vaccines, which, given what we know about current manufacturing capacity, means there will be a limited supply for countries who can’t afford to do so. The exact terms and conditions of these funding agreements are shrouded in secrecy.

MW: This is one of the key points we make in our report, “‘Whoever Finds the Vaccine Must Share It’: Strengthening Human Rights and Transparency Around Covid-19 Vaccines.” Despite the massive amount of public money spent on vaccine development there is no open and transparent way of tracking how this funding is being used, and whether governments have made sure it will be used for public benefit rather than private profits.

What do these bilateral deals mean for vaccine accessibility?

AK: The current approach – shrouded in secrecy, competition, and a race to fund and conclude vaccine deals – has resulted in “vaccine nationalism” rather than cooperation. This is dealing a massive blow to any global vision for universal, equitable, and affordable access. It is why one of the key asks in our work is for governments not to sign bilateral deals in ways that undermine equitable global allocation according to public health need.

MW: The fear expressed by intellectual property rights and access to medicine advocates we interviewed is that pharmaceutical companies will hold the power to determine how widely a vaccine will be produced and made available because they own the intellectual property, the know-how. As one expert put it, she worries that drug companies are going to “play god.” Governments should use their power and make sure that once we have a safe and effective vaccine, access to it, including the ability to manufacture and distribute it, is fair and equitable.

Don’t governments have a responsibility to protect their own citizens first?

MW: Governments do indeed have obligations to protect the health of their own people, but they also have obligations not to interfere with or prevent other governments fulfilling their obligations to their citizens. There are moral, practical, and strategic reasons – as well as human rights obligations – to cooperate, especially in times like these, when we are dealing with a global public health crisis that affects every country in the world. The virus knows no borders. No country can be fully safe and protected from Covid-19 until the people of other countries are also protected. It’s therefore in everyone’s best interest for their governments to cooperate.

AK: Countries and supply chains are globally interdependent. Economies and people’s lives and livelihoods won’t recover if countries opt for a vaccine strategy that only looks at their own people.

Will there be enough vaccine for everyone?

MW: There is not going to be nearly enough vaccine to reach the entire world’s population right away, but to make sure we can scale up the production of vaccines, once they have been approved, we need to clear away some of the barriers that are contributing to this scarcity, such as exclusive licenses for the use of the technology behind a vaccine. This is one of the reasons why India and South Africa have proposed that some provisions of the World Trade Organization’s (WTO) agreement on intellectual property rights be suspended until new Covid-19 infections have substantially decreased and most countries have vaccinated their populations.

AK: A system that would put companies in control of vaccine supply and prices without taking relevant measures on the intellectual property front will put the vaccines out of reach for many under-resourced economies. Already, there are lawsuits challenging the intellectual property of companies developing Covid-19 vaccines, and lawyers have publicly warned of the effect intellectual property barriers will have on the availability of vaccines. Normally, without governments intervening, companies only voluntarily license to a few or even just one partner, a strategy designed to boost profits as opposed to access to the medicine. If companies that succeed in having a vaccine approved were to share their technology and intellectual property to as many vaccine manufacturing entities as possible, manufacturers could produce a much higher amount of doses of vaccines. This would also reduce the price per dose. That’s why technology transfers and sharing IP are so important. It would be unimaginably tragic to allow intellectual property to come in the way of saving lives during a pandemic.

Women wait in line for food in Nairobi, Kenya during Covid-19-related movement restrictions. © 2020 Brian Inganga/AP Photo

Will a Covid-19 vaccine be affordable for low- and middle-income countries?

MW: Many experts are saying that the costs currently being cited are too high and risk putting the vaccine out of reach for countries that may not have the buying power of richer ones. Governments need to use their leverage, not least because of the huge amounts of public funds handed over, to demand transparency from pharmaceutical companies involved in developing a vaccine and push for affordability. Given the devastating economic effects that this pandemic has had and the reality of global poverty, ‘affordability’ in many places will mean the vaccine has to be free for the patient.

AK: Companies claim they need to recover the money they and their investors spent on research and development. The wide range of cost per dose that have been cited – anywhere from US$3 up to US$72 – calls for more oversight. We need transparent pricing coupled with third party audits to ensure that public money is put to maximum use for the public.

Given the scarcity you describe, what thinking is going into how limited vaccines might be distributed on a national basis?

MW: Decisions about distribution need to be based on public health strategies taking into account human rights obligations related to the right to health, life, and livelihoods. The WHO has outlined their initial thinking on distribution during scarcity which they said focuses on reducing mortality and protecting the health system. They do have a body of experts from a variety of fields who will advise them on this issue going forward.

AK: Whatever criteria the WHO or governments develop to try to ensure fairness and equity in distribution, the ultimate solution needs to be based on government cooperation to solve scarcity. Under the WHO framework, an estimated 20 percent of a country’s population might be covered in the initial stages. To expand that, the challenge for all governments acting in good faith is to cooperate to maximize manufacturing, and increase that percentage so there is universal and equitable access.

What lessons can be learned from past vaccine roll outs? 

AK: In the past, the availability of vaccines has been limited because of barriers stemming from intellectual property claims. This is what put vaccines for human papillomavirus (HPV) or pneumonia in children out of reach for a lot of poor people. If there is one vaccine that we need to ensure is affordable, and produce in vast quantities and quickly, it is the Covid-19 vaccine.

MW:  Decisions around access to vaccines and medicines have too often been determined by opaque, profit-driven systems that allow big pharmaceutical companies that hold the technology to determine how that technology is used. But this pandemic is unprecedented. If there ever was a time to challenge these systems, this is that time. There are so many people whose lives could be saved, who could be protected from getting severely ill if a vaccine were to be made globally available on an equitable basis. 

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