First COVAX vaccines in Africa: Fair and equitable?

1. The issue of equal vaccine distribution is the greatest moral test facing of the global community.
2. A strongly unequal distribution increases contagion in the countries that receive them in lesser or no quantity, and this favors the emergence of new mutations.
3. The impact on the consequent spreading of the infection could jeopardize the effect of the vaccination policies of the richest countries.

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Almost three months after the first vaccinations in the UK, there was very good news for Africa that yesterday Sudan received its first delivery of 900,000 doses. This was coordinated by UNICEF in the framework of the COVAX program. Additional good news is the announcement that tomorrow Uganda will receive its first batch of 854,000 doses, which are also part of the 3.5 million it is expecting to receive in the framework of that program.

This good and long-awaited news does not allow the unequal supply of vaccines to put be swept under the rug, which is mainly a consequence of hoarding by the richest countries, the policy of the pharmaceutical firms, and of a weakness of countries which does not affect only the lowest-income nations. In her viral web intervention at the European Parliament, Ms. Manon Aubry extended the accusation of weakness to the European Union and to her president, Ms. Ursula van Leyden, and called the attention to the too many unknown clauses of the vaccine contracts.

There have been several requests to suspend the intellectual property rights (IPRs) of the vaccines, at least while the COVID-19 pandemic continues. The competent international organization for this matter is the World Trade Organization (WTO) which in the meeting of its General Council and its Committees, scheduled for March 1 – 5 is supposed to make a decision on the proposal of India and South Africa that patents and other IPRs on drugs, diagnostic tests ,and vaccines against COVID-19 be suspended for the duration of the pandemic.

This proposal received support from the World Health Organization (WHO) and by Médecins Sans Frontières (MSF), whose international president, Mr. Christos Cristou, has requested the support of the President of the European Union and of the Italian Prime Minister, Mr. Mario Draghi, in order to have the proposal approved. The identification of the addressees was not accidental. Indeed, the European countries constitute the large majority of the minority of the WTO member states opposing the measure.

At the time of writing, the conclusion of the WTO meeting is not yet known, but this does not make any less timely an analysis of the general aspects of the issue and of the situation on 2 continents – Africa and Latin America – that badly need a change of policy in vaccine distribution.

A WTO decision might appear to be unnecessary. There are other instruments that might allow, at least at a national level, such a decision as sometimes has occurred in the past. It is not so, for reasons that include the effectiveness of national measures, the unique character of the geographic diffusion and gravity of this pandemic and several others broader in their scope.

The two core questions are:

• Is the principle that health is a public good of higher category than the commercial interests of the pharmaceutical companies?
• Does this give the states the right of regulating this matter?

Posing these questions, one does not deny the importance of what pharmaceutical companies have done. Their action allowed the extraordinary result of having safely approved vaccines in less than one year. However, it should not be forgotten that they received very significant public funding and economic commitment. In some cases, like in Israel and the UAE, there was also support for the testing of the vaccines. Financing and collaborating countries received these pre-emption rights with the exclusion of any co-participation in IPRs.

WTO had already the opportunity to consider the proposal at the December meeting of its General Council. The proposal, despite counting with the support of a majority of the 164 member states, did not reach the threshold for approval. The most that majority could obtain were generic statements, such as that the instrument of the Advance Market Commitments (AMCs) is not exempt of critics on ethical and medical efficacy grounds for distorting vaccine distribution on the basis of financial capacity, rather than on medical grounds, and the recognition that these concerns reflected in statements by some WTO members.

Actually, MsF, besides referring to shared ethical principles, highlights additional reasons that justify an enlargement of the vaccine production. Vaccine function is not only to protect from a potential infection. A strongly unequal distribution, as it happens to be the case, increases contagion in the countries that receive them in lesser or no quantity, and this favors the emergence of new mutations. Their geographical control is impossible, as shown by the experience of migrations from Africa to Italy and Spain through the Mediterranean Sea. The impact on the consequent spreading of the infection could jeopardize the effect of the vaccination policies of the richest countries. Some politicians like to stress that it is illegal. And so, what? It is a fact that as many others is not unknown to the richest countries.

However, these countries seem to prefer to rely on a free market that allows them to secure the necessary doses, and their leaders often preferred to make commitments of financial support to acquire vaccines that, at least until now, did not arrive, or to suggest sending surplus vaccines to lower-resource countries instead of declaring loudly that the decision-makers for public goods are the States.

Pharmaceutical firms claim that sharing of know-how is impossible. This is false. Such a sharing occurred in countries like India, Brazil, Argentina, and Mexico. Other countries that would have the technical capacity needed to participate in the production have seen their request to buy, we repeat to buy, the rights ignored. This happened in the case of the Dominican Republic. This country has a high-level Biotechnology Center, which, as confirmed by the President of the Conference of University Rectors, has the scientific and technical capacity of producing vaccines. Last August, the president of the republic, Mr. Luis Abinader, asked one major producer firm to negotiate not only the buying of vaccines but also the rights of production. The request was ignored.

The short vision of the richest countries is not only proved by their neglecting of the epidemiological risks of a policy where there are “have” and “have not” countries.

Possibly for reasons of internal policy, the goal of these countries is to reach, each of them individually, herd immunity as soon as possible through a vigorous campaign of vaccinations. Possible anticipations of the expected achievement date are announced with pride, even if accompanied by statements that the pandemic must be defeated everywhere because, as the Spanish president, Mr. Pedro Sánchez, said in the Abu Dhabi G20 Summit, “We will not be safe until everyone is safe.”  

It has been ignored that a study, commissioned by the International Chamber of Commerce (ICC), estimates that if the richest countries succeed completing the vaccination of their populations in the first half of the year, whereas, by then, poor countries have only achieved a marginal vaccination, the economic consequence would be scarring: a loss of over 9,000 billion dollars. This loss will significantly affect rich countries which should face the market contraction of poor countries and severe effects on the chain production due to the decrease in having their demand for raw materials, parts, and components satisfied.

The geopolitical impact can of course be judged differently, depending on the country. The production hoarding by several Western countries, with purchases and purchase options often exceeding their needs and perhaps the production itself, may find an explanation in dynamics of domestic politics, or in uncertainties about delivery times, but certainly possible direct and indirect consequences seem to be underestimated. The shortage of Western-produced vaccines is favoring use of the Russian and Chinese vaccines. There should be little doubt that this will favor the Chinese vaccine diplomacy announced in Abu Dhabi by President Xi Jinping: “We will meet our commitments, offer help and support to other developing countries, and work hard to make vaccines a public good that citizens of all countries can use and afford,” and this will not favor the latest plans announced by President Biden, regarding trade competition with China.