Americans over 16 are now eligible for Covid-19 vaccines. But in our interconnected world, any success combating the pandemic at home could be quickly undermined if Covid-19 and its increasingly dangerous variants are not brought under control abroad. As of last month, however, just 0.2% of vaccinations had reached the arms of people in low-income countries.
The Biden administration has begun to address this growing vaccine inequality crisis with new high-level appointments, statements, donations, and convenings of international funders to support vaccination in low- and middle-income countries. But if the administration focuses primarily on donations to low-income countries its efforts will fall far short of the 11 billion doses required for global herd immunity.
President Biden pledged $4 billion to Covax, a global effort to distribute vaccines. Nonetheless, Covax is struggling to reach even its modest goal of 20% vaccinations in low- and middle-income countries. Donating surplus vaccines won’t achieve vaccine equity or halt the pandemic.
A better diplomatic approach—sharing U.S.-funded technology with the world—could end this pandemic once and for all.
Keys to Rapidly Expand Global Vaccine Access
The U.S. holds two keys to enabling low- and middle- income countries to make vaccines for themselves.
First, the U.S. government, with taxpayer dollars, provided funding and critical research underlying several successful vaccines. The Moderna vaccine is a good example. This breakthrough technology was not the result of private industry going it alone, but the fruit of a critical public-private partnership.
When Chinese scientists published the SARS-cov-2 genetic data in January 2020, it was Dr. Barney Graham’s team at the National Institutes of Health that rapidly redeployed the technology they were working on and sent it to their partners at Moderna to manufacture for government-funded clinical trials. In all, the U.S. paid over $2.7 billion to fund Moderna’s work—over 99% of the vaccine’s cost.
Second, the U.S. government holds the patent in a key piece of the technology underlying the Moderna and other vaccines. All of this gives the administration critical leverage to expand supply and achieve equitable global vaccine access in 2021, not later.
The Biden administration must use this leverage and force Moderna and other companies to share publicly-supported technology and know-how with the world.
Some Positive Signs
There were positive signs this month when, at a closed-door World Trade Organization meeting, U.S. Trade Representative Katherine Tai labeled vaccine inequalities “completely unacceptable” and called for extraordinary action from government, WTO, and industry—challenging drug companies “to be the heroes they claim to be.”
The solution, though, will not be found in voluntary actions by drug companies. Requiring companies to pool critical technology can enable other manufacturers with experience serving lower income markets to produce low-cost, high quality medical goods.
Collaborating with the World Health Organization, public health experts and generic manufacturers in Africa, Asia, and Latin America could set up multiple sites for manufacturing. Within months, with an investment of just a fraction of what we are paying to donate vaccines, factories could be retrofitted to produce millions of doses of high quality vaccines.
Moderna has already stated it will not enforce Covid-19 patents. But that is not enough. The proposal by India and South Africa to temporarily waive WTO rules on enforcing patents for Covid-19 technologies would give companies in developing countries security to build new vaccine capacity. These technologies, paid for by taxes, should be treated as public goods—compensating innovators fairly, but not with a global monopoly over producing and pricing vaccines critical to saving lives and ending the pandemic.
Some argue that without patents companies would not develop life-saving medicines and vaccines. Patents certainly incentivize pharmaceutical companies to innovate certain drugs that serve those who can afford to pay. This is why we have numerous new drugs to treat erectile dysfunction and baldness— but not malaria and tuberculosis, which are, alas, diseases of the poor.
Companies also have little incentive to prioritize doses for the poor. This is why Moderna’s pledge to make just 700 million to 1 billion vaccines this year so far includes no sales to Covax for lower- income countries. Giving companies monopolies in this context does not incentivize innovation, but undermines global public health.
In this pandemic, key research is coming from public and university sources. Recently, another university-developed vaccine, using HexaPro-based technology well-suited for lower resource contexts entered clinical trials in Brazil, Mexico, Thailand, and Vietnam. But such innovations will matter little if they are ultimately trapped in global monopolies like vaccines developed by NIH and Oxford have been trapped.
In fact, tech transfer was at the heart of the 1995 Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPs) that governs global IP rules today. Developing countries did not want to agree to a system that would charge them monopoly rates for technology they would forever be importing, because they lacked technological capacity and know-how.
They ultimately came to the table, however, on the promise that developed countries would incentivize private companies to share their know-how and build innovative capacity in the developing world: the promise of tech transfer.
The TRIPs agreement was controversial from the start, decried as colonial policy triggering huge royalty streams from lower-income to high-income countries. The only thing giving it legitimacy was the promise of technology transfer.
If the wealthy countries turn their backs on that promise, and during a crippling global pandemic at that, the entire international IP infrastructure is exposed. Drug companies should cooperate because they are morally and legally obligated to do so, and the Biden administration should lead this effort.
This column does not necessarily reflect the opinion of The Bureau of National Affairs, Inc. or its owners.
Matthew Kavanagh is director of the Global Health Policy & Politics Initiative at Georgetown University’s O’Neill Institute for National and Global Health Law and assistant professor of International Health.
Madhavi Sunder is associate dean for Graduate and International Programs and professor of law at Georgetown University Law Center.