In the past few days, the UK, the EU, the US and other countries have announced travel bans against southern African countries because of a new “horrific” Covid-19 strain, now named Omicron. For the moment scientists don’t know if the new variant is more deadly than previous ones, or if it can evade vaccines. What they do know is that this situation was entirely predictable.
Back in March 2020, there was enough goodwill going around the world that we believed we were all in this together. World leaders threw unprecedented amounts of money at vaccine development. They stood unified on the global stage calling for a “people’s vaccine” that would be developed with public money and available to all.
It turns out that was only a temporary moment of benevolence. As death tolls began to rise and pharmaceutical companies inched closer to the finishing line of market authorisation for their vaccines, the pre-orders for doses started piling in. In order to get vaccines to poor countries, the idea was that rich ones would go ahead and make their orders directly from the pharma companies and then donate doses to the Covax scheme, which would act as a central distributor for vaccines.
To say the efforts to vaccinate the world on a fair timetable have fallen short is an understatement. As of today, only 5.8 per cent of people in low-income countries have received a single dose of the vaccine, and only one in four health care workers in Africa has been fully vaccinated.
Vaccine inequality isn’t only a moral travesty for the West. It’s also bad science. Speaking in January of this year, Tedros Adhanom Ghebreyesus, the director of the World Health Organisation (WHO), warned of the “catastrophic moral failure” of vaccine hoarding.
“Even as they speak the language of equitable access, some countries and companies continue to prioritise bilateral deals, going around Covax, driving up prices and attempting to jump to the front of the queue. This is wrong,” he said.
“Not only does this me-first approach leave the world’s poorest and most vulnerable people at risk, it’s also self-defeating. Ultimately, these actions will only prolong the pandemic, the restrictions needed to contain it, and human and economic suffering.”
An unvaccinated population provides a breeding ground for viruses to mutate. This happened with the Delta variant, which was first detected in India in October of 2020. Just as the country thought it could declare victory over coronavirus, the new variant, which was at least 50 per cent more transmissible than the first, swept through first India and then the world in the early months of this year. By April 2021, only 8.5 per cent of the Indian population had been vaccinated, even though the country is one of the biggest producers of vaccines.
New mutations of the virus are not all that India and South Africa have in common. In October of 2020, the two countries proposed a patent waiver at the World Trade Organisation (WTO) for all Covid-related technologies. This was in direct response to the vaccine inequality the two nations were witnessing from Covax.
Even before a single vaccine had been administered, rich countries were rushing to get pre-purchasing agreements from the pharma companies, and in some cases ordered more vaccines than they had people. The EU ordered twice as many doses as its population, the UK and the US four times as many, and Canada six times as many. Many low-income countries couldn’t make their first orders until January of this year.
The Biden administration gave its support for the patent waiver in May and immediately set off a firestorm from Big Pharma. The industry voiced its opinion that the waiver would do nothing to accelerate equitable global access to vaccines unless generic biotech companies were given the trade secrets alongside the patents.
Pharmaceutical companies are fiercely protective of their intellectual property and insist it’s impossible to share the trade secrets in a timely manner because it’s too specialised for most generic biotech companies to copy. But trade secret transfers are not impossible to do, nor do they take an incredible length of time. The UK was able to make the tech transfers and build four new vaccine manufacturing sites by February of this year.
Another reason the pharma industry and some rich nations are against the waiver is because they say the WTO already provides loopholes for compulsory licences during a medical emergency. Under Article 31bis of the Trips Agreement of the WTO, countries are allowed to export medicines to an already contracted third country. The problem with this export exception is that it’s so difficult to use that it renders the exception ineffective. The first and only time the export exception was ever used was for an order of generic antivirals from Canada to Rwanda, and the procedure was so cumbersome that the company publicly stated it would never attempt the export provision again unless the system was reformed. A biotech company in Canada has been trying to make use of the Trips provisions to export doses to Bolivia but has been continually stonewalled by Justin Trudeau’s government.
Even though it’s been more than a year since the patent waiver was first introduced, the WTO is set to continue discussions about its fate next week. While countries wait, they are at the mercy of handouts from Covax, which announced in September it had to slash its goal of administering two billion doses by 30 per cent. Another problem with Covax is that not all the doses that have been donated are useable. On 16 November it was reported that the UK disposed of more than half a million AstraZeneca doses after they passed their expiry date, instead of donating the doses to poorer countries. In September millions of doses donated by the UK and Canada to the African Union were set to expire in a matter of weeks, which would make it nearly impossible to get them from ports and into arms in time.
There is a circular pattern to covering vaccine inequality during this pandemic. World leaders say they are going to do something to make sure poor countries get their fair share of doses, and Big Pharma promises there are enough doses, including booster shots, to go around. The cycle goes something like this: Promises are made for more donations – targets aren’t met – excuses are given – warnings are issued – new targets are missed – new false promises are given.
Countries such as India and South Africa are exhausted from all the promises of donations. Unlike Western countries, India and South Africa cannot afford extensive lockdowns. Working from home is not an option, nor is mass testing. Inoculation is the best hope the world has if it’s to prevent a more deadly variant that can evade vaccines. Maybe this new South African variant will be what it takes to break the cycle and make the world pay attention to vaccine inequality. But if the virus’s almost two-year history is anything to go by, vaccine inequality will become as endemic as the virus itself.
[See also: International coronavirus vaccine tracker: how many people have been vaccinated?]
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