As we are nearing the second year-end in the COVID-19 pandemic, vaccine inequity is a stark global reality: on December 13th 2021, while global vaccine coverage stands at 56% of the population, this figure drops to 7.1% for low-income countries. In addition, new variants such as Omicron threaten to wreak havoc even on countries with relatively high levels of vaccination and dampen hope of near-term economic and social recovery from the pandemic.
Indeed, Omicron has brought a growing realization that truly ‘no one is safe until everyone is safe’ in the COVID-19 context as the more regions remain without access to vaccines, the higher the likelihood of the virus spreading which potentially heightens risks of new variants emerging. Accordingly, we see continued calls that COVID-19 vaccines should be a global public good, and a complex global institutional landscape has emerged for pathways to achieve equitable global access for vaccines which in turn is the focus of our recently published article in the Journal of Medical Ethics.
In this context, the last twenty months have seen the establishment and promotion of several mechanisms to pool, share, or donate COVID-19 vaccines and associated health-technologies, and the know-how, and intellectual property rights (IPRs) needed to produce these. At a global level, the most prominent among these proposals are the World Health Organisation’s (WHO) COVAX model, the WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS intellectual property waiver, and technology transfer proposals including the WHO’s mRNA hub in South Africa. In addition, in December the World Health Assembly agreed to take steps to commence negotiation on an international pandemic preparedness instrument, expected to be finalised by 2024. In some cases, these multiple proposals around how to achieve vaccine equity have become a matter of institutional tugs-of-war. The multiplicity of proposals has also created a level of confusion among the broader public and no small amount of debate in the policy context as to the respective merits and demerits of each.
For these reasons, we argue that there is a clear need for greater scrutiny around the institutional dynamics between and across these various proposed instruments if we are to achieve the public health aim of global vaccine equity for COVID-19. To increase vaccine manufacturing capacity globally, several components are necessary, including addressing intellectual property (IP) obstacles and expediating technology transfer. Many currently proposed instruments have the potential to be highly complementary if they are sufficiently supported and used in a targeted manner. For example, current proposals to mandate a TRIPS IP waiver, or to encourage voluntary sharing of IP via C-TAP, could be used alongside mechanisms to facilitate technology transfer via the WHO mRNA hub, to form key elements of a broader strategy to quickly upscale vaccine manufacturing capacity globally. The COVAX system used alongside such mechanisms could continue to provide a short-term vaccine distribution system for LMICs while an institutional ecosystem to build sustainable solutions for increasing vaccine manufacturing is developed.
Yet, despite this potential for complementarities, the overlapping multiplicity of mechanisms, in some cases, may in fact slow down decisive action. For one, this multiplicity may be used strategically by states, pharmaceutical firms, or other actors to stall action or circumvent public pressure until they are forced to act, or to adopt a ‘wait and see’ attitude, letting institutional jostling play out. Furthermore, proposals for new voluntary instruments such as additional voluntary licensing mechanisms or a pandemic preparedness instrument just as there is mounting support for the TRIPS waiver have the potential to delay progress on solutions for COVID-19 vaccine equity. Indeed, certain stakeholders interested in preserving the status quo could be banking on the distraction caused by new proposals to dilute support for existing global proposals.
On the other hand, the greater support grows for mandatory solutions like the TRIPS waiver, the more likely industry may be to engage with voluntary mechanisms such as C-TAP. Thus, institutional multiplicity could also be a lever for change. Nonetheless, to date we have not seen sufficient industry or international cooperation to achieve global vaccine equity – and with the threats posed by COVID-19 vaccine inequity, there is simply no time to spare on this.
There is now a clear and urgent need for concerted global multilateral action to provide a pathway for collaboration in attaining global equitable access. While the institutional infrastructure and proposals to achieve this amply exist, there needs to be much greater cooperation from industry, which has been far too reluctant to engage at a sufficient level with voluntary mechanisms to radically upscale vaccine production even in the face of global catastrophe. In the (likely) continued absence of this, decisive and coordinated action from states and international organisations on the TRIPS waiver is vital to clear IP obstacles and facilitate a pathway to enable the upscaling of COVID-19 vaccines, medicines and diagnostics.
Global equitable access to vaccines must be our priority if we are to bring COVID-19 under control, and the steps needed to achieve this must be taken as a matter of urgency.
Authors: Susi Geiger & Aisling McMahon
Affiliations: School of Business, UCD, Dublin, Ireland; Department of Law, National University of Ireland Maynooth, Maynooth, Ireland.
Competing interests: AM and SG are members of Access to Medicines Ireland (AMI), a voluntary membership group of Comhlámh. The views expressed here represent the authors’ views and are not representative of AMI.