Monday, April 12, 2021

Teminology: Vaccine apartheid

Copyright © Françoise Herrmann

As the COVID-19 vaccination campaign picks up speed in the US, with a record 3 to 4 million vaccinations per day, issues of global access to COVID-19 vaccines and of vaccination campaign equity have arisen. Vaccine apartheid is the term that has been coined in reference to global inequity in vaccine distribution, and corollary access to COVID-19 vaccination. By way of comparison, for example, according to Médecins sans frontières/Doctors Without Borders, a country like Iraq has received 360,000 doses of the Astra Zaneca vaccine for a population of 40 million (Ebeid, O., 2021). 

According to the British scientific research journal Nature, the following threefold issue is at the root of the emerging global inequity of COVID-19 vaccine distribution: 1>COVID-19 vaccine production capacity, 2> the purchasing power of rich nations who have pre-ordered vaccines, and 3> patenting rights, which exclude the transfer of technologies beyond those few companies owners of the intellectual property (IP) rights, already producing the vaccines at full capacity, primarily in the West, China and Russia. In other words, patenting rights perceived as obstructing the supply of COVID-19 technologies, in response to an extremely urgent demand. In sum, whatever vaccine production exists, it is already largely earmarked for those (rich) countries, who have pre-ordered, compounded by the fact that patenting rights prevent production from being distributed elsewhere, among other facilities, for example in medium–income nations. A production that would cover local populations, and the population of the poorest nations, without facilities or any purchasing power. 

Thus, medium-income, and poor nations, not only have to wait for vaccines (perhaps till 2022 or 2023), they have to wait far longer than necessary, because production is prevented from happening elsewhere. In terms of numbers, poorer nations, making up to 80% of the world population, currently have access to less than one-third of the available COVID-19 vaccines (Nature Editorial, 2021). The World Trade Organization (WTO), is thus currently under the pressure of an India and South Africa-led coalition of 100 nations, with civil society support, demanding that intellectual property rights for COVID-19 vaccine technologies be temporarily lifted, at least until the pandemic is under control, so that production can be set up elsewhere than at the few facilities of the western world for the Pfizer, Moderna, Johnson & Johnson, and Astra Zaneca vaccines, as well as for the Sinopharm vaccine in  China and the Sputnik V vaccine in Russia. (The People's VaccineGlobal Justice now).

Such a dramatic situation, oblivious of the public health interest, is not altogether unfamiliar. With hindsight from the disastrous monopoly on antiretroviral therapies (ART) within the context of the AIDS pandemic, pharmaceutical companies, such as Moderna, have indeed waived enforcing their patenting rights against others making the COVID-19 vaccine till the end of the pandemic, and will grant licensing rights for the mRNA technology post-pandemic. A pledge that technically lifts the monopoly on pricing conferred by patenting rights, promoting the development of a new vaccination paradigm, while still falling short on the possibility of transferring vaccine know-how and manufacturing to the Third World, during the pandemic (Shore, 2020). However, considering the absence of electricity for 1.5 billion people in the Third World, the Moderna vaccine is also considered an unsuitable candidate vaccine for the Third World, primarily due to the low-temperature storage conditions and to the costs of a double-dose regimen (Curtis, 2020). Likewise, for the same reasons, the Pfizer vaccine is deemed even more significantly ill-suited for the Third World, considering the extreme cold storage conditions (-70 degrees Celsius) required for the costly double-dose regimen of the Pfizer vaccine (1). Thus, the small set of pharmaceutical companies, producing effective COVID-19 vaccines worldwide, and especially those deemed more suitable for the Third World  (e.g.; Astra Zaneca), are being specifically urged to live up to the spirit of solidarity that was put forward during the early phases of public funding for research and development of COVID-19 vaccine development (Ellman, 2021). An urgent request that often forcibly ends up as a desperate appeal to all rich countries and pharmaceutical companies implicated, for the purchase and donation of vaccines to poorer nations, not only in need of COVID-19 vaccines right now, but of the right vaccines (Nature Editorial, 2021).

If the obscene cruelty of an unnecessary wait for medical technologies appears to be repeating within the context of the emerging vaccine apartheid of the COVID-19 pandemic, an even greater threat is seen lurking on the horizon. According to UNAIDS Executive Director Winnie Byanyima, vaccine apartheid for the poorest countries of the world not only prevents those countries from exiting the health and economic crisis brought about by the COV-2 pandemic, on a par with the rest of the world, vaccine apartheid also puts the rest of the planet at risk, canceling the possibility of eradication. Indeed, according to Byanyami: 

"The longer the virus is allowed to continue in a context of patchy immunity, the greater the chance of mutations that could render the vaccines we have and the vaccines some people in rich countries have already received, less effective or ineffective." (Byanyima, 2021)

In other words, for all who have survived to tell the tale of the year 2020, the COVID-19 pandemic clearly illustrates global interdependency, just in case such a dynamic might have previously appeared untenable. As Democracy Now! puts it succinctly: “If one person is unprotected, we are all unprotected.” (Goodman & Moynihan, 2020), a situation that vaccine apartheid might be in the process of amplifying. 

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(1) As of March 5, 2021 Rwanda is the only African country thus far with a Pfizer vaccination campaign, launched using special storage technology. Astra Zaneca, the vaccine generally known to be a more suited vaccine for the Third World, was also launched  in Rwanda (Uwiringiyimana, 2021).

References

Byanyima, W. (Feb. 18, 2021) UNAIDS -  A global vaccine apartheid is unfolding. People’s lives must come before profit. UNAIDS.   https://www.unaids.org/en/20210203_oped_guardian

Curtis, J. (Nov. 30, 2020) Coronavirus: Access to vaccines in developing countries. https://commonslibrary.parliament.uk/coronavirus-access-to-vaccines-in-developing-countries/

Ellman, T. Dr.  (Feb. 18, 2021) Southern Africa needs the right COVID-19 vaccines, at the right price – right now. Médecins sans frontiers (MSF)/Doctors Without Borders (DWB).   https://www.msf.org/msf-urges-rich-countries-share-appropriate-covid-19-vaccines-southern-africa

Ebeid, O. (March 31, 2021) Only vaccination will end the ferocious spread of COVID-19 in Iraq. Médecins sans frontiers (MSF)/Doctors Without Borders (DWB).   https://www.msf.org/iraq-only-vaccination-will-end-fast-spread-covid-19

Glenza, J. (March 31, 2021) Coronavirus: How wealthy nations are creating a vaccine apartheid. The Guardian.    https://www.theguardian.com/world/2021/mar/30/coronavirus-vaccine-distribution-global-disparity 

Global Justice Now! https://www.globaljustice.org.uk

Goodman, A & D. Moynihan (FEb. 25, 2021) Vaccine Apartheid: If One Person Is Unprotected, We Are All Unprotected.    https://www.democracynow.org/2021/2/25/vaccine_apartheid_if_one_person_is

O’Neill, J. (March 18, 2021) End vaccine apartheid by waiving patents and save us all from Covid-19. The Guardianhttps://www.theguardian.com/world/2021/mar/18/end-vaccine-apartheid-by-waiving-patents-and-save-us-all-from-covid-19

Shores, M. (November 2020) Breaking Down Moderna’s COVID-19 Patent Pledge: Why Did They Do It? https://www.ipwatchdog.com/2020/11/11/breaking-modernas-covid-19-patent-pledge/id=127224/

Staff (March 31, 20210 It’s time to consider a patent reprieve for COVID vaccines. Nature.   https://www.nature.com/articles/d41586-021-00863-w

Staff (March 21, 2021) Interview: Three questions on worrying COVID-19 surge in Papua New Guinea. Médecins sans frontiers (MSF)/Doctors Without Borders (DWB).   https://www.msf.org/png-health-system-verge-collapse-following-covid-19-surge An

Staff (March 25, 2021) COVID-19 support desperately needed as second wave overwhelms Yemen. Médecins sans frontiers (MSF)/Doctors Without Borders (DWB).   https://www.msf.org/covid-19-support-desperately-needed-second-wave-overwhelms-yemen

The People's Vaccinehttps://peoplesvaccine.org/ 

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