End Global Vaccine Apartheid Now!
“You can’t have an individualistic mindset in an infectious disease scenario.” - Justin Feldman, epidemiologist
“When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live — forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence — knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual; disguised, malicious murder, murder against which none can defend himself, which does not seem what it is, because no man sees the murderer, because the death of the victim seems a natural one, since the offence is more one of omission than of commission. But murder it remains.” - Freidrich Engels, The Condition of the Working Class in England, 1845
“Who owns the patent on this vaccine?”
“Well, the people, I would say. There is no patent. Could you patent the sun?” - Jonas Salk, one of the virologist contributors to the development of the polio vaccine, during a television interview with Edward R. Murrow in 1955
------------------
What is vaccine apartheid?
Vaccine apartheid is the incredibly unequal distribution of who gets vaccines and who doesn’t around the world. It is not accidental nor inevitable. It is a result of the capitalist ruling class prioritizing profits over people through enforcing a global regime of intellectual property at the expense of human lives and our collective well-being. It is maintained by such imperialist institutions as the World Trade Organization and the World Bank, with the full backing of pharmaceutical corporations, philanthro-capitalists like Bill Gates, and the bipartisan warmongering of the Trump and Biden administrations. Vaccine apartheid targets poor people in the Global South for early death, while undermining the health and safety of every poor and working-class person on Earth.
The inequality is stark and appalling. By the end of January 2022, nearly 6 million people were confirmed to have died from COVID-19 around the world, although the true death toll is undoubtedly higher due to difficulties reporting. At that time, less than 12% of people in low-income countries had received a single dose of the vaccine, while 78% of people in high and upper-middle-income countries had been at least partially vaccinated, with a higher percentage of people in the US and Canada receiving booster shots than the total number of people in Africa who had received any shot of the vaccine. Countries bearing the brunt of centuries of imperialist plunder and control, such as Iraq, Nigeria, and Haiti, reported full vaccination rates of 16.2%, 2.7%, and less than 1%, respectively. As billions of people are forced to remain unvaccinated, the two biggest companies manufacturing COVID-19 vaccines, Pfizer-BioNTech and Moderna, are raking in $1,000 profit every second. The disparities are lethal on a monumental scale.
While the Biden administration chastises people in the United States that this is a “pandemic of the unvaccinated,” it is the US-backed prioritization of profits that ensures the majority of the world remains unvaccinated. Leaving vast swaths of the world without access to the life-saving vaccine also actively undermines the effectiveness of individual protections for anyone vaccinated, whether in the US or abroad. Preventing successful vaccination campaigns in any country ensures that multiple variants will spread, millions of people will die from infection, and billions of people will suffer from the mounting challenges to our healthcare, educational, agricultural, and social support systems. It didn’t have to be this way.
How did we get here? Who is to blame?
In February 2020, as the world was learning of a novel and rapidly spreading coronavirus, experts formed a working group at the World Health Organization (WHO) to create an “R&D Blueprint” against the virus. What they proposed was a vision of global collaboration in researching the virus and developing tests, treatments, and vaccines. The assumption was that the WHO would prioritize cooperation among countries. Instead, the WHO would be used to prevent this necessary collaboration in order to consolidate the intellectual property power of pharmaceutical corporations.
On May 29, 2020, the WHO announced a “Solidarity Call to Action” and unveiled the COVID-19 Technology Access Pool (or C-TAP), a global knowledge fund for collecting and sharing research about the virus and life-saving interventions. That same day, then President Trump announced the withdrawal of the US from the World Health Organization. The day prior, executives from Pfizer, AstraZeneca, GlaxoSmithKline, and Johnson & Johnson gave a COVID-19 media briefing as part of the International Federation of Pharmaceutical Manufacturers and Associations. In his concluding remarks, the president of the federation, emphasized, “That’s why our collaboration in this vaccine accelerator is so important to all the companies, and when you listen to the four companies present today, and they’re just a small spectrum of the industry overall, we are in there together. And these companies will deliver. We will find a vaccine, and we will find the vaccine of vaccines in collaboration and partnership with others.” The accelerator referenced was not C-TAP, the WHO’s COVID-19 Technology Access Pool, but rather the Access to COVID-19 Tools (ACT) Accelerator, launched the previous month as part of the WHO by the foundation of billionaire philanthro-capitalist, Bill Gates. As Alexander Zaitchik has written, “Like other Gates-funded institutions in the public health arena, the Accelerator was a public-private partnership based on charity and industry enticements. Crucially, and in contrast to the C-TAP, the Accelerator enshrined Gates’s long-standing commitment to respecting exclusive intellectual property claims.” It is no accident that for someone whose entire fortune has been predicated on upholding monopoly against open access, asserting drug companies’ exclusive control over life-saving technologies on a global scale would be of particular interest.
The vaccines pillar of the Accelerator would be the COVID-19 Vaccines Global Access program, or COVAX, which proposed to use donations and sales from richer countries to subsidize poorer ones, instead of facilitating sharing that could enable many countries to develop and distribute effective vaccines at low costs. From the outset, COVAX set the goal of providing donor-funded vaccines for just 20% of people in low to middle-income countries, a strikingly low threshold for what was described as an “ambitious global plan.” Fast forward to a year after the vaccine’s successful development: wealthy countries are falling far short of sharing their pledged donations while also hoarding many times the necessary number of vaccines necessary for their own populations. The COVAX model of vaccine distribution has only delivered half of the promised doses, and these failures are being used as potential justification for anyone wishing to point out inherent limits to global solidarity, while also disguising that the COVAX model was always intended as a model of collaboration between corporations and world institutions, not a model of collaboration among nations.
Even if poorer countries had received the full 20% of promised vaccines, they are still on the hook within the COVAX model for paying for the remaining 80% of vaccines by entering (and thereby competing with other countries in) a global market. In order to finance their purchases in this market, low-income countries are encouraged to utilize multilateral development banks such as the World Bank in order to fund vaccine purchases and critical infrastructure for their distribution. What this means is that poor countries, already underdeveloped through centuries of imperialist extraction and exploitation, are being coerced further into crippling debt in order to fund their access to critical health technologies in the midst of a pandemic, all to the profit of vested corporate interests.
And profitable the pandemic has indeed been for pharmaceutical companies. Each aspect of the COVAX model further entrenches and solidifies the deeply unequal global economic order that had been taking shape before the start of the current SARS-CoV-2 pandemic. Wealthy countries, with their capital and clout, could negotiate Advance Purchase Agreements (APAs) with pharmaceutical corporations through COVAX that guaranteed profitable prices to the corporations and priority access to vaccines for already powerful countries. As written in The Lancet:
APAs [Advance Purchase Agreements] are legally binding contracts whereby one party, such as a government, commits to purchasing from a vaccine manufacturer a specific number or percentage of doses of a potential vaccine at a negotiated price if it is developed, licensed, and proceeds to manufacture. These bilateral agreements often secure priority access to vaccine and manufacturing capacity. Governments of countries that disagree with the ethics and effectiveness of APAs or that do not have the financial resources to purchase vaccines at comparable prices or engage in commercial negotiations are at risk of not having access to vaccines when they first become available and of having access delays while manufacturing capacity is fulfilled first by wealthy countries’ orders.
In addition to being forced to wait in line behind wealthier countries, countries in the Global South were expected to use their own sovereign assets as collateral against any negligence or even outright fraud perpetrated by corporations such as Pfizer in delivering vaccines. In other words, any mistake made by Pfizer — even those committed knowingly and maliciously — would be paid for directly by poor countries with the full endorsement of COVAX.
All of these profitable deals for pharmaceutical companies come after the most lucrative set-up for them: we already paid for these vaccines. While Moderna raked in $18 billion of profit in 2021 alone, the vaccine with its name should really be called the NIH-Moderna vaccine because it was fully funded by the US National Institutes of Health with public funding. Only 2% of the AstraZeneca vaccine, also known as the Oxford/AstraZeneca vaccine, was funded by private industry. As Aishu Balaji writes, “Pharmaceutical companies have become gatekeepers to products that are, in reality, a sum of collective resources and knowledge. COVID-19 vaccines, for example, are built on existing technologies and data from public-sector workers and institutions, and developed with billions in public funding.” After we’ve provided nearly all of the funding for our vaccine development, corporations get to keep the credit and the profits. While being lauded as benevolent heroes for their participation in COVAX, corporations like Pfizer see their stock valuations soar with the announcement of new variants. Most fundamentally challenging to ending vaccine apartheid, COVAX provides a veneer of seeming goodwill because it appears as a commitment to vaccine access while instead serving to make pandemic profiteering more palatable.
Critical to securing corporations’ monstrous profits has been the enshrining of intellectual property rights as the key to innovative research and development of life-saving technologies and treatments, such as vaccines and antiviral medicines. While it is now a widely-held truth that corporations must profit in order to research and develop innovative health tools, this wasn’t always the public’s understanding of how medicine should be made and delivered. As Alexander Zaitchik demonstrates in his book, Owning the Sun: A People’s History of Monopoly Medicine from Aspirin to COVID-19, the equating of medical innovation with corporate intellectual property dominance was only won recently through decades of lobbying and public relations campaigns by pharmaceutical corporations and other champions of utilizing federal power to reinforce monopoly, like billionaire and intellectual property devotee, Bill Gates. Maintaining monopoly, whether it concerns computers or drugs, is ultimately about power, and using the intervention of state power — on both a national and international scale — to uphold those monopolies.
A primary tool for reinforcing intellectual property power on a global scale has been the World Trade Organization and their multi-country agreement on the Trade-Related Aspects of Intellectual Property Rights (TRIPS), signed into law in 1994. As law professor Jerome Reichman writes, “Taken together, the TRIPS Agreement’s standards amounted to a veritable revolution in international intellectual property law from which the research-based pharmaceutical industry emerged as one of the biggest winners.” TRIPS requires all countries to provide patent protection to intellectual property holders from any country, while threatening devastating sanctions for non-compliance. This agreement effectively carries any wealthy country’s domestic patent protections across all borders, and forces underdeveloped and poor countries to protect these patent-holders “rights” to profit, even at the expense of their own citizens’ health and lives. While there are some legal tools that poorer countries can pursue to potentially override the World Trade Organization’s prioritization of private property patents and demand access to life-saving drugs and technologies, such as compulsory licensing and waivers, these legalistic methods are costly, time-intensive, and severely limited in their scope of success.
On October 2nd, 2020, India and South Africa proposed a waiver from certain provisions of the TRIPS agreement for the prevention, containment, and treatment of COVID-19, with over a hundred other countries signing on to the waiver proposal. While the Biden administration lent verbal support for a general TRIPS waiver as a seeming reversal of the Trump administration’s open opposition, Biden put no pressure on other wealthy countries to support this specific proposal while also undermining the strength and scope of the waiver proposal in closed-doors negotiations, leading to a glaring gap between the current administration’s words and actions. A deal was finally reached in mid-March 2022, but within much narrower terms than those originally envisioned by India and South Africa. The proposed compromise most notably only includes an intellectual property waiver on COVID-19 vaccine patents, while leaving out tests and antiviral medications that are essential to identifying infected persons and treating the virus. And overriding vaccine patents alone does not force companies such as Moderna to share needed information about vaccine manufacture with developing countries. The deal also stipulates that the waiver would only apply to “any developing country member that exported less than 10% of world exports of COVID-19 vaccine doses in 2021,” effectively preventing China, a country with a massive vaccine and medical technology manufacturing capacity, from manufacturing and distributing the vaccine among its people and to other countries. As Aishu Balaji writes, “The removal of IP [intellectual property] barriers is a moral imperative, but this uneven manufacturing capacity suggests it’s a baseline rather than a ceiling….vaccine justice means addressing the broader structures preventing so many countries from developing and expanding their domestic capacity to manufacture pharmaceuticals.” Overall, the proposed deal in its current form leads to the creation of as many hurdles as it eases in overcoming private property patent protections and distributing life-saving care.
At the beginning of March, the Biden administration released the National COVID-19 Preparedness Plan as a roadmap for fighting COVID-19 with four main goals. The fourth goal states the administration’s intent to “continue to lead the effort to vaccinate the world and save lives.” Days later, Congress passed a $1.5 trillion spending bill that had notably excluded the $15.6 billion of requested COVID-19 relief funding for domestic and international efforts, while including $6.5 billion to the Pentagon. We are spending more on manufacturing and distributing weapons than we are on vaccine development and sharing anywhere.
We demand global vaccine justice now!
While corporations profit, wealthy countries such as the United States benefit from the power that comes from wielding the vaccines as instruments of reinforcing empire. “Leaving it to the market” in the global economy means surrendering decisions over who lives and who dies and who gets to determine what constitutes public health to enormous corporations. Even as vaccines promise a desperately needed cure for the virus, nothing in COVAX challenges the status quo of endorsing pharmaceutical company profits as the virus churns through the entire global population, killing both unvaccinated and vaccinated people, and facilitating the suffering of every poor and working class person. The more we rely exclusively on vaccines as the only interventions against the pandemic, the more power we hand over to the companies with control over this important tool for health. Without non-pharmaceutical interventions, we risk reinforcing the ever-increasing monopolistic power of corporations such as Pfizer. No matter how many good-hearted and talented scientists work for them, no corporation can ever guarantee public health while their entire existence is motivated by increasing profits for shareholders.
Contrary to the ruling-class ideas promoted by the World Trade Organization and the World Bank, intellectual property is not an answer or a solution to public health concerns. Billionaires like Bill Gates cannot solve problems they’ve created or exacerbated through their commitment to monopoly capitalism, and we cannot allow them to co-opt global health initiatives such as the World Health Organization. As Madhukar Pai and Ayoade Olatunbosun-Alakija wrote in Science, “The COVID-19 pandemic is the biggest test of humanity’s ability to think and act as humankind. To pass the test, rich nations must stop vaccine hoarding, immediately redistribute surplus vaccines, meet their pledges to the COVID-19 Vaccines Global Access (COVAX) program, support the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver, and mandate pharmaceutical companies to transfer know-how for diagnostics, vaccines, and therapeutics.” We need a medical research system that is not controlled by profiteers in the form of corporations or philanthro-capitalists. We don’t have to force countries to go into debt in order to receive vaccines, especially as their own capacity to develop and manufacture vaccines is also being stifled in the name of profit. The vaccines belong to the people, and they are ours to share with the world to save lives and end the pandemic. As working class people, in any “developed” or “developing” country, we need collective approaches to challenging the primacy of pharmaceutical patents that are not rooted in legalistic labyrinthine approaches that ultimately serve to uphold imperial institutions of power like the World Trade Organization.
So our message to the Biden administration is clear. Action must be taken now to protect us, our families, and all our brothers and sisters in the Global South. Stop hoarding the vaccines, stop underfunding and defunding non-pharmaceutical interventions to COVID-19, and stop expanding the military and policing budgets to kill people at home and abroad. The vaccines do not belong to any company, they belong to the people — share the vaccines immediately with every country. Prioritize the lives of people over intellectual property by pressuring other rich nations to accept a sweeping TRIPS waiver immediately, and fully support information sharing and technological transfer to ramp up manufacturing of the vaccines in all countries to a scale that will save lives now. Support countries like South Africa trying to replicate the vaccine by forcing Moderna to fork over the vaccine recipe made possible in the first place by the National Institutes of Health. End all economic and military sanctions against other countries, as sanctions only serve to undermine health and kill people in the name of empire. Address the full scale of the crisis at home by pushing for improved and universal healthcare for all now. These are the tools we need to keep people safe and lead the effort to vaccinate the world and save lives.
None of us are safe until the most vulnerable among us are safe.