Ensuring vaccine equity

Also, Covax needs multi-billion-dollar funding, with one estimate pegging the requirement at $5 billion just to cover the bottom 20% of poor nations’ populations.

In October last year, WHO director general Tedros Adhanom Ghebreyesus and president of the European Comission Ursula von der Leyen had written, “None of us will be safe until everyone is safe”. They had called upon the global community to ensure equity in access to Covid-19 vaccines, testing and treatment.

Seven months later, the world is nowhere close to passing this “stress test for global collaboration” meaningfully. As of last Friday, high and upper-middle-income countries accounted for 81% of the doses administered while low-income countries accounted for just 0.3%.

Part of the problem stems from rich nations cornering the bulk of available vaccines in bilateral deals with manufacturers—they are estimated to have contracted a billion surplus doses. Indeed, high income nations hold 4.7 billion of the 8.9 billion confirmed doses purchased globally, and low-income nations hold just 0.77 billion. Against this backdrop, G7 countries showing willingness to share a large chunk of the surplus and even allocate significant funds to the WHO-Gavi-CEPI’s Covax initiative that aims to provide vaccines to 92 low- and middle-income nations is welcome.

But, the Covax initiative faces challenges from its dual gateways—one allowing rich countries to procure vaccines through it even as the other aims to cater for poor nations. Indeed, many rich nations had requested “early access” under the window. Also, Covax needs multi-billion-dollar funding, with one estimate pegging the requirement at $5 billion just to cover the bottom 20% of poor nations’ populations.

Another solution proposed—spearheaded by India and South Africa at the WTO—is to free vaccines from IPR obligations, temporarily at the very least. The US, which had resisted initially the proposal, seems to be coming around. As per media reports, US trade representative (USTR) Katherine Tai has discussed, among other things, the possibility of a waiver with AstraZeneca and Pfizer leadership; while the outcome of the meeting is not yet public, a social media post from the USTR spokesperson read: “… Tai has emphasised her commitment to working with WTO members on a global pandemic response that addresses critical gaps in global vaccine production and distribution”.

The pharma industry has argued against the proposal, focusing on the R&D costs of vaccine development and how a waiver could have a chilling effect on further research, as also the fact that the waiver can’t “flip a switch”—there will be capacity constraints despite IPR being eased, at least for some time. But, rich-country governments have to remember that while ensuring vaccination for their populations may offer protection in the interim, vaccine-beating variants from a country that couldn’t vaccinate a large enough proportion of its population could always reach their shores.

To that end, even as IPR waiver is debated, rich countries must strengthen the Covax window, by fast-tracking sharing of surplus through it as well as increasing funding for it—Covax’s 2020-21 budget is pegged at $11.7 billion, and total contributions till early April stood at $8.6 billion; this funding gap needs to be bridged urgently.