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Oppose Global Vaccine Apartheid

The case for vaccinating the globe is evident — millions of lives are more important than pharmaceutical profits or intellectual property rights.

Rishab Chawla

In the Fall of 1884, representatives from thirteen European nations and the United States met to develop a plan to seize and divvy up the content of Africa for imperial gain. What ensued was decades of violent domination, occupation, and pillaging of natural resources in what was dubbed the “Scramble for Africa.” The colonization of indigenous people and seizure of their land has severely affected the social and economic development of their countries, with significant implications for contemporary global health.

Indeed, superimposing a map of the history of colonialism on top of a map of global COVID-19 vaccine distribution would more or less yield one image. As of May 1, over half the world’s countries have vaccinated less than 1% of their populations, ten of which have yet to vaccinate a single person. Also, 75% of vaccine doses have gone to a tiny handful of countries, a trend that is expected to continue with high- and upper-middle income countries having procured contracts to 6.3 billion out of 8.9 billion reserved doses. While the US can vaccinate its entire population multiple times over, millions of predominantly Black and Brown people in the Global South are not expected to be vaccinated until as late as 2024.

The disturbing inequities in the number of vaccine doses administered largely stem from stringent intellectual property (IP) rules implemented at the World Trade Organization (WTO) in the 1990s that restrict access to life-saving medications. The WTO agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires all member countries to guarantee drug companies monopoly control over the public research and technology used to produce pharmaceuticals and forbids generic production. Essentially, TRIPS was designed to anchor the economic standing of low- and middle-income countries to an inescapable IP regime.

At the October 2020 Council on TRIPS meeting, India and South Africa introduced a proposal — supported by 100+ countries — calling for a temporary waiver in order to scale up local generic production of vaccines, but the US and select other countries have blocked it. Since then, 10 US Senators and hundreds of organizations* including Public Citizen, OxFam, Human Rights Watch, Justice is Global, and Physicians for Human Rights have called on President Biden to remove patent protections and commit to a people’s vaccine.

To divert these grassroots demands, Western philanthropic parties including the Gates Foundation have touted the WHO’s COVAX scheme, which is projected to vaccinate ~20% of the population of participating countries by the end of the year. However, it is has to date supplied under 50 million doses and is not operating at a fast enough pace to reach global herd immunity. Though a welcome and crucial initiative, COVAX ultimately preserves the power differential between the Global North and South and entrenches reliance on charity over self-determination. The growing movement for a people’s vaccine, in contrast, calls for justice at the point of production, not just distribution.

Critics of relieving IP restrictions claim that it is an ineffectual gesture because the main barriers lie in manufacturing capacity, not patents. But data compiled by Knowledge Ecology International (KEI) tells a very different story through current vaccine manufacturing capacity of several countries' facilities, many of whom are in queue for case-by-case negotiations with pharmaceutical manufacturers and would be able to scale up production if they had the blueprint or technical knowledge. Bangladesh-based company Incepta, for example, is on standby to make hundreds of millions of doses pending approval from Moderna, Johnson & Johnson, or Novavax.

Proponents of a people’s vaccine acknowledge the shortage of raw materials in the most impoverished nations and do not see freeing up patents as the only goal. Rather, it is only the first step. In the 1990s and 2000s, the Treatment Action Campaign and allied groups organized mass global actions to make HAART and anti-fungal drugs available to patients with HIV/AIDS in South Africa. Not only did they successfully pressure Pfizer to supply fluconazole to clinics at a sharply reduced price, but their efforts led to unprecedented investments in public health infrastructure and expansion of services. A similar feat can and must be done again.

The longer the SARS-CoV-2 virus is allowed to replicate, the greater its potential to mutate and increase in transmissibility. Most recently in India, a new variant has emerged and been linked to several countries, owing to India’s devastatingly high daily caseload of now over 400,000. This pandemic knows no borders, none of us are truly safe until all of us are safe.We must not accept a new normal in which COVID-19 becomes a relic of the Global North, but becomes endemic to the most resource-strapped pockets of the Global South.

As medical students, many of us were fortunate to be vaccinated as early January, and soon after had the opportunity to volunteer to vaccinate our communities. But we may feel powerless knowing that we cannot quite reach the arms of billions who are in dire need of a dose. The global drive to vaccinate the world has likewise called for alliances between academic institutions and on-the-ground health justice activists. We all have a role to play in ensuring that governments and pharmaceutical companies place people over profit and make available the fruits of massive public investment. It is time to roll up our sleeves once more and get to work.

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*Conspicuously absent in this list is the American Medical Association, which has not yet made a public statement on the topic. My team has introduced a resolution to be heard at the June 2021 annual meeting calling on the AMA to take immediate action in support of a people’s vaccine. If you are an AMA-MSS member, you can add your testimony here until 05/10/21.

The views expressed are those of the author alone and do not represent those of his institution.


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