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Don't let drug firms create a system of vaccine apartheid

It has been over a year since the World Health Organization for COVID-19 issued a public health emergency statement of international concern. Despite the pledges of the world market leaders as well as the manufacturers of diagnostics and therapies to solidarity and mutual cooperation in 2020, the worst fears of all have arisen about the lack of real solidarity in this health crisis.

Around 100 million people worldwide have contracted COVID-19 and over 2 million have died. Due to several political factors, including hoarding supplies and knowledge, the world now faces the very real possibility of not attaining immunity to the world's population anytime soon – at a time when new varieties and pressures emerge and health systems, life and life effectively disrupt livelihoods everywhere.

While the United States and many rich countries are trying to control their epidemics through the use of highly effective vaccines, Africa currently has little access to COVID-19 vaccines. This is eerily similar to the HIV / AIDS epidemic and access crisis of the late 1990s and early 2000s, when the diagnostic and therapeutic tools to save millions of lives were in place, but the will to share them wasn't – until activists all over the world entered the world.

This month, the WHO also announced that the number of COVID-19 vaccinations worldwide has exceeded the number of reported infections. However, the organization reports, "More than three-quarters of these vaccinations are in just 10 countries, which account for nearly 60% of global GDP."

Around 130 countries, home to 2.5 billion people, had to administer a single dose of vaccine as of February 5, while the WHO reports: “Some countries have already vaccinated large parts of their populations that are or are at lower risk of serious illnesses Death. "This vaccine nationalism will therefore result in many countries lacking full access to vaccines by 2022 or even 2023, prolonging the pandemic and potentially causing up to $ 9.2 trillion in global economic damage.

COVAX, the public-private partnership established to offer subsidized doses of vaccine to poor countries (and some self-financing middle-income countries), is led by Gavi, the Vaccine Alliance, a private foundation. Gavi says that by the end of 2021, only about 27 percent of the most vulnerable populations in developing countries will likely benefit from COVAX vaccines, further delaying the possibility of immunity for the world's population soon.

No rich country would accept the notion that only 27 percent of its population would benefit from a vaccination mechanism designed to pool supplies, and the rest of the world should not advocate it. In South Africa – where many of the leading vaccine candidates have undergone trials – the first health care worker received a shot on February 17, more than two months after the UK started vaccinating seniors.

A harmful form of vaccine apartheid has emerged, characterized by prioritizing access for some countries and for some people based mainly on wealth and geography, which in turn leads to a largely self-inflicted global supply crisis. In the midst of a global pandemic, it means no one is safe. The project of the immunity of the world population is now in jeopardy.

Today's crisis is a tragic repeat of the early years of the AIDS pandemic, which was also marked by a lack of universal access to affordable life-saving medicines, resulting in preventable death and suffering. Access to drugs in the late 1990s and early 2000s in countries such as Brazil, India, South Africa and Thailand led to a direct confrontation with local and global patent regimes, and thus with multinational corporations that hold patents.

These movements mainly focused on affordability and pricing; the ability to import generic versions; and the ability to legally rely on multiple suppliers at the same time. As the world saw then, healthcare innovation and research will only reach those who are poor or uninsured if direct action is taken. And while advances were made back then, millions of black and brown people and workers still need better access to diagnostics, PrEP (pre-exposure prophylaxis) and antiretroviral therapy today.

The difference to COVID-19 is of course the current shortage of vaccine supplies. While generic versions of antiretroviral drugs were available for HIV / AIDS, monopoly power and patents precluded their distribution. (And in South Africa the scientific denialism of the Thabo Mbeki government prevented broad access for a long time.)

These days, access to vaccines is restricted for the same reasons: markets and patents. These reasons are deeply rooted in a global order that prioritizes the protection of intellectual property even in times of severe public health crisis. Rather than reciting weary pledges to respect intellectual property, it is time governments put in place state licenses and other mandatory measures to consolidate explicit collaboration and technology sharing as there is no time to lose, especially co-funding governments and helped to develop top candidates for vaccines.

The world must not make the same mistakes as the AIDS crisis. The response to a pandemic should not be based on voluntary cooperation, but rather on urgent war measures, including mandatory measures.

The gap in equitable global coverage and limited access of African nations to available supplies is in large part due to the fact that richer nations placed multiple single orders with several pharmaceutical companies as well as with COVAX due to advanced market commitments before clinical results were available ;; These companies also agreed to serve some markets and countries before others, with limited timely sub-licensing agreements.

These unilateral and often opaque contracts are not based on an epidemiological or solid approach to public health and are very similar to the differences in access to antiretroviral drugs for the treatment of HIV in the late 1990s and 2000s.

As with HIV / AIDS, patent monopolies determine which countries get access to certain vaccines, which companies make supplies, which regions are prioritized, and which populations benefit first. Governments that negotiated in the driver's seat with public institutions and used public funds with corporations to accelerate critical vaccine research over the past year have ignored the need for equitable access, affordability, and scale-up of production and instead focused on narrow national supplies .

Despite initial commitments to global solidarity, vaccine nationalism is a major threat to the immunity of the world's population – so much so that both WHO director-general Tedros Adhanom Ghebreyesus and U.S. infectious disease expert Anthony Fauci recently faced its effects have warned the current global goal of vaccinating everyone. This nationalism manifests itself in three ways: through individual country or regional agreements, export bans and the refusal to force the scale-up of production beyond a handful of companies and only for certain countries.

Worse still, the very institutions that were set up to address global access justice were initially undermined by the opaque behavior of richer nations and, for the most part, refuse to publicly condemn this behavior.

Since July 2020, the South African and Indian governments have been urging the World Trade Organization to renounce trade-related aspects of intellectual property rights (TRIPS). Despite the backing of 140 nations, efforts continue to be shamelessly blocked by nations that have launched their own selfish nationalist vaccination programs.

The TRIPS waiver is at the center of the fight for access to vaccines. The opposition of the richer nations in the European Union – as well as the United States, Canada, Australia, Great Britain, Japan and even Brazil – is an existential threat to the continued practice of drug treatment as a commodity.

The blatant crisis in vaccine supply has shown why this approach is no longer correct or sustainable – medically and economically – during this and future pandemics. The opposition from these countries is based on fears that the successful waiver of COVID-19 will open the door to a partial relaxation of patents that the industry may not be able to close, setting a precedent for future pandemics.

This means that pharmaceutical companies cannot defend the monopoly protection and thus the unrestricted power to segment the markets. unilaterally decide whether or not to cooperate on technology transfer; Make exclusivity agreements; Determine sub-licenses and the timing of the exchange of information or know-how; Setting prices without reference to actual production and research costs (although these are often co-financed by public bodies); demand indescribable compensation; and make huge profits now and in the future.

This is an industry that seldom commits itself to a high level of transparency. Even with HIV / AIDS, lawyers and activists have had to question the often unspecified terms of sublicensing agreements that directly impacted people's health and corporate opaque pricing practices to insist intermittently on research and development cost disclosure antitrust avenues to challenge life-saving drug monopolies. Incidentally, no pharmaceutical company or vaccine manufacturer has yet voluntarily entered the WHO technology access pool.

The White House has now activated the U.S. Defense Equipment Manufacturing Act to a limited extent to expand domestic capabilities. Although this is country-specific, it indicates a trend reversal. More recently, following Tedros' comments and warnings, Fauci also noted that the U.S. government could actually help bolster global manufacturing capacities through both political interventions and pharmaceutical companies working together to relax some patents – according to an open letter from the People & # 39; s Vaccine Campaign for South Africa to Fauci and others signed by the Anglican Archbishop of Southern Africa, Thabo Makgoba.

This is a start – but if the pharmaceutical industry is forced to breathe life into patents and profits, governments and civil society around the world will have to exert even more pressure. Médecins Sans Frontières have repeatedly emphasized: “Even a global pandemic can prevent pharmaceutical companies from taking their usual approach. Therefore, countries must use all available tools to ensure that COVID-19 medical devices are accessible and affordable for everyone who needs them. "

The current call for a TRIPS waiver is based on what happened 20 years ago during the HIV / AIDS epidemic in South Africa when affordable generics made in countries where patents did not block production saved millions of lives. At the time, many groups in the human rights and medical access community were fighting to open up this space through antitrust actions, litigation, advocacy and patent protection campaigns. The ability for generic drug companies to travel to low-income, high-HIV countries has been a cornerstone.

Without the temporary TRIPS waiver, countries will now have to take individual domestic and legal measures – and at the same time cope with a pandemic. This is why waiver is important, but also why all COVID-19 health tools and technologies should be viewed as global public goods, free from the barriers that patents and other intellectual property impose.

There will of course be resistance from companies and their lobbyists. The pharmaceutical industry is able to continuously improve and expand patent protection and in some cases "play the patent system". In addition, the wrong impression often arises that all innovations in medicine and public health – supposedly for the common good – belong solely to the industry. Indeed, such innovation depends on co-funding, public investment and public research. Without these contributions, the innovation needed to help millions of vulnerable and sick people would be lacking, and access to essential and life-saving diagnostics and therapeutics for many chronic diseases would be limited.

In a public health crisis like COVID-19, patent and market exclusivity must be replaced with equitable access and the treatment of science as a public good. Otherwise, only the promise of patent protection will fuel scientific innovation and continue to benefit only the rich and powerful while millions die.

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