Equitable access to Covid vaccine a challenge

Dinesh C Sharma
Science commentator

By all indications, the likelihood of a vaccine effective in tackling Covid-19 becoming available in 2021 is high. Dozens of vaccines are under development globally and a few of them are undergoing various stages of human clinical trials in many countries, including India. Russia has claimed the success of its Sputnik vaccine in early trials and is looking to India for further trials and mass-manufacturing.

The Union Ministry of Health and Family Welfare has begun preparations for distribution of the vaccine and is drawing up strategies to roll it out, in anticipation of one becoming available before mid-2021.

The WHO also sees a vaccine becoming available during the next one year.

While everyone is eagerly awaiting a vaccine, the biggest worry should be about an equitable access to such a vaccine or an effective drug, whenever it becomes available.

In early 2020, when the pandemic was in its formative days, world bodies like the UN and WHO talked about putting up a united fight against the pandemic. As the virus spread to all continents, infecting millions of people and killing thousands, the race to develop medical tools like vaccines and pharmaceuticals also picked up.

The WHO and national governments put vaccine development on the fast track. In April, the WHO, along with a few global health entities, launched the ‘Access to Covid-19 Tools Accelerator’, or the ACT, to boost the development and production of new therapeutics, diagnostics and vaccines. This was supposed to be the face of the so-called global pandemic response with rich nations promising support to it.

However, the ACT lost steam and a new actor entered the scene — COVAX — as the vaccine pillar of ACT. It was touted as a platform to support ‘research, development and manufacturing of a wide range of Covid-19 vaccine candidates, and negotiate their pricing.’ It promised the world that it would make available two billion doses of the vaccine by the end of 2021.

Actually, COVAX is not a new player, but old wine in a new bottle. It is supposed to be a three-way partnership of the WHO, Vaccine Alliance (earlier known as GAVI) and the Coalition for Epidemic Preparedness Innovations (CEPI). In effect, however, it is a partnership between WHO and the Bill and Melinda Gates Foundation, because both CEPI and Vaccine Alliance are its babies.

The result: though the ACT has been floated by WHO, it is the Gates foundation which is in the driving seat through COVAX. What appears to be a so-called public-private partnership has been turned into a front for a privately owned and managed charity. This is hugely problematic, given that the Gates foundation and entities created by it are not transparent and are answerable only to their trustees.

By outsourcing an important function in its pandemic response — coordinating the availability and distribution of vaccine — WHO has disappointed its member-nations. Equity and access are important principles in global health, which the world body is expected to uphold at any cost.

So far, 76 of WHO’s member-countries have signed up for COVAX as ‘self-financing’ members. Another 92 low- and middle-income countries are eligible to participate through the Advance Market Commitment (AMC) mechanism of GAVI. Many rich countries, like the US, have decided to stay out of all this.

Developed countries that have signed up with this facility are also entering into bilateral deals with vaccine manufacturers separately.

If there is going to be a finite number of doses of an effective vaccine available, then such countries may claim assured supplies through COVAX as well as directly from manufacturers with promising vaccines. This could put others in a disadvantageous position as all likely supplies of vaccines may have been booked in advance this way.

Instead of letting WHO pass on the ACT leadership to the Gates foundation, the UN should have brought together its agencies — WHO, the World Trade Organisation and World Bank — to put up a joint response. This approach should have been used to develop and make available effective as well as affordable medical tools. All such tools should have been declared ‘global public goods’, freeing them from any kind of patents or intellectual property protection under WTO rules so that they could be made available universally.

Doctors Without Borders had demanded this in May, and this week, India and South Africa have moved the WTO, requesting the waiver of the relevant sections of the TRIPS Agreement ‘in relation to prevention, containment or treatment of Covid-19 till widespread vaccination is in place globally.'

In view of the unprecedented situation posed by the pandemic, the two countries want the WTO to ensure that 'intellectual property rights such as patents, industrial designs, copyright and protection of undisclosed information do not create barriers to the timely access to affordable medical products' or scaling up of research and development.

Some countries are already planning changes in national patent laws to expedite the issue of compulsory licences for Covid-related medical tools. At the same time, companies engaged in vaccine development have already filed patents relating to vaccine platforms, like the mRNA.

Once medical tools are declared 'global public good', the World Bank or International Finance Corporation could have developed the financial mechanism necessary for vaccine development and equitable distribution. All public funds and funds from charities like the Gates foundation could have been pooled for development, field-testing, distribution, stockpiling, etc. If a couple of vaccines become successful, and freed from patents, they could be manufactured in a decentralised manner in different countries like India which have a high quality vaccine manufacturing capacity.

This approach would have helped keep costs affordable. Together, multilateral agencies could have funded research, helped manufacturers and raised funds for equitable distribution. A transparent governance platform under the aegis of the UN would, perhaps, be more credible and acceptable to the world community than an opaque, privately-driven mechanism.