By Daniel Rangel
In the beginning of August, some media outlets started reporting that the Biden administration was planning to convene a “first-of-its-kind, global leader-level summit” focused on ending the COVID-19 crisis and preparing for future pandemics. The summit was scheduled in parallel to United Nations General Assembly (UNGA) and was supposed to rally the international community to step up its efforts to increase vaccine production and enhance equitable global distribution as the Delta variant surges.
After nearly a full year of frustrated negotiations at the World Trade Organization (WTO) to try to enact a temporary, emergency COVID-19 waiver of certain rules of the Agreement on Trade Related Aspects of Intellectual Property (TRIPS), UNGA seemed an appealing multilateral venue to discuss the direly needed global actions required to bring an end to the pandemic. Hence, for several weeks, journalists, diplomats, academics and activists – but most of all, regular people in the Global South unable to access COVID-19 vaccines – pinned their hopes on the summit that the U.S. president was organizing.
A group of more than 50 civil society organizations – including Doctors Without Borders, Oxfam, Universities Allied for Essential Medicines, Public Citizen and Health GAP, – sent President Biden a letter urging him to lead action at UNGA to ensure equitable vaccine production and distribution. The letter described the actions needed so that the president’s announced goal, vaccinating 70% of the population of every country within the next year, might actually be fulfilled.
Our organizations outlined the four crucial steps that would truly make America the world’s “arsenal” of global vaccine access:
- work with allied countries on a final text to speedily enact a TRIPS waiver for COVID-19 health technologies including vaccines, diagnostics, and treatments;
- launch an ambitious global vaccine manufacturing program with other countries to help produce billions more highly effective doses within one year and support a dedicated financing line item in the Build Back Better Act committing billions of dollars to this effort;
- use U.S. government’s full authorities to require the few firms with monopolies over effective vaccines, diagnostics, and therapeutics to transfer technology and production know-how to manufacturers in the Global South; and
- set an example for other governments by reallocating excess doses available in the United States to countries in the Global South via COVAX or regional procurement mechanisms.
And then the day of Biden’s COVID Summit arrived. It is difficult to imagine how anyone could have felt anything other than disappointment and ire after watching the four-hour long recording of the event. The “summit” was more a recollection of self-celebratory speeches and pre-recorded statements than a high-level debate between world leaders. And it certainly was not designed to launch a global partnership to end the pandemic with specific solutions and verifiable commitments.
The event was divided into four sessions that were supposed to address the urgent need to vaccinate the world to end the COVID-19 pandemic; the dire shortages of oxygen, testing kits, therapeutics and personal protective equipment (PPE) that are ravaging the developing world; and plans to be better prepared for the next pandemic.
Although the targets and commitments related to testing, therapeutics and PPE are woefully inadequate as well, this piece will focus on the problems with the portion of the summit that dealt with vaccine production, distribution and access.
From the outset, it is important to clarify that the Biden administration’s new 500 million vaccine dose donation is commendable. Similarly, the fact that with this new commitment to purchase and donate more doses to a total of 1.1 billion shots makes clear that the U.S. administration is willing to make financial efforts to get shorts in arms not just on American soil, but all over the world.
Yet, it is also true that this action will not end this pandemic or lay the foundations for a global public health framework that delivers for everyone, regardless of their country of birth. And it will transfer hundreds of millions more U.S. taxpayer dollars into the coffers of Pfizer, a company that has reaped windfall profits from the pandemic while blocking the ability of qualified producers in developing countries to make enough doses to cover the world.
At this point, no one thinks that we can “donate” our way to safety. Pledges to redistribute doses from high-income countries with relatively high vaccination rates to low-income and lower-middle income countries are only the first and most basic step needed to stop the global vaccine apartheid we are witnessing.
Why? Because this approach retains control by a few powerful donor countries and the existing monopolist vaccine firms. So, if and when shots get to arms is decided not by the governments needing doses but by those with other priorities and interests. For starters, that means most of the promised doses only are scheduled to be delivered in 2022. Of the 1.1 billion doses that the United States plans to reallocate, 800 million are not expected to ship until next year. And, to date, less than 15% of the vaccine donations that high-income countries have pledged have actually materialized.
Those realities make Biden’s COVID-19 summit not that different from the May Global Health Summit in Rome. There, many European countries pledged to redistributed doses as the main tool to address vaccine inequity, but four months later have failed to live up to the commitments. As a result, people from the Global South are still waiting for these vaccines to arrive. To make things grimmer, Biden’s call for other countries to join the United States in donating more doses only was answered by just four countries. And, the pledges made by Spain, Italy, Japan and Australia, combined, do not surpass 100 million doses.
This is an unacceptable outcome for an event that was billed as the place where world leaders would unite to agree on a plan to end the pandemic. Fortunately, South African president Cyril Ramaphosa, during his intervention at the summit, did spotlight what is necessary to reach the 70% vaccination goal: We need a global plan for developing countries to be able to manufacture their own vaccines and procure them directly.
In the same vein, UN Secretary-General António Guterres recalled his appeals for a global vaccination plan to solve the problems of intellectual property, technical support and finance to quickly ramp up vaccine manufacturing in different regions of the world.
The U.S. government also has backed the idea of expanding regional production of mRNA, viral vector, and/or protein subunit COVID-19 vaccines for low- and lower-middle income countries. However, until now, the United States has left untapped the myriad policy instruments and resources it could harness to translate this aspiration into reality.
Instead of committing to throw his weight behind the TRIPS waiver or announcing that he will use U.S. government’s contractual rights or statutory authorities to mandate the sharing of vaccine production knowledge, during the summit President Biden focused on the scattered actions that his government has carried out to support final-stage vaccine fill and finish operations in some developing countries.
Particularly, President Biden referenced the Quad partnership to finance the production of one billion doses in India and the recent deal to manufacture 500 million doses of Pfizer-BioNTech’s vaccine in South Africa. Both of these deals do not represent transformative solutions that reduce Big Pharma’s control over supply, distribution and pricing of life-saving medicines neither for the COVID-19 pandemic nor for future health crises.
The Quad partnership underpins vaccine production of Johnson & Johnson’s (J&J) shots by Indian producer Biological E. However, for the time being, Biological E is poised to carry out only the final formulation stage, being dependent on J&J for the supply of drug substance. Similarly, the deal between Pfizer-BioNTech and South Africa’s Biovac is just for fill and finish operations. These contractual arrangements do not represent autonomous manufacturing in the developing world and do not entail significant technology transfer or knowledge sharing.
The vaccine apartheid will not end and developing countries will not have autonomous capacity to protect their citizens until there are regional production hubs around the world churning out significant volumes of vaccine doses from start to finish. And, the U.S. government could contribute a great deal towards this goal if it uses its political clout and innumerable resources and levers to get a TRIPS waiver enacted and create the conditions for broad technology and knowledge transfer.
However, President Biden failed to mention the TRIPS waiver during the summit even if the White House factsheet released after the event did reference the waiver, the only truly global initiative to end the pandemic.
At the 76th Session of UNGA, the U.S. administration lost an unbeatable chance to engage with world leaders and deliver a TRIPS waiver for which it announced its support since May. Dread that this foreshadows a similar failure at the imminent November WTO Ministerial Conference.
As for the plans to be better prepared for the next pandemic, Vice president Harris unveiled a proposal to create a new financing mechanism for epidemic surveillance, vaccine development and vaccine delivery. This Financial Intermediary Fund for Pandemic Preparedness is to be hosted by the World Bank.
The U.S. will contribute $250 million, and the objective is to raise $10 billion. The final destination for these huge sums of money is, as of now, unclear. But, unless something changes radically, the only certainty is that the fund will keep nurturing the bottom line of the same pharmaceutical companies that today deny vaccine access to those that need them the most.
The lack of U.S. leadership and the fact that the COVID-19 summit did not yield any meaningful commitment resulted in an UNGA where progress on a global vaccination plan was noticeably absent, despite the calls from African heads of state for support for the TRIPS waiver. Instead of the promised first-of-its-kind, global leader-level summit to end the COVID-19 pandemic, the summit was a peak of missed opportunity.