The covid-19 pandemic will not be over for us until it is over for everyone

The following call to global leaders for vaccine equity co-authored by a working group has been joined by over 1000 scientists, public health and legal experts, and community leaders. The signatories list can be viewed and joined here. This call was started by those assembled from around the world for the Conference on Retroviruses and Opportunistic Infections (CROI)

One year into the covid-19 pandemic, after over 100 million cases and 2.5 million deaths globally, we could lift the strain on our communities, health systems, and economies by prioritizing truly global immunity to help control the pandemic. Instead, inequity in global access to covid-19 vaccines is causing needless deaths, and prolonging the pandemic and viral transmission that fosters variants which undermine vaccine efficacy. 

We call on global leaders to share vaccine knowledge and expand global capacity for vaccine production. We must use vaccines this year to control the pandemic around the entire world, not just in a few high-income countries. Leaders should know that:

• Aiming to make vaccines available to only a small portion of people in low- and middle-income countries in 2021 is a political choice, not an inevitability.
• Vaccine production in Africa, Asia, and Latin America can expand within months if technology and know-how are shared more widely, beyond a few limited agreements.
• Temporarily suspending enforcement of intellectual property on COVID-19 technologies during the pandemic, as proposed at the WTO, will not undermine innovation and research.

High income countries are vaccinating millions of people per day. Several, like the US, plan to make vaccines available to their entire adult populations in the first half of this year. Countries dependent on the COVAX facility, however, will have vaccines to cover just 3.3% of their population in that time. By the end of the year, COVAX hopes to provide for 20% of their populations—perhaps up to 27% if all goes according to plan.  This is far below what is needed for pandemic control. Higher income countries would not accept such low levels of vaccine coverage. This same standard applies to all countries in the world. Unless we see a  significant change, 85 countries will not have covid-19 vaccines widely available until 2023.

Limited vaccine supplies are being allocated by wealth and geography, not by science, public health, or human need. Globally, it is disproportionately affecting Black and ethnic minority  communities. They have been excluded from accessing the benefits of science. In Latin America, countries with some of the highest death rates in the world have far fewer doses than countries with less need, but more wealth. In African countries, many hospitals overwhelmed by covid-19 have no vaccines to give to health workers. Several Asian countries with high covid-19 rates and large populations can access doses for only a tiny part of their population. In all of these regions there is remarkable human and technical capacity, which we could unleash with technology transfer.

Twenty years ago, scientists and public health experts called on world leaders in the Durban Declaration to accept the science of HIV treatment and share effective medicines with those who needed them. Millions died from the slow pace of response. We cannot repeat that delay. We must remove the artificial scarcity by making the incredible work of vaccine scientists and developers, much of it financed directly or indirectly by public funding, open to all countries to make.

We are in a global public health emergency—it is time to use all available legal and public health tools to get more vaccines to those who need them most, as WHO, UNAIDS, and others have called for. This requires expanding global vaccine production, technology transfer, temporarily waiving intellectual property rules, and pooling know-how. Companies that received public funding should voluntarily step up with licensing and share their knowledge with multiple producers—moving from a limited set of contract manufacturers to a coordinated effort with multiple producers, like the one WHO has proposed. Since most companies have not appeared willing, governments must act. Two thirds of WTO members support exercising provisions to temporarily waive TRIPS intellectual property rules during the pandemic. As Tedros Adhanom WHO’s director general recently noted, in this emergency “If now is not a time to use them, then when?”

Therefore it is time for:

• The United States government to immediately incentivize companies like Moderna, Johnson & Johnson, and Pfizer to share knowledge on how to produce the vaccines developed with significant public funding with countries around the world. The U.S. should fund urgent renovation and expansion to factories in Africa, Asia, and Latin America to produce these vaccines and reverse the Trump-era policy of opposing the TRIPS waiver.
• European and other high-income governments to do the same, using their political, legal, and financial leverage to expand open global production of vaccines financed by their taxpayers and ending their opposition to the TRIPS waiver.
• COVAX partners to acknowledge that neither covering 3% of the population in the first half of the year or 20% by the end of the year is acceptable or sufficient and that we need expanded production and reduced prices. COVAX partners should together back a global push to reach epidemic control everywhere with open global production and a temporary TRIPS waiver while making pricing and contract provisions transparent for all.
• Governments in Africa, Asia, and Latin America to deepen solidarity, set an epidemic control goal in the coming year, and use every legal tool at their disposal to expand vaccine production and access.
• Researchers and technical experts around the world to share their knowledge and support the opening of science for all.

In a world where there are enormous inequalities COVID vaccinations offer us the opportunity to provide everyone globally, regardless of income, race, or nationality, immunological equity to be protected from SARS-CoV-2.

The covid-19 pandemic will not be over for us until it is over for everyone.

Carlos del Rio is a Distinguished Professor of Medicine, Epidemiology and Global Health at Emory University.  He is the International Secretary of the U.S. National Academy of Medicine and a member of the CROI Program Committee.
Twitter: @CarlosdelRio7

Gregg Gonsalves is an Assistant Professor of Epidemiology at the Yale School of Public Health and an Associate Professor (Adjunct) at the Yale Law School.
Twitter: @gregggonsalves

Fatima Hassan is a South African human rights lawyer and social justice activist, founder and director of the Health Justice Initiative (HJI) in South Africa.
Twitter: @_HassanF

Matthew Kavanagh is assistant professor of international health at Georgetown University and director of the Global Health Policy & Politics Initiative at the O’Neill Institute.
Twitter: @MMKavanagh 

Competing interests: none declared.

Editor’s note: The number of signatories to the open letter was updated in 18 March 2021.