When we enter the second year of the pandemic, all eyes are on COVID-19 vaccination. In the United States, the introduction of vaccines has been plagued by logistics issues, because states have to develop their own distribution plans without sufficient resources. Although former President Donald Trump promised to vaccinate 20 million people by the end of 2020, only about 2.8 million Americans had received the vaccine before the beginning of this year. After taking office, President Biden announced his goal of vaccinating 1
In discussing the introduction of vaccines in the United States, scarcity has always been the main theme: there are not enough vaccines to meet the demand, and the people who need it most (healthcare workers, people of color, frontline workers, people over 65) Yes, it’s not accessible. But compared to most countries in the world, the United States performs well. We have used the most doses in all countries and ranked fifth in terms of per capita doses. At the same time, many countries have not even started vaccination, The United States is increasing the difficulty of vaccinating them. According to the data collected by the Duke University Global Health Innovation Center and the body weight speedometer, another 200 million doses of vaccine obtained by the United States bring the country’s retained vaccine dose to 1.2 billion doses. 60 countries and multinational alliances have confirmed the reservation of vaccine doses. The share of the United States is greater than the total reservation of 45 of these entities. For comparison purposes, Pakistan’s population is approximately 68% of the United States, but its vaccine reserves are US’s 17.5%.
“This [vaccine] Krishna Udayakumar, founding director of the Duke Global Health Innovation Center, said that global recession is one of the reasons for inequality, and this is a problem we have been worried about for some time. When it comes to vaccine doses, it seems that rich countries will only become richer, which provides opportunities for less affluent countries to obtain vaccines. According to data from the Economist Intelligence Unit, some countries may not see that a large part of the population has been vaccinated until 2024.
Since the pandemic began, as Udayakumar mentioned, global health experts have been anticipating this possibility. In June, the World Health Organization, in cooperation with the Epidemic Preparedness Innovation Alliance and the Vaccine Alliance Gavi, released a plan called COVAX to pool resources from countries for the development and purchase of COVID-19 vaccines. At the time, investing in vaccine development was a risky proposal. Some people are betting on whether any of the more than 100 vaccines under development are safe, effective and put on the market. COVAX allows countries to pool their resources and adopt a “portfolio approach”, which means putting their contributions into the vaccine investment pool. Udayakumar said: “You can aggregate demand and use market forces to get better vaccine prices.” Gavi wrote in September and explained that once the vaccine is obtained, it will be based on the total population of all participating countries at the same rate. Dispense a dose to it.
However, once the results of promising vaccine trials were released, wealthy countries transferred resources from COVAX to pharmaceutical companies. Udayakumar said: “We are not seeing COVAX as the main platform for purchasing vaccines, but seeing that most countries in the world decide to purchase or retain vaccine doses according to their own bilateral agreements.” Likang has the political and financial power to negotiate deals directly, and often issues emergency use orders to speed up the procurement process. To date, of the 8.2 billion confirmed vaccine doses that have been confirmed, more than 7 billion have come directly from such transactions, of which only 1.1 billion have been obtained through COVAX. “There is only so much capacity in the world to produce these vaccines, and this capacity is restricted by some wealthy countries; “The remaining money is nothing. “Said Leena Menghaney, global intellectual property consultant for the MSF Accessibility Campaign. From Menghani’s point of view, the United States alone has received more doses than COVAX. Our supply is almost enough to vaccinate the entire U.S. population at least Twice, accounting for 15% of the total global confirmed purchases.
These bilateral agreements not only reduce the opportunity to obtain vaccine doses immediately, but also weaken COVAX’s negotiation and purchasing power. “Acquisitions made through bilateral agreements are excluded from other agreements,” said Safura Abdool Karim, a South African public health lawyer and member of the African Vaccine Delivery Alliance of the African Centers for Disease Control and Prevention. Pharmaceutical companies know that they can make large deals directly with rich countries, so they have no incentive to deal with COVAX. As a result, vaccine doses are now mainly concentrated in North America and Europe. Menghaney said: “By the middle of this year, you will be vaccinated with 30 to 40 vaccines in high-income countries, or even half of its population, while developing countries will still barely reach 3% of the population.” Last Friday, the United States Pledged to donate US$4 billion to COVAX and encourage other wealthy countries to do the same, but only after the country has reached a direct deal with the company.
These rich countries are also blocking another potential way to improve access to vaccines: abandoning intellectual property rights in COVID-related technologies. Most vaccine developers are private companies, so vaccines are their intellectual property. In the global health community, there has been a long-standing debate on intellectual property rights. Although some people point out that intellectual property rights are a way to stimulate investment in innovative products, it is disadvantageous to give companies full power in vaccine production and distribution. Intellectual property rights may pose a barrier for manufacturers who want to produce universal vaccines, which may increase supply, but it is not good for large companies, which will reduce their prices. These generic drugs will provide the buyer (in this case, the country) some leverage to negotiate with the company. They may actually threaten to import generic drugs or create their own generic drugs, Abdool Karim said.
In October, India and South Africa called on the World Trade Organization’s Trade-Related Intellectual Property Council, or TRIPS, to recommend that the organization issue exemptions to prevent WTO member states from implementing COVID-19 copyright and patented technologies and products. The two countries invoked the article in the Marrakesh Agreement that established the WTO, which allows the suspension of intellectual property rights under “special circumstances.” (If it is not a special case, what is this epidemic?) A month later, Kenya, Mozambique, Pakistan and Eswatini signed the “Trade-related Intellectual Property Agreement” exemption as co-sponsors, according to MSF According to the organization, 100 countries “welcome or fully support the proposal.” But rich countries like the United States, the European Union, Japan and Australia oppose it. “The state and pharmaceutical companies work together; this is the story of Pfizer and the United States and Bayer in Germany.” Menghaney said. “[Governments] Think that this harms the company’s commercial interests. ”The exemption proposal will be The next meeting of the Council on TRIPS on Tuesday.
If the WTO does require exemption from the TRIPS agreement (some experts, such as Udayakumar, are not optimistic about this), then this change will not immediately lead to more vaccine production capacity. Even if the intellectual property rights are given up, a vaccine will not be made overnight. Manufacturing capabilities such as investments in construction, machinery, and well-trained workers can take months (or even years) to recover.
The continuing shortage of vaccines has made countries scramble to buy any dose of vaccine. As countries become more and more desperate, they are considering using more vaccines than before. Udayakumar said: “These institutions have varying degrees of transparency in the data behind them, but so far, they have received less regulatory scrutiny than other institutions.” (Especially Russia’s Sputnik V and China’s Sinopharm vaccine are popular Choice, but still a controversial choice.)
Abdool Karim said that in South Africa, for example, the issue of vaccine supply has become a huge political issue. As countries such as Hungary and Egypt have purchased millions of uncensored vaccines, the South African public wants to know why its government is less proactive about purchasing vaccines-but such discussions do not always include availability The nuances of the vaccine, and whether it has passed the review of regulatory agencies. In this criticism, the South African government abandoned the evidence of the use of the AstraZeneca vaccine, which suggests that the vaccine may be ineffective against the 501Y.V2 variant. As part of the research, the company also announced that it will begin to administer unapproved Johnson & Johnson vaccines to medical staff. In addition to the initial 80,000 doses, the country has added at least 9 million doses.
However, the number of available doses is only one factor in the competition for vaccines. Some national and regional alliances are also trying to find ways to improve their position in the vaccine distribution cohort. “Whether it is to purchase 100 million doses or 10 million doses, its importance is beginning to decrease, and [more] Compared with other products you have already purchased, when can you deliver them? Udayakumar said. To be precise, how countries negotiate is not transparent because these terms are stipulated in the contract, but detailed information available to the public shows that the timing of vaccination drives political action in countries. Udayakumar said: ” We have seen some of these phenomena in the dispute between the European Union and the United Kingdom. As AstraZeneca faces manufacturing challenges at its EU plant, the country has to reduce its supply to the European Union. “We are also starting to consider purchasing vaccines with specific dates,” for example, the African Union negotiated an agreement with Pfizer, Johnson & Johnson and AstraZeneca to deliver 670 million doses and begin distribution in the next few weeks.
As the pandemic intensifies, the issue of equitable distribution of vaccines and intellectual property will only become more important. For new variants, it may be necessary to strengthen vaccines or develop seasonal vaccines, which means we need to improve the existing vaccine distribution system. Udayakumar said: “It is difficult to say that we need to vaccinate almost everyone in the world, but it is even harder to say that we need to be vaccinated over and over again.” “We will have to review these investments in manufacturing, and Make sure we expand all other resources, including supply chain access, training labor, all supplies, data systems to track who has been vaccinated and who has not been vaccinated.’t.”
To gain a deeper understanding of vaccine fairness, it is important to remember that resources for this issue are limited. In the past year, the world has devoted a lot of resources to the challenge of COVID, while often ignoring other public health challenges. “This is not just this pandemic in resource-poor countries; it is actually about the fragility and protection of their overall healthcare system and the health and well-being of the entire people.” Abdool Karim said. “When the entire system is strained, what is the long-term impact of the pandemic?”
Future Tense is a partner of Slate, New America and Arizona State University, researching emerging technologies, public policy and society.