GJIA: Let us start off with the current state of vaccine distribution. The Economist Intelligence Unit reports that all developed countries are expected to achieve widespread vaccine coverage by late 2021, whereas eighty-five developing countries will have to wait until 2024, at best. What is driving this disparity, and are there not global initiatives in place meant to avoid this exact problem?
LS: First of all, this is an unconscionable inequality and one of the greatest moral catastrophes of our generation. The United States and other high-income countries should be deeply ashamed of their response.
What is occurring is a global supply shortage of vaccines, combined with high-income countries hoarding the vaccine to themselves. The United States, Canada, European Union, and the United Kingdom signed contracts with pharmaceutical companies far in advance to procure most of their doses, and they have hoarded those doses. As a result, low- and middle-income countries have been in crisis with very few vaccines. Even though the United States has already vaccinated virtually all of its healthcare workers, frontline workers, and the elderly, poor countries are nowhere even near vaccinating their own healthcare workers, so their health systems are in collapse. There was a mechanism that was supposed to prevent this, which is the COVAX facility, a joint World Health Organization (WHO) and Gavi Alliance initiative. But the COVAX facility has been starved of dollars and doses, so it cannot even meet its modest goals. Recently, the United States has begun to step up. At the G-7 Summit in the United Kingdom, President Biden pledged 500 million doses of the Pfizer/BioNTech vaccine, 300 doses this year and 200 next year. This is a major start, but only a drop in the ocean with a global population of 9 billion.
The situation in India has also brought more attention to the short supply of vaccines. In the midst of this, the Biden administration announced its support of a proposal at the World Trade Organization (WTO) to temporarily waive intellectual property (IP) rights for these vaccines—something that the pharmaceutical industry and many developed governments around the world oppose. What would this proposal do, and why has the administration decided to support it?
Let us talk about India for a second. Another reason that there is a global shortage of vaccines is because India was supposed to be the vaccine engine of the world, and they were planning on exporting a majority of its vaccine supply to low- and middle-income countries. When they entered the crisis, the government ordered a ban on [vaccine] exports to increase domestic vaccination. The result is that COVAX did not get its expected vaccines.
India tugs at the moral heartstrings of America and the world. President Biden’s support for an IP waiver is transformational. I never thought I would live to see the day that the US government would support a waiver of intellectual property at the WTO. I think the reason they did is because President Biden was under enormous political pressure from progressives, global health activists, and Democratic members of Congress to support the waiver. Still, the European Union has opposed an IP waiver, so its future is very much in doubt.
On the very day that Biden announced his support for the waiver, I was on a call with Dr. Tedros, the head of the WHO. We both agreed that the United States would probably never support the waiver, but I had been lobbying the White House to do just that. And then later in the day, Biden shifted course; it was a historic landmark for United States diplomacy.
The pharmaceutical industry, alongside many developed governments, like the European Union, Switzerland, and Japan, oppose a waiver. They argue it would reduce the incentive to innovate, making it harder to develop vaccines and treatments for future pandemics. How concerning is this, and how might the waiver actually impact vaccine distribution?
The pharmaceutical industry is crying wolf, once too often. If we are ever going to waive intellectual property rights for a public health emergency, it would be now. If not now, then when? We suffered a pandemic of historical proportions, something that none of us have ever experienced in our lifetimes. The world is in an economic and health crisis. Now is absolutely the time not to allow business as usual to get in the way of vaccine production.
I think the pharmaceutical industry is wrong. This is only a temporary waiver. It is an industry that makes very strong profit. It has also profited off of huge government investments, such as the biotechnology research and development from the National Institutes of Health (NIH), Operation Warp Speed, and subsidies from the European Union. They are operating with a lot of public funding, and they have a moral obligation to be part of the solution and not oppose having other countries produce these vaccines. If you are going to have enough supply, you need to have regional vaccine hubs where vaccines are produced in places like Mexico, Brazil, Indonesia, and certainly India.
The proposal at the WTO requires a consensus of 164 countries. Right now, it only has around 120, including the United States. Do you think the administration’s decision will actually make a difference given that the proposal needs the consensus of all 164 countries?
Having the United States behind this is going to convince many other countries to support it, particularly the United Kingdom and the European Union. Once the United States, the European Union, and the United Kingdom are on board, it is very possible that other countries will come on board.
By WTO rules, you do not have to have consensus—that has only been their protocol. I am hoping that the Biden administration will put on a lot of diplomatic pressure to get this passed to the WTO, but it remains to be seen. [Passing the proposal] needs a lot of political muscle.
If this waiver is approved, how long might it take for vaccine production to ramp up? Are there any other steps besides the waiver that are necessary to create these regional vaccine hubs that you talked about?
It is going to take months, and in some places, it will take a year. It is going to require an IP waiver, and pharmaceutical companies and governments will have to transfer the technology. There must be a lot of financial assistance to build up capacity in these manufacturing hubs, and a lot of technical assistance to get a skilled workforce to do it. We need to go big and bold on the response to this pandemic. Weak and timid just does not work anymore.
Do you think that the Biden administration is leaning towards this “big and bold” route you are talking about?
No, not yet. We are pushing them in that direction. The United States has done big and bold in relation to a lot of other health crises around the world. The best model is AIDS and the President’s Emergency Plan for AIDS Relief (PEPFAR). We also lead on polio and smallpox eradication, and on the Ebola epidemic in West Africa and the Zika epidemic in Latin America. I think that there is a history and a tradition of bipartisanship in the United States, but we need to make that a reality. I think the United States has suffered so badly from this pandemic that it has lost its moral vision and has become inward looking. That has to change.
Looking back on previous health crises, some experts have also drawn parallels between Covid-19 and the AIDS epidemic, where nations were unable to access HIV treatment for years. Do you think that the United States and the international community are doing better this time around? Or are they falling into the same trap?
We [the United States] are absolutely falling into the same trap. The problem is that we were impacted much less during the AIDS epidemic because it already moved a lot to Sub-Saharan Africa. As for COVID-19, we have had a huge impact on every part of our community, and we have spent trillions of dollars on our own domestic response and recovery. Whether or not we can come up with billions and trillions more for the global response remains to be seen.
Do you have any final thoughts or recommendations that you would like to share?
President Biden should work with Congress and our allies, the G7 and the G20, to come up with something that is big and bold, which includes huge donations of vaccines. We also should pressure the pharmaceutical industry to transfer [vaccine] technology and Congress to provide the funding for technical assistance and capacity building [to manufacture vaccines] in lower-income countries.
This transcript has been lightly edited for clarity and length.
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Professor Lawrence Gostin is the Director of the O’Neill Institute for National and Global Health Law at Georgetown University, the O’Neill Chair in Global Health Law, and the Director of the World Health Organization Collaborating Center on National and Global Health Law. He is also the Legal and Global Health Correspondent for the The Journal of the American Medical Association, and serves on the Board on Global Health at the The National Academies of Sciences, Engineering, and Medicine. He has most recently authored the book Foundations of Global Health & Human Rights (Oxford University Press 2020). His Twitter handle is @LawrenceGostin
Image Credit: Georgetown Global Engagement, Creative Commons License
