[News] World Faces Covid-19 “Vaccine Apartheid”

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Fri Jan 1 14:19:53 EST 2021

Faces Covid-19 “Vaccine Apartheid”
Sharon Lerner - December 31, 2020

*Pfizer CEO Albert Bourla* recently heaped praise on “the almost 44,000
people who selflessly raised their hands to participate in our trial.”

“Each of you has helped to bring the world one step closer to our shared
goal of a potential vaccine to fight this devastating pandemic,” Bourla
wrote in an open letter
to volunteers who took part in Pfizer’s Covid-19 vaccine research, which
was conducted in Argentina, South Africa, Brazil, Germany, and Turkey as
well as the U.S. His letter was published on November 9, the same day
Pfizer announced that the vaccine was more than 90 percent effective at
preventing the disease, and Bourla laid this considerable accomplishment at
the feet of the medical volunteers: “You are the true heroes, and the whole
world owes you a tremendous debt of gratitude.”

But Argentina, South Africa, Brazil, and Turkey will have to be satisfied
with Pfizer’s gratitude, because (like most countries in the world
they won’t be receiving enough of the vaccine to inoculate their
populations, at least not anytime soon.

Meanwhile, the U.S. and Germany — along with Canada and the rest of the
European Union — have contracted for enough doses of various Covid-19
vaccines to inoculate their populations several times over
While the U.S. is struggling
with the logistics of its vaccine rollout — fewer than 3 million
<https://covid.cdc.gov/covid-data-tracker/#vaccinations> people have
received the first dose so far — adequate supplies should eventually be
available. The U.S. pre-purchased 100 million doses of the Pfizer vaccine
for $1.95 billion in the summer (and reportedly passed
on the opportunity to secure another 100 million doses). Last week, the
Department of Health and Human Services announced a deal
to buy another 100 million doses of the vaccine by July 2021, and the
government has the option to purchase an additional 400 million doses. The
U.S. has also purchased 200 million doses of the Moderna vaccine, which is
also extremely effective against Covid-19. Those doses are due by the
second quarter of 2021, and the government may buy up to 300 million more
doses. And the U.S. has contracts for additional vaccine doses from Ology,
Sanofi, Novavax, and Johnson & Johnson, whose candidates are in earlier
stages of development.

Pharmaceutical companies and individual executives are already profiting
handsomely from their medical breakthroughs. On the same day that he sent
his open letter, Bourla, whose net worth is estimated at more than $26
million, sold
more than $5 million worth of his shares of Pfizer stock. Pfizer has
already made an estimated $975 million from the vaccine this year and is
expected to earn another $19 billion in revenue from the vaccine in 2021,
according to Morgan Stanley. Pfizer’s profit margin on the vaccine is
at between 60 and 80 percent. Moderna is projected
to make more than $10 billion from its vaccine next year.

[image: Picture taken on December 18, 2020 shows a corona vaccination
center at the fair grounds in Hamburg, northern Germany, amid the ongoing
novel coronavirus / COVID-19 pandemic. - The European Union is facing heavy
pressure to approve vaccines after Britain and the United States have
already administered tens of thousands of shots while China and Russia have
begun efforts with their own vaccines. The bloc intends to start its
inoculations with the Pfizer-BioNTech vaccine before the end of the year.
(Photo by Axel Heimken / AFP) (Photo by AXEL HEIMKEN/AFP via Getty Images)]

A corona vaccination center at the fair grounds in Hamburg, Germany, on
Dec. 8, 2020.

Photo: Axel Heimken/AFP/Getty Images

The estimated $100 billion
in sales to be made from a Covid-19 vaccine was clearly part of what
attracted pharmaceutical companies to vaccine research. For the
participants in that research, the calculus is different. In developing
countries, “you find people who don’t have medical care and are desperate
for medical attention and will grasp at the straws of medical research,”
said Harriet Washington, a medical ethicist and author.

A relative lack of oversight and lower operating costs are some of the
reasons that pharmaceutical companies do the majority of their research in
less affluent countries.

That desperation is only part of the reason that pharmaceutical companies
do the majority of their research in less affluent countries, according to
Washington, who pointed to a relative lack of oversight and lower operating
costs as additional reasons that the industry is drawn to those places. The
Covid-19 vaccine research participants in South Africa, Argentina, Brazil,
and Turkey “will work more cheaply than the people in the U.S. and
Germany,” she said.

The ethical problem this creates — that people in developing countries have
less access to medical breakthroughs despite shouldering a disproportionate
share of the risk that enables their development — far predates the
coronavirus pandemic. “There are inherent inequities that are repeated in
every epidemic,” said Washington. “It’s a consistent pattern; you’ll see it
as far back as you want to go.”

Whether they participate in drug research or not, people in low- and
middle-income countries often lack access to lifesaving medical
breakthroughs, which are sometimes priced out of their reach. Gilead, which
holds the patent on the hepatitis C drug sofosbuvir, has provided a clear
and tragic illustration of how deadly this dynamic can be. Only about one
in seven people who needed the company’s lifesaving drug in Brazil had
received it as of June 2019. In that country alone, thousands died of the
treatable disease, according
to the nonprofit group Make Medicines Affordable. Though many drugs
eventually become available, access is often delayed for people in
developing countries, as was the case for lifesaving HIV medications, which
are still unavailable to some 15 million infected people around the world
and arrived in some poorer countries more than a decade after they were
used in wealthier ones.

“We see lags occur in almost every intervention in the world whether it’s a
new drug or medical device,” said Dr. Krishna Udayakumar, founding director
of the Duke Global Health Innovation Center. “There’s not as much money in
products reaching markets in low- and middle-income countries.” As a
result, in much of the world, access to lifesaving developments often
depends on funding from donors, “which is always less than you’d like,” he

The deadly consequences of delayed access to the Covid-19 vaccine will be
on display in the coming year. The number of people vaccinated worldwide in
2021 will depend partly on whether other potential vaccines candidates are
successful and whether they’re delivered as one dose or two
But it’s already clear that the majority of countries will not have enough,
while rich countries are hoarding
vaccine supplies.

[image: The Coronavirus Crisis]Read Our Complete CoverageThe Coronavirus
Crisis <https://theintercept.com/collections/the-coronavirus-crisis/>

An international initiative to ensure equitable access to the vaccine,
called <https://www.gavi.org/vaccineswork/gavi-covax-amc-explained> the
COVAX Advance Market Commitment and governed by the public-private
health alliance Gavi, aims to provide participating countries with enough
vaccines to inoculate up to 20 percent of their populations by the end of
2021. But even under the best-case scenario, this goal would leave the vast
majority of the population unvaccinated — and is “subject to funding
availability,” as the group’s website
<https://www.gavi.org/vaccineswork/covax-explained> makes clear.

[image: ANKARA, TURKEY - OCTOBER 27: A health care worker injects the a
syringe of the phase 3 vaccine trial, to a volunteer at the Ankara
University Ibni Sina Hospital in Ankara, Turkey on October 27, 2020. This
vaccine candidate developed against the novel coronavirus (COVID-19)
pandemic by the U.S. Pfizer and German BioNTech company. (Photo by Dogukan
Keskinkilic/Anadolu Agency via Getty Images)]

A health care worker injects a syringe of the phase 3 vaccine trial, to a
volunteer at the Ankara University Ibni Sina Hospital in Ankara, Turkey on
October 27, 2020.

Photo: Dogukan Keskinkilic/Anadolu Agency/Getty Images

Some international health activists have become frustrated with Gavi. “On
day one, when the first person was vaccinated in the U.K., we should have
been seeing the equivalent in a developing country,” said Kate Elder,
senior vaccines policy adviser for Médecins Sans Frontières. “But we
didn’t. And we don’t have any precision about when we can expect those
doses in developing countries.”

Elder pointed out that, despite its stated goal of providing equal
access, the international vaccine distribution effort is hindered by the
global power and wealth imbalance. “Gavi will never call out vaccine
nationalism because its biggest donors — like the U.K. government — are the
most powerful members of their board,” she said.

The international vaccine distribution effort is hindered by the global
power and wealth imbalance.

The World Bank is providing additional aid for the delivery of vaccines,
but it is in the form of loans, which poor countries will need to repay. As
a result of the delays, many people in low-income countries will likely not
get the vaccine until 2023 or 2024, which will result in an unknown number
of deaths.

“We’re facing a global vaccine apartheid,” said Zain Rizvi, law and policy
researcher at Public Citizen, who predicted that the delay in vaccine
access will prove “calamitous.”

Public Citizen has proposed
several ways that the U.S. could expand access to the vaccine, including
building new production facilities and taking advantage of an obscure
statute <https://www.law.cornell.edu/uscode/text/28/1498> that allows the
government to override companies’ patents on inventions they fund.
Meanwhile, Kenya, India, and South Africa put forward a measure at the
World Trade Organization that would waive some intellectual property rights
for coronavirus-related products, including vaccines. The proposal, which
was supported by 99 countries, has yet to pass after being opposed by
wealthy countries, including the U.S., European Union members, Japan, the
U.K., and Australia.

But the waiving of patents is only the first step in ensuring global access
to vaccines. “Know-how is the bigger problem than patent rights in the
shorter run,” said James Love, who directs the nonprofit advocacy group
Knowledge Ecology International. Love pointed to Moderna, the federally
funded vaccine maker that has already pledged
not to enforce the patent on its vaccine. “But you still can’t go out and
make their vaccine unless you know how they did it,” said Love. “You need
to force the people who have the know-how to share the know-how because
it’s a fucking pandemic.”

While the U.S. government and the companies it funded to make vaccines are
already getting credit for ending the pandemic, Love points to a big hole
in that success story: that taxpayers wound up paying for deals that
limited global access.

“Some people are going to say this is a massive success because the
innovation story is pretty good,” said Love. “But the reality is the
government took our money, gave it to the companies, and wrote terrible
contracts so we ended up with very few rights over the inventions that we

The problem was entirely avoidable, according to Love. “The government
could have put mandatory sharing of know-how built into each of its
contracts so the technology transfer would have started as soon as these
vaccines were in clinical trials,” he said. “That did not happen. And one
of the consequences of these giveaways is that we’ve condemned developing
countries to delayed access to vaccines.”

The Trump administration has been particularly generous
with the pharmaceutical industry, removing standard protections
from some of their contracts, and has shunned international efforts to pool
resources to fight the pandemic. But it’s not too late for the country to
reverse course.

“President-elect Biden has the power to change that,” said Public Citizen’s
Rizvi. “He can think bigger and share the vaccine recipe and help ramp up
production and manufacturing capacity to further expand vaccine supply

The ethical dilemmas raised by conducting Covid-19 vaccine research in
countries that may not have their own supply for years are fixable too,
according to Washington. “The inequities are easy to address,” she said.
“You simply treat people in the developing world the same way you treat
everyone else.”
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