It is good to see that the United States is effectively bridging the chasm from vaccines to vaccinations. Almost 50% of the US population has been fully vaccinated. In the US, vaccines are now freely available and authorized not only for adults but also for children over the age of 12. Additionally, the CDC has recently announced that individuals do not need to wear masks in most instances; two weeks after they are fully vaccinated. Many restaurants and local businesses are now open and resuming business indoors. Even Disneyland in California is once again open for out-of-state visitors. Schools and universities have announced plans for in-person sessions, starting in Fall. As a rising high school senior, whose sophomore and junior years have been disrupted by the pandemic, this means my friends and I may actually have a normal senior year of high school! I may even be able to visit a few college campuses in-person, and meet college students and professors, before I send in my application. What a wonderful feeling it is to see life in the US starting to return to normal!
Vaccines and vaccinations have been the turning point in this recovery. This progress to overcome the COVID-19 pandemic has been possible not just because of science, but by combining breakthrough scientific discoveries with thoughtful and ethical public policies, laws, and economic relief. In addition to the US, several other developed countries such as the UK, Canada and Israel have also made good progress in getting their citizens vaccinated, and are starting to reopen businesses and institutions. However, many of the less developed countries – the ones that the World Bank describes as developing and Low and Middle Income Countries (LMICs) – have not yet bridged the chasm from vaccines to universal vaccination.
In the graph above, based on Our World In Data, I have selected 20 countries including developed and developing countries and LMICs. The graph shows, as of May 29, 2021, the percent of the total population with at least one dose of an authorized COVID-19 vaccine. The chart reveals a stark contrast between the developed countries and the rest of the world. Countries such as Israel, UK, United States, Canada, and France have all vaccinated over 35% of their total population. There’s a clear break between these countries and the less developed countries such as Brazil, India, Indonesia, and South Africa, which range from 27% vaccinated to just under 1% of the population having received even a single dose of the vaccine.
Such stark contrast and disparity are so disheartening and unfair. This should not be acceptable. Period. While the level of infections, hospitalizations, and deaths have gone down dramatically in the developed world, they are still rising in much of the underdeveloped world. This humanitarian crisis persists, and is even accelerating in underdeveloped countries. This is a global pandemic that knows no boundaries. No one country is truly safe unless all countries are vaccinated. That we must not lose sight of. The world must urgently find effective ways to provide access to COVID-19 vaccines for the developing countries and LMICs.
It is in this context that TRIPS has been in the news over the past month. Developing countries, such as India and South Africa, have proposed to the World Trade Organization (WTO) a plan to temporarily suspend certain aspects of the WTO Agreement on Trade Related Aspects of Intellectual Property (TRIPS); especially those related to COVID-19 vaccines. In early May, 2021, during the two-day meeting of the WTO General Council, the United States government announced that it would support temporarily waiving the COVID-19 vaccine patents. Soon thereafter countries such as Germany and the UK announced that they would not support suspending the TRIPS provisions. There has been a lot of media coverage of this topic. Given my interest in both Biotechnology as well as in Business Law and Ethics, I wanted to further study and reflect on this topic in my blog.
Intellectual property (IP) – including patents, know-how, and research – are vital for innovation. Protection of intellectual property allows for companies and individuals to reap the rewards for their work, giving the ability to focus on future research, ideas, and development. In the current context, intellectual property is vital for pharmaceutical companies who are investing heavily, at risk, to develop new and promising therapies and vaccines. While some have succeeded there are dozens of companies that have not. At its core, IP laws give research institutions, individuals and companies the right to the creations of their own minds and efforts. It is also important to note that availability of patents alone are not sufficient to develop complex vaccines and therapies. A lot of the “secret sauce” is in the scientific and technical “know-how” that individual companies have developed. The WTO TRIPS agreement is an important trade agreement between all 164 WTO members. Established in 1994, TRIPS plays an important role in facilitating global trade and providing increased legal clarity on matters of global trade and economic relations. TRIPS does allow for compulsory licensing at times of public health emergencies, and the COVID-19 pandemic certainly qualifies as one.
Both sides in the TRIPS debate have been making their case over the past month. Those in favour of suspending TRIPS and waiving the patents make the arguments that it would remove some of the primary obstacles in the way of an equitable access and distribution of vaccines: production bottlenecks, financing, and patents. They argue that the TRIPS waiver and thereby giving access to vaccine patents will make it possible for LMICs to produce the vaccines themselves. They claim that this would cut both production bottlenecks as well as financing issues for the country, and allow LMICs to produce their own generic form of the COVID-19 vaccines. Each country could then produce the vaccines needed to support their populations, as opposed to relying on developed countries such as the United States, the UK, and Germany. A secondary benefit, they argue, is that by formally waiving the patents, it won’t set or encourage the wrong precedent of countries simply ignoring intellectual property rights in order to get access to effective vaccines. Those against suspending TRIPS point to the negative future implications of the proposal. They argue that such waivers would set a bad precedent, not address the current supply limitations, and create less incentives for innovation in the future.
I think there is a need to reframe the question and the discussion on this topic. All the focus and debate on whether or not to suspend TRIPS and waive patents may be misplaced and distracting from the overarching objective. I believe the main objective is to overcome the COVID-19 pandemic globally, as fast as possible, by vaccinating a vast majority of the global population and giving all countries, including those less developed, access to effective vaccines in massive quantities. I think the right question to ask then, is not whether the US should waive COVID-19 vaccine patents, but what can the US and other rich countries do to ensure that all countries have access to safe, effective and affordable vaccines as rapidly as possible and in massive quantities? This will help move beyond the current debate, from a particular tactic to focusing the world on achieving the overall objective. From villainizing rich countries and innovative companies that have given us these effective vaccines in record time, to effective global engagement. From an us-versus-them mindset to one of collaboration for the greater good.
What then is slowing down the massive scale of vaccine manufacturing and access? My reading and research suggests that just suspending the TRIPS provisions and waiving the COVID-19 vaccine patents, while antagonizing the innovative companies that developed these vaccines, will not be effective in addressing this supply and access shortfall. Expecting massive availability of vaccines within a year from now to meet the vaccine supply needs of all countries merely by waiving the patents would be like a high school swimmer hoping to win an olympic medal in a year, soley by reading a book and practice log on the current olympic champion. The probability of this approach succeeding is infinitely low. I certainly would not be depending on such an approach with thousands of lives, mostly in the less developed world, at stake. The challenges to rapidly increasing vaccine production go well beyond just access to patents. They revolve around having enough supplies of raw materials and key ingredients, access to validated and approved vaccine manufacturing sites, quality control, and manufacturing and technical know-how, beyond just the patents.
So while the debate around TRIPS and suspending the vaccine patents makes for interesting headlines and media debates, I believe that the most effective way to provide access to vaccines in large quantities, quickly, is for the developed world and philanthropic organizations to work with all the companies that have efficacious, authorized vaccines to massively scale-up manufacturing and supply chains so that there are enough vaccines to immunize the global populations. This would be the fastest, safest, and most effective path to overcome the pandemic; not just in the developed world, but also globally.
As I reflect on this blog and proposed solution, I think there is one critical PBH (Philosophy of Biology and Health) lense that warrants further study: the Economics Lense. How would the economics of this proposed solution work; is the solution I am suggesting even feasible? I will plan to cover the economics separately in a subsequent blog.