![]() At the beginning of South Africa’s HIV/AIDS epidemic, President Nelson Mandela’s government took steps to reduce the cost of expensive new antiretroviral drugs, including issuing compulsory licences to allow local production. There is an unfortunate precedent for this. ![]() ![]() MSF, which is supporting the Covid-19 response in more than 70 countries, also claims that patent-holders are putting profits before lives, giving as an example South Africa’s recent difficulties in obtaining proprietary chemicals used in Covid-19 tests, partly due to patent-holders not wanting to release formulas. ![]() “Is it sensible to have one Indian company producing so much of your vaccine?” asks Yuanqiong Hu, a senior legal and policy advisor for the international NGO Médécins Sans Frontières (MSF) in Geneva. And on 21 January, a fire broke out there - though SII claimed this had not affected vaccine production. For instance, the vaccine-producing colossus, the Serum Institute of India (SII), is the only licensed Indian supplier of the Oxford-AstraZeneca vaccine, though the country has many vaccine manufacturers.īut because India has a bad local epidemic, its government has decided that SII must meet emergency domestic needs before it ships to COVAX, which means that those shipments are likely to be delayed until the spring. Those who support it argue that it is, if nothing else, a wise insurance policy in a pandemic. The waiver proposed by India and South Africa is an attempt to achieve equitable access in a different way - by wresting control of lifesaving technologies from the patent-holders, and opening up their manufacture to generic producers sooner than those patents allow. COVAX, meanwhile, has secured around 1 billion doses. Only around 1.5 billion doses have gone to middle-income countries (combined population around 6 billion) and just 270 million doses have gone to low-income countries. (Though last week’s announcement that the US will join COVAX, having stayed out under the Trump administration, could help.) Of the 7 billion vaccine doses whose advance purchase has been confirmed, more than half (4.2 billion), have gone to high-income countries, whose combined population is around 1 billion, out of a global total of nearly 8 billion. Since the pandemic first hit, it has become clear that well-meaning initiatives like COVAX - which brings together governments, global health organisations and the private sector to try to ensure equitable global access to Covid-19 vaccines - are not enough to counter vaccine nationalism. As the WHO’s director-general Tedros Adhanom Ghebreyesus said earlier this month: “Vaccine nationalism hurts us all and is self-defeating.” Leaving poorer countries without vaccine protection could trigger a number of undesirable consequences for every nation - from disrupting global supply chains, including of the vaccine itself, to potentially driving the emergence of new variants of the virus. More broadly, it’s a simple fact that rich countries are serving themselves first – but in practising such “vaccine nationalism” they are doing the world a disservice. Indeed, its fragility was highlighted only last night, when it was revealed that the EU is threatening to block exports of the Belgian-produced Pfizer jab – of which the UK is expecting almost 3.5 million doses. The pandemic has highlighted the fact that demand and supply don’t necessarily go together, in turn raising the question of whether our system for producing new medicines - driven as it is by commercial incentives - is fit for purpose. At the moment, with rare exceptions, manufacturers must be licensed by the patent-holder for the duration of the patent, which is typically 20 years. If approved, this would mean that for the duration of the pandemic, a country could locally manufacture a vaccine, ventilator or Covid-19 test while they were still under patent elsewhere, boosting supplies and getting these technologies to those who need them faster. Last October, two members of the World Trade Organisation (WTO), India and South Africa, proposed a waiver that would allow countries to choose not to enforce certain intellectual property (IP) rights relating to tests, treatments, equipment and vaccines for Covid-19. Depending on how it is resolved, it could change the landscape of medical innovation permanently - and take decisions about which diseases are prioritised out of the hands of the pharmaceutical industry. It’s a struggle that will also affect how soon effective treatments will be available. A gargantuan yet widely unreported struggle is taking place in Geneva that could affect how quickly billions of people are vaccinated against Covid-19.
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