More than 1 million people around the world have lost their lives to Covid-19. At least another 38 million people are infected; many became seriously ill. As almost every country in the world reported Covid-19 cases, the social and economic consequences of the pandemic were devastating and far-reaching. A vaccine against Covid-19 is crucial to end the pandemic and save lives. The race to develop such a vaccine is underway. But who will eventually be able to access and afford it? Birgit Schwarz talks to Human Rights Watch’s senior business and human rights lawyer, Aruna Kashyap, and senior researcher on children’s rights, Margaret Wurth, on the need for more transparency and the fair allocation of vaccines based on health needs, does not apply.
Who is involved in the development of a Covid-19 vaccine?
AK: The World Health Organization (WHO) maintains a list of companies and other institutions currently involved in research and development of Covid-19 vaccines. Nearly 200 vaccination candidates are in the pipeline. But as of 19 October, according to the WHO, there were only ten candidates for vaccination in the final stage of clinical trials. High-income countries such as the USA, Germany, the United Kingdom, Norway, South Korea, Saudi Arabia and Canada, together with the European Commission, invest huge sums of public money in research and development on Covid-19 vaccine, mostly through funding private enterprises and other entities leading the research. By mid-September, more than US $ 19 billion had been raised to fund vaccines.
What do governments expect in return?
AK: Governments that have the means to do so are negotiating bilateral transactions for their own countries with companies and other institutions to discuss large quantities of future vaccines, which means that there is a limited supply for countries that cannot afford it. The exact terms and conditions of these financing agreements have been kept secret.
MW: This is one of the key points we make in our report, ” Whoever finds the vaccine must share it ‘: strengthening human rights and transparency around Covid-19 vaccines. “Despite the large amount of public money spent on vaccine development, there is no open and transparent way to track how this funding is used, and whether governments have made sure that it is used for public benefit rather than private profits.
What do these bilateral transactions mean for vaccine accessibility?
AK: The current approach – shrouded in secrecy, competition and a race to fund and close vaccines – has led to ‘vaccine nationalism’ rather than collaboration. This is a huge blow to any worldview for universal, equitable and affordable access. This is why one of the most important questions in our work is that governments should not sign bilateral transactions in a way that undermines fair world allocation according to the need for public health.
MW: The fear expressed by intellectual property rights and access to advocates for medicines that we have interviewed is that pharmaceutical companies will have the power to determine how widely a vaccine will be produced and made available, because they own the intellectual property, the knowledge, possession. As one expert puts it, she is worried that drug companies are ‘going to play god’. Governments must use their power and ensure that once we have a safe and effective vaccine, access to it, including the ability to manufacture and distribute it, is fair and equitable.
Do not governments have a responsibility to protect their own citizens first?
MW: While governments have obligations to protect the health of their own people, they also have obligations not to interfere or prevent other governments from fulfilling their obligations to their citizens. There are moral, practical and strategic reasons – as well as human rights commitments – to work together, especially in times like these, when we have a global public health crisis affecting every country in the world. The virus knows no boundaries. No country can be fully safe and protected against Covid-19 before the people of other countries are also protected. It is therefore in everyone’s interest that their governments work together.
AK: Countries and supply chains are interdependent worldwide. Economies and people’s lives and livelihoods will not recover if countries opt for a vaccine strategy that only looks at their own people.
Will there be enough vaccine for everyone?
MW: There will not be nearly enough vaccine to reach the entire world’s population immediately, but to ensure that we can scale up vaccine production, it must be one of the barriers to this scarcity, such as exclusive licenses for the use of the technology behind a vaccine. This is one of the reasons why India and South Africa have proposed that some provisions of the World Trade Organization (WTO) agreement on intellectual property be suspended until new Covid-19 infections have decreased significantly and most countries have vaccinated their populations.
AK: A system that will put businesses in control of the supply and prices of vaccines without taking relevant intellectual property measures will put the vaccines out of reach for many economies that do not have enough resources. There are already lawsuits challenging the intellectual property of companies developing Covid-19 vaccines, and lawyers have publicly warned about the effect that intellectual property barriers have on the availability of vaccines. Normally, without government intervention, companies only voluntarily license a few or even just one partner, a strategy designed to increase profits, as opposed to access to the drug. If companies that succeed in getting a vaccine approved share their technology and intellectual property with as many vaccine manufacturing companies as possible, manufacturers could deliver much higher doses of vaccines. It will also lower the price per dose. That’s why technology transfer and IP sharing are so important. It would be unimaginably tragic to allow intellectual property to save lives during a pandemic.
Will a Covid-19 vaccine be affordable for low- and middle-income countries?
MW: Many experts believe that the costs currently being cited are too high and that it runs the risk of putting the vaccine out of reach for countries that may not possess the purchasing power of the richer. Governments should use their leverage, not least because of the large amounts of public funds handed over, to demand transparency from pharmaceutical companies involved in vaccine development and striving for affordability. Given the devastating economic consequences of this pandemic and the reality of global poverty, ‘affordability’ in many places would mean that the vaccine would have to be free for the patient.
AK: Companies claim to have to recover the money they and their investors spent on research and development. The varying cost per dose quoted – from US $ 3 to US $ 72 – calls for more supervision. We need transparent pricing along with third-party audits to ensure that public money is used to the maximum for the public.
Given the scarcity you describe, do you think about how limited vaccines can be distributed nationally?
MW: Distribution decisions should be based on public health strategies taking into account human rights obligations related to the right to health, life and subsistence. The WHO set out their initial thinking on scarcity distribution, which they say focuses on reducing deaths and protecting the health care system. They do have a group of experts from different fields who will advise them going forward.
AK: Regardless of the criteria the WHO or governments develop to try to ensure fairness and equity in distribution, the ultimate solution should be based on government cooperation to resolve scarcity. According to the WTO framework, it is estimated that 20 percent of the country’s population may be covered in the initial phase. To expand it, the challenge is for all governments in good faith to work together to maximize production, and increase the percentage so that there is universal and equitable access.
What lessons can be learned from the vaccination of previous vaccines?
AK: In the past, the availability of vaccines has been limited due to barriers arising from intellectual property claims. This is what vaccines for human papillomavirus (HPV) or pneumonia in children put out of reach of very poor people. If there is one vaccine we need that is affordable and produces in large quantities quickly, it is the Covid-19 vaccine.
MW: Decisions regarding access to vaccines and medicines are too often determined by opaque, profit-driven systems that large pharmaceutical companies that own the technology can determine how the technology is used. But this pandemic is unprecedented. If ever there was time to challenge these systems, it’s that time. There are so many people whose lives can be saved, who can be protected from the fact that they become seriously ill if a vaccine is made available on a fair basis worldwide.