Covid vaccines: how to end the wait for billions of people  

Developing countries have been hit hard by the pandemic. But they are struggling to get vaccines as "vaccine nationalism" has taken hold and pharma companies have preferred to sell to rich countries. Keystone / Aaron Ufumeli

Travel restrictions in response to the new Omicron Covid variant caused the World Trade Organization (WTO) to postpone a key ministerial meeting that had been planned for this week in Geneva. This gives it more time to address a key issue it has yet to solve: how to amend trade rules to help solve vaccine inequity.

A waiver on intellectual property rights could be the key to getting more Covid drugs and vaccines to the developing world. But countries, NGOs and the pharma industry are divided on the best way to get more supplies to billions of people in low-income countries. For example, less than 10% of people on the African continent have been vaccinated, compared with some 65% in Switzerland and a higher rate in many rich countries.

Proponents of a waiver say it would ease access to these life-saving products. But others, including Switzerland, say it is not the solution. More than a hundred of the WTO’s 164 member countries back an India-South Africa proposal for a temporary waiver under the WTO’s TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement.External link But the IP waiver talks have been ongoing for more than a year, and there is still no consensus, which the WTO normally needs.

The idea is that more laboratories around the world could have access to the technology and produce generic versions. This, in the view of the proposal’s authors, would both reduce the cost of anti-Covid vaccines in particular, and expand global production. 

What’s at stake?  

A simple look at the numbers from the pandemic highlights the urgency of providing greater access:  More than five million people worldwide have died. And even though poor countries with already weak health systems have been hard hit, more than three-quarters of the 5.5 billion Covid-19 shots administered worldwide have gone to high and upper-middle income countries, which account for just over a third of the world’s population.

Doctors without Borders (MSF) and other NGOs including Amnesty International say companies like Pfizer and Moderna have been using their intellectual property (IP) rights to prioritise manufacturing and supply of their vaccines in high-income countries and keep their prices up. The companies deny this. 

“The India-South Africa proposal was really born out of frustration with the slow rollout of vaccines in the developing world and a number of high-profile reports that the owners of IP relating to the vaccines in particular were not engaging in voluntary licensing,” says Duncan Matthews of the UK-based Queen Mary Intellectual Property Research Institute.   

He points to reports that potential manufacturers in Bangladesh, South Africa and Canada sought voluntary licences but were refused. “So that kind of raised a big international question about, well, if there’s a global pandemic, why are the owners of the IP refusing to grant voluntary licences to increase manufacturing capacity?”  

How would an IP waiver work? 

“What the WTO’s TRIPS Agreement on IP does is set minimum standards of IP protection enforcement, which must be in the national law of WTO member countries,” explains Matthews. “There is often a misconception that this waiver would automatically remove the IP rights for vaccines and related technologies. It doesn’t automatically do that. What it does is give the discretion for a WTO member country to set those rights aside. India, South Africa and their supporters have said explicitly what we really want is voluntary licences. And if we can’t get them, we want to bring the IP owners to the table and say, if you don’t negotiate this on fair and reasonable terms, we’ve got the ultimate power now to waive your IP rights under a national law.” It is about giving more power to the developing countries as they try to negotiate voluntarily, he concludes.  

Voluntary licences are a typical commercial tool for IP owners to commercialise their intellectual property rights “because if you sign a voluntary technology transfer agreement, you’re usually going to get paid royalties”, Matthews further explains. Under such agreements, knowledge is shared on a confidential basis, and if this is breached the IP owner can go to court. Under the IP waiver proposal, there would be no royalties and no legal recourse. 

Some vaccine companies have concluded such voluntary agreements, notably Astra Zeneca’s deal with the Serum Institute of India (SII), which also has a mandate to supply vaccines to the World Health Organization’s COVAX initiative.  COVAX aimed to deliver 2 billion vaccine doses to developing countries by the end of this year but has repeatedly had to revise down its projections because of supply problems.  

Pfizer has belatedly done a deal with Biovac of South Africa to start local manufacturing of its vaccines for Africa in 2022. Matthews thinks pressure at the WTO for an IP waiver “will have been a factor in Pfizer’s decision to engage in this collaboration with Biovac in South Africa”. 

“Part of the solution” 

Prime opponents of a waiver are the European Union, UK and Switzerland, all with strong pharmaceutical sectors. “We believe that intellectual property protection is really part of the solution and not part of the problem,” says Didier Chambovey, Switzerland’s ambassador to the WTO. “It’s an incentive for research-based laboratories to innovate and develop new vaccines and therapeutics.”   

Chambovey argues that a lot of the research spending was on the basis of private venture capital in the decade preceding the pandemic, which might not have been forthcoming if there were the threat of intellectual property rights being waived. Government contributions have reinforced this effort, especially since 2020, he told SWI swissinfo.ch. “So this is an ecosystem where we have cooperation between the private and the public sector, and both are doing a lot. It’s working, it’s generating innovation.”  

The Swiss representative says companies have managed to ramp up supply through voluntary partnerships, and that these are the only way to generate the necessary trust. Switzerland also recognises there is a distribution problem and that the vaccination rate in many regions of the world is “much too low”. But Chambovey thinks this is not an intellectual property issue. He says the UN has existing instruments to help tackle the problem, while containing export restrictions and removing obstacles to trade in essential medical goods could also improve the situation.   

The EU has put forward an alternative proposalExternal link aimed at clarifying TRIPS rules to ease some trade and manufacturing bottlenecks for Covid vaccines and drugs. Opponents say it is not enough.  

The pharmaceutical industry also opposes the India-South Africa waiver proposal. “A waiver is the simple but the wrong answer to what is a complex problem,” the Geneva-based International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  said in MayExternal link. “On the contrary, it is likely to lead to disruption [of production] while distracting from addressing the real challenges in scaling up production and distribution of Covid-19 vaccines globally: namely, elimination of trade barriers, addressing bottlenecks in supply chains and scarcity of raw materials and ingredients in the supply chain, and a willingness by rich countries to start sharing doses with poor countries.”  

Not just vaccines 

That IFPMA statement came after the US under Joe Biden announced in May that it would, unlike the Trump administration, support a waiver on Covid vaccine patents. But it has not expressed support for the wider proposal, which would also include medicines and such things as “knowhow on complex technology, designs on diagnostics and respirators, and any copyright which is relevant for those technologies as well”, according to Matthews.  

Michelle Childs of the NGO Drugs for Neglected Diseases says a waiver is also needed for anti-Covid drugs and diagnostics. With new anti-Covid drugs now starting to be approvedExternal link, she fears that “vaccine nationalism” could also be extended to “therapeutics nationalism”, with rich countries pre-ordering promising new Covid medicines.  

Swiss company Roche is one of those with an anti-Covid drug approved by the WHO. MSF’s Yuan Qiong Hu says this Roche drug is expensive and there are limited supplies. Hu argues that developing countries need “all the tools” to fight the pandemic, whether vaccines, drugs, or respirators. Even if everyone agrees with her, the devil lies in the detail. 

While still far from consensus, WTO member countries have agreed to continue talking with a view to re-convening the TRIPS Council at short notice, possibly in mid-December, if there were to be a breakthrough. On November 29, UN human rights experts urgedExternal link States to “act decisively to ensure that all people have equal and universal access to Covid-19 vaccines, particularly those in low-income countries who have largely been left out of the global response”. The postponement of the WTO ministerial conference should not be a reason for delay particularly in light of the new Omicron variant, they continued, but “confirms the urgent need to take collective action to address vaccine inequality”.

Video of protesters in Geneva calling on WTO members to waive patents on Covid-19 vaccines: