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More than 1 million people around the world have lost their lives to Covid-19. At least another 38 million people have been infected; many have fallen seriously ill. With nearly every country in the world reporting Covid-19 cases, the social and economic consequences of the pandemic have been devastating and far-reaching. A Covid-19 vaccine will be critical to ending the pandemic and saving lives. The race to develop such a vaccine is on. But who will finally be able to access and pay for it? Birgit schwarz speaks to Human Rights Watch’s senior business and human rights attorney, Aruna kashyap, and principal investigator on the rights of the child, Margaret Wurth, on the need for greater transparency and the equitable allocation of vaccines based on health needs, not money.
Who is involved in the development of a Covid-19 vaccine?
AK: The World Health Organization (WHO) maintains a list of companies and other entities that are currently involved in the research and development of Covid-19 vaccines. About 200 vaccine candidates are in the pipeline. But as of October 19, according to the WHO, only 10 vaccine candidates were in the final stages of clinical trials. High-income countries such as the US, Germany, the UK, Norway, South Korea, Saudi Arabia and Canada, along with the European Commission, are investing huge amounts of public money in research and development of the Covid-19 vaccine, mainly through funding. private companies and other entities leading the investigation. By mid-September, more than $ 19 billion had been earmarked for financing vaccines.
What do governments expect in return?
AK: Governments that have the resources to do so are negotiating bilateral agreements for their own countries with companies and other entities to reserve large quantities of future vaccines, which, given what we know about current manufacturing capacity, means there will be a supply. Limited for countries that can’t afford it. The exact terms and conditions of these financing agreements are kept secret.
MW: This is one of the key points that we highlight in our report, “‘Whoever finds the vaccine should share it’: Strengthening human rights and transparency around Covid-19 vaccines.” Despite the huge amount of public money spent on vaccine development, there is no open and transparent way to track how this funding is being used and whether governments have ensured that it will be used for public benefit rather than private benefit. .
What do these bilateral agreements mean for the accessibility of vaccines?
AK: The current approach, shrouded in secrecy, competition, and a race to fund and conclude vaccine deals, has resulted in “vaccine nationalism” rather than cooperation. This is dealing a serious blow to any global vision of universal, equitable and affordable access. That is why one of the key requests in our work is that governments do not sign bilateral agreements in a way that undermines equitable global allocation in accordance with public health needs.
MW: The fear expressed by the advocates of intellectual property rights and access to medicine we interviewed is that pharmaceutical companies have the power to determine how widely a vaccine will be produced and made available because they own the intellectual property, the knowledge. As one expert put it, he worries 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.
Don’t governments have a responsibility to protect their own citizens first?
MW: Indeed, governments have an obligation to protect the health of their own people, but they also have an obligation 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 obligations, to cooperate, especially in times like these, when we are faced with a global public health crisis that affects every country in the world. The virus knows no borders. No country can be completely safe and protected against Covid-19 until people in other countries are protected as well. Therefore, it is best for everyone if their governments cooperate.
AK: Countries and supply chains are globally interdependent. Economies and people’s lives and livelihoods will not recover if countries opt for a vaccine strategy that only considers their own people.
Will there be enough vaccine for everyone?
MW: There are not going to be enough vaccines to reach the entire world population immediately, but to make sure that we can increase vaccine production, once they have been approved, we need to remove some of the barriers that exist. contributing to these shortages, such as exclusive licenses to use the technology behind a vaccine. This is one of the reasons India and South Africa have proposed suspending some provisions of the World Trade Organization (WTO) agreement on intellectual property rights until new Covid-19 infections have subsided substantially and the majority of countries have vaccinated their populations.
AK: A system that would put companies in control of vaccine supply and prices without taking appropriate action on the intellectual property front would put vaccines out of the reach of many resource-poor economies. There are already lawsuits challenging the intellectual property of companies developing Covid-19 vaccines, and lawyers have publicly warned of the effect that intellectual property barriers will have on vaccine availability. Typically, without government intervention, companies only voluntarily license a few or even a single one, a strategy designed to increase profits rather than access to drugs. If the companies that get a vaccine approved shared their technology and intellectual property with as many vaccine manufacturers as possible, the manufacturers could produce a much larger number of vaccine doses. This would also reduce the price per dose. This is why technology transfers and shared intellectual property are so important. It would be unimaginably tragic to allow intellectual property to get in the way of saving lives during a pandemic.
Will a Covid-19 vaccine be affordable for low- and middle-income countries?
MW: Many experts say that the costs that are currently mentioned are too high and risk putting the vaccine out of reach of countries that may not have the purchasing power of the richest countries. Governments must use their influence, not least because of the huge amounts of public funds provided, to demand transparency from pharmaceutical companies involved in developing a vaccine and to push for affordability. Given the devastating economic effects this pandemic has had and the reality of global poverty, “affordability” in many places will mean that the vaccine must be free to the patient.
AK: Companies say they need to get back the money they and their investors spent on research and development. The wide range of costs per dose that have been cited, from US $ 3 to US $ 72, requires 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 shortage you describe, what are your thoughts on how limited vaccines might be distributed nationally?
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MW: Distribution decisions should be based on public health strategies that take into account human rights obligations related to the right to health, life and livelihoods. The WHO has outlined their initial thinking on distribution during shortages, which they said focuses on reducing mortality and protecting the health system. They have a body of experts from a variety of fields who will advise them on this topic in the future.
AK: Regardless of the criteria that WHO or governments develop to try to ensure fairness and equity in distribution, the final solution must be based on government cooperation to resolve the shortage. Under the WHO, it is estimated that 20 percent of a country’s population could be covered in the initial stages. To expand that, the challenge for all governments acting in good faith is to cooperate to maximize manufacturing and increase that percentage so that there is universal and equitable access.
What lessons can be learned from previous vaccine launches?
AK: In the past, the availability of vaccines has been limited due to barriers arising from intellectual property claims. This is what put vaccines against the human papillomavirus (HPV) or pneumonia in children out of reach of many poor people. If there is a vaccine that we need to make sure that it is affordable and produced in large quantities and quickly, it is the Covid-19 vaccine.
MW: Too often decisions about access to vaccines and drugs have been determined by for-profit opaque systems that allow large pharmaceutical companies that own the technology to determine how that technology is used. But this pandemic is unprecedented. If ever there was a time to challenge these systems, this is that time. There are so many people whose lives could be saved, who could protect themselves from getting seriously ill if a vaccine were available to everyone in an equitable way.
