Covid-19: Overcoming Global Vaccine Inequality

With over 3 million deaths as of April 2021 and an economic cost which could be as high as 14 trillion US dollars, the Covid-19 pandemic has caused social and economic catastrophes, being described as “the most challenging crisis since World War II.” On 31 December 2019, the World Health Organisation (WHO) was informed of the outbreak of a life-threatening viral pneumonia in Wuhan, China; over the course of the following months, the disease caused a worldwide health crisis and plunged humanity into the worst economic recession since the Great Depression. Although viral spread can be mitigated through measures such as social distancing, use of face masks and testing and tracing, the pandemic is unlikely to end until there is a global roll-out of effective vaccines that can prevent infection and drive herd immunity. Since the start of the Covid-19 pandemic, the world has seen unprecedented progress in vaccine development, manufacturing and deployment. Within a record time of less than one year, 11 vaccines are already in clinical use and approximately 900 million doses have been administered across 155 countries. Furthermore, 88 vaccines are undergoing clinical trials and 184 additional vaccine candidates are at the pre-clinical stage.

However, having licensed vaccines which are produced in large numbers is not enough to achieve control of Covid-19; they must also be priced affordably and distributed effectively on a global scale so that they are available where needed. National interests – especially those of high-income countries – remain the dominant factor in vaccine rollout. Developed nations have stipulated massive advance-purchase agreements with pharmaceutical companies, which means that rich countries have secured the majority of available doses. Several wealthy nations have pre-ordered a number of Covid-19 vaccines that far outnumbers their populations, fuelling an extraordinary gap in vaccine access around the world. The EU has ordered 1.6 billion doses for its adult population of roughly 375 million, which will create a surplus of approximately 525 million vaccinations. Similarly, the UK has ordered 219 million vaccines for its 54 million adults (a surplus of 165 million), while Canada has ordered 188 million doses for its 32 million adults (an excess of 156 million vaccines). Although high-income nations only account for 19% of the global adult population, collectively they have laid claim to 54% (4.6 billion) of all vaccine doses purchased to date, leaving 3.2 billion doses for the rest of the world combined. This global disparity in vaccine access may have devastating consequences: billions of individuals will not be vaccinated by the end of 2021, which could prolong the pandemic and raise the risk of further viral mutations emerging, potentially undermining the efficacy of existing vaccines.

Covid-19 vaccine technologies, production and prices are entirely controlled by profit-driven pharmaceutical companies that fiercely compete on the global market. Despite the WHO’s efforts, vaccines remain unaffordable and/or inaccessible for many countries. As a possible remedy, calls have been made for patents to be waived in order to accelerate manufacturing and supply of vaccines in low and middle-income countries. To this end, some governments have proposed a waiver of parts of the TRIPS Agreement, the World Trade Organisation’s international treaty which protects intellectual property at a global level. The proposal, which was jointly submitted by India and South Africa in October 2020, has been backed by over 100 developing countries. Despite receiving full support from numerous international organisations, the bid to suspend Covid vaccine patents is facing opposition by many States, assiduously working to protect the interests of their pharmaceutical industries. Those who oppose the waiver argue that pharmaceutical companies have taken significant risk and should be rewarded for their considerable investments in vaccine research and development. Governments in the US and Europe as well as the International Federation of Pharmaceutical Manufacturers claim that the waiver would threaten profits and disincentivise private investment in vaccine research, thus hampering scientific progress and innovation. However, others argue that the urgent need for vaccines should take priority over intellectual property rights, and that the waiver could be an important step towards scaling up vaccination in impoverished areas of the world. In addition, supporters of the waiver point out that research for Covid vaccines benefited from extensive public funding, and therefore private companies should not have exclusive rights to profit from the results.

The ongoing debate over the production and distribution of vaccines leads to an important question: to what extent are Covid vaccines the result of private research and investment? Virtually all currently available Covid vaccines are largely the product of government-funded research rather than private investment. The development of several viable vaccines in less than a year represents a monumental scientific achievement, but the springboard was decades of massive public investment in vaccine research and testing. It is estimated that the US government’s National Institutes of Health (NIH) spent 17.2 billion dollars in vaccine technologies from 2000 to 2019; this funding was essential to the speed and success of the Covid-19 vaccination programme. Most of the leading vaccine candidates prime the immune system against the viral spike protein (the viral receptor-binding domain), an approach based on the pioneering work of scientists at the NIH and other government- funded institutions. Specifically, two fundamental discoveries that emerged from public research laid the groundwork for nearly all available Covid vaccines: the viral protein designed by Barney Graham and his colleagues at the NIH, and the concept of RNA modification, first introduced by Drew Weissman and Katalin Karikó at the University of Pennsylvania. In addition to the key contributions made by public research in the past, an unprecedented amount of public funding has been poured into vaccine development and manufacturing during the pandemic. Initially, most pharmaceutical companies were reluctant to invest in Covid vaccines. Creating vaccines, especially in the wake of an acute health emergency, did not prove profitable during previous epidemics. The development process is long, and the outcome is far from certain. In some cases, the failure rate may be as high as 94%. Furthermore, vaccines are generally regarded as low-margin products with a limited expected growth potential compared to pharmaceuticals in other therapeutic areas. Therefore, private investors showed little interest in the race for a vaccine. Only when governments and agencies stepped forth with funding pledges did pharmaceutical companies get to work on the Covid vaccine. Since the beginning of the Covid-19 pandemic, the leading six vaccine candidates have received an estimated 12 billion dollars of taxpayer and public money, including 1.7 billion dollars for the Oxford/AstraZeneca jab, 1.5 billion dollars for the Johnson & Johnson vaccine and 2 billion dollars for BioNTech’s and Moderna’s messenger-RNA vaccines. According to a recent study, public grants accounted for 97-99% of the research and development funding towards the Oxford/AstraZeneca vaccine, with less than 2% coming from private industry.

Waiving vaccine patents will not change this reality. But the fact that the bourgeois state is ready to intervene in cases of emergency, in times of peace as well as of war, by providing capital, tax concessions of every kind, by imposing moderate or sustained prices, by making its forces and means available, does not alter the fact that goods are produced and sold in any case, within capitalist relations of production. The state of the capitalists helps the capitalists to solve their problems, it comes to the aid of the capitalists. Obviously, by referring to the other classes and the half-classes. But the fact that the bourgeois state, in cases of emergency, is ready to intervene, in time of peace as well as in time of war, by providing capital, tax concessions of all kinds, imposing moderate or sustained prices, making its forces and means available, does not mean that goods are not produced and sold within capitalist relations of production. The state of the capitalists helps the capitalists to solve their problems, it comes to the aid of the capitalists. Obviously, by referring to the other classes and the half-classes. Thus it does not escape Marxist analysis that the “public contribution” of the bourgeois state goes to strengthen capitalism, does not condition it, and is not qualitatively different from that of private investors. While the recent vaccine news has brought hope, it has also exposed our economic system’s dramatic inability to deal with a global threat such as the Covid19 pandemic. A solution can only be achieved through the eradication of existing property relations, the single greatest barrier to universal access to lifesaving vaccines and therapeutics.