Plenty Of Vaccine For Rich Countries-- Not Much For Poor Countries

COVID-19 Has Created 9 New Billionaires

In an extensive report yesterday, the Associated Press took on the mind-boggling vaccine gap between rich countries and poor, reminding readers that "a plummeting jet takes all passengers with it, whether or not they are wearing masks. And the failure to provide vaccines across the globe ensures that COVID-19 will continue to spread, and mutate, and sicken, and kill." The writers began by asserting that "no one expected a vaccine gap between the global rich and poor that was this bad, this far into the pandemic," making me wonder if they are naive about the nature of capitalism and human greed.

They are certainly aware of the problems. "Inequity," they wrote, "is everywhere: Inoculations go begging in the United States while Haiti, a short plane ride away, received its first delivery July 15 after months of promises-- 500,000 doses for a population over 11 million. Canada has procured more than 10 doses for every resident; Sierra Leone’s vaccination rate just cracked 1% on June 20... There was a global purchase plan to provide vaccines for poorer countries, but it was so flawed and underfunded that it couldn’t compete in the cutthroat competition to buy. Intellectual property rights vied with global public health for priority. Rich countries expanded vaccinations to younger and younger people, ignored the repeated pleas of health officials to donate their doses instead and debated booster shots-- even as poor countries couldn’t vaccinate the most susceptible."

The disparity was in some ways inevitable; wealthy nations expected a return on their investment of taxpayer money. But the scale of the inequity, the stockpiling of unused vaccines, the lack of a viable global plan to solve a global problem has shocked health officials, though it wasn’t the first time.

“This was a deliberate global architecture of unfairness,” [the African Union’s envoy for vaccine acquisition Strive] Masiyiwa told a Milkin Institute conference.

“We have no access to vaccines either as donations or available for us to purchase. Am I surprised? No, because this is where we were with the HIV pandemic. Eight years after therapeutics were available in the West, we did not receive them and we lost 10 million people.”

“It’s simple math,” he said. “We have no access. We have no vaccine miracle.”

...Coalition for Epidemic Preparedness and Innovations, or CEPI, was planning for the worst. CEPI announced “a call for proven vaccine technologies applicable for large scale manufacturing,” according to minutes from its scientific advisory group. CEPI said it would be critical “to support the strategy for global access” early in the game.

CEPI quickly invested in two promising coronavirus vaccines being developed by Moderna and CureVac.

“We said very early on that it would be important to have a platform where all countries could draw vaccines from, where there’s accountability and transparency,” said Christian Happi, a professor at Nigeria’s Redeemer’s University and a member of CEPI’s scientific advisory committee. “But the whole idea was that we thought rich countries would fund it for the developing world.”

Happi said officials never expected the pandemic would strike first and hardest in Europe and the U.S. Or that their assessment of preparedness in the world’s most advanced economies would prove horrifically optimistic.

Global health experts would soon come to realize that rich countries “could sign a piece of paper saying they believe in equity, but as soon as the chips are down, they will do whatever they want,” he said.

...The race to make and secure vaccines was on, and the United States and Britain were leagues in front of the rest of the world-- a lead they wouldn’t lose. Still, both countries would see life expectancy decline by at least a year in 2020, the biggest drop since World War II. In the European Union, 22 countries saw their average lifespans cut short, with Italy leading the list.

But as grim as the situation was, all those countries had a major advantage: They were home to the pharmaceutical companies with the most promising vaccine candidates, the world’s most advanced production facilities, and the money to fund both.

...Operation Warp Speed supercharged the global race to secure vaccines, but it would still take another two weeks until COVAX-- the COVID-19 Vaccines Global Access Facility-- was formally announced as the entity to ensure equity, with the Serum Institute of India as the core supplier for the developing world.

COVAX had the backing of the World Health Organization, CEPI, vaccines alliance Gavi and the powerful Gates Foundation. What it did not have was cash, and without cash it could secure no contracts.

“Operation Warp Speed signed the first public deals and that started a chain reaction,” said Gian Gandhi, UNICEF’s COVAX coordinator for supply. “It was a like a rush on the banks, but to buy up the expected supply.”

Some involved in the COVAX project flagged India as a potential problem early on, according to minutes of meetings in late spring and early summer of 2020.

India’s government had blocked exports of protective gear, but many global health authorities who hadn’t fully grasped the extent of pandemic nationalism found it unimaginable that the country would block vaccines when the world was counting on them. Also, India had so far been spared the waves of death that were sweeping across Europe and the Americas.

A separate plan put forward by the government of Costa Rica and the World Health Organization to create a technology-sharing platform to expand vaccine production foundered. Not a single company agreed to share its blueprints, even for a fee-- and no government pushed them behind the scenes, according to multiple people involved in the project.

On the global scale, the one organization that could have pushed for more technology sharing was the Gates Foundation, whose money to WHO nearly matches that of the U.S. government.

Instead, Bill Gates defended stringent intellectual property rights as the best way to speed innovation. His foundation poured money and influence into the Access to COVID-19 Tools Accelerator, which also failed to generate the money or influence needed to ramp up production outside already existing hubs.

In the United States, meanwhile, manufacturing and the trials went on in parallel, which is where taxpayers and the companies took enormous risks that paid off for both.

...The mRNA vaccines are widely considered a scientific and manufacturing triumph-- and a risky bet. Never before approved for use against any disease, they are now considered a hugely promising medical innovation and a potential gamechanger against infection.

But by the time it was clear the mRNA doses were a viable alternative, even in poor countries with limited cold chain, the available supply had been snapped up in Europe, the United States and Canada. And India, in the throes of its own COVID-19 surge, diverted its vaccines for its own use.

According to the People’s Vaccine Alliance, a grouping of human rights organizations advocating for broader sharing of vaccines and their underlying technology, the coronavirus has created nine new billionaires. The top six are linked to the successful mRNA vaccines.

For [Winnie] Byanyima, of UNAIDS, this is a travesty and a sign that the world has learned little in the decades since the AIDS pandemic was brought under control in the United States, only to kill millions in Africa because treatments were unaffordable: “Medicines should be a global public good, not just like a luxury handbag you buy on the market.”

COVAX has delivered only 107 million doses, and now is forced to rely upon uncertain donations from countries that may prefer to donate directly to the needy, so they can receive the credit.

A readout from its June board meeting slipped in an acknowledgement that it needed to better interpret and respond to market conditions and “the reality that a higher risk appetite is needed in a pandemic setting.”

For the pharmaceutical industry, mRNA is the ultimate confirmation that hard work and risk-taking is rewarded. And those companies keep tight hold on the keys to their successful vaccines.

When Moderna and Pfizer created new production lines, it was in the insular European and American manufacturing networks that had as much stake as anyone in both ensuring that the injections meet the highest standards and keeping promises not to abuse intellectual property.

Many public health officials have pushed for technology transfer during the pandemic. Initially resistant, the Gates Foundation has changed its position in favor of sharing.

Dr. Clemence Auer, the EU’s lead negotiator for vaccine contracts last summer, said the question of compelling pharmaceutical companies to suspend their vaccine intellectual property rights to increase the worldwide supply of coronavirus vaccines never even came up.

“We had a mandate to buy vaccines, not to talk about intellectual property, ” Auer said.

“The global community should have had this discussion back in 2020 but that didn’t happen,” he said. “Maybe we should have done it last year, but now it’s too late. It is spilled milk.”

CEPI includes equity clauses in the vaccines that it invests in, among them the successful Moderna candidate, but has yet to invoke them during the pandemic. Some include requirements to make a vaccine available to populations in need at affordable prices, as is the case in CEPI’s Moderna contract. But Moderna was first available exclusively in wealthy countries and even now only limited amounts are going outside Europe and the United States.

A separate push to lift intellectual property restrictions on vaccines and medicines has also gone nowhere in the World Trade Organization.

And WHO is reticent to make demands of donor nations or the pharmaceutical companies. It needs them for other aspects global health-- and for its own continued existence. The Biden administration has reversed Trump’s decision to defund and leave WHO, but the damage has been done.

“A lot of these multinational organizations, these plans, these coalitions, they don’t have teeth to enforce what they think is a fair and equitable way to distribute resources,” said Dr. Ingrid Katz, an infectious disease researcher at the Center for Global Health at Massachusetts General Hospital. She said the key question is whether vaccines and essential medications are a commodity or a right.

“If it’s going to be a commodity, we’re going to keep walking down this road every time we have something like this,” she said.

And if it is all going to rely on the generosity of rich countries, a lot of people are going to die. Four million have died already.

In all, at the recent Group of Seven meeting of wealthy nations pledged to donate 850 million doses, compared with the 11 billion that WHO says will be needed to end the pandemic.

A close look at the G-7 promises of donations shows that most aren’t expected to be delivered until well into 2022. The Biden administration fell short on its pledge to send 80 million doses abroad by the end of June: By mid-July, at least 44 million doses had been sent, including 2.5 million to Canada, which has already given at least one vaccine dose to more of its population than any other country. Africa has yet to receive its doses from the United States.

...Both Trump and Biden administration officials reject the notion that the U.S. or any country would share vaccines until they’d protected their own. And they both note that the U.S. bore the brunt of the pandemic last year, topping the world in confirmed cases and deaths.

...“It speaks volumes about where we are as a globe when you have the source of decision-making sitting with very few people who have a lot of wealth and are essentially making life and death decisions for the rest of the globe,” Mass General’s Katz said. “Every month that we lost put us further and further behind.”

Now... here in the U.S., where millions of right-wing imbeciles refuse to be vaccinated, we were just informed, via a new CBS News poll that "unvaccinated and partially vaccinated Americans, the groups most vulnerable to Covid, are the least concerned about the more contagious Delta variant. While 48% of 'not fully/not vaccinated' respondents in the poll released Sunday said they were concerned about the Delta variant, 72% of fully vaccinated Americans are worried."

Trumpists in 5 states are responsible for most of the new cases and hospitalizations and are the ones dying (albeit not fast enough): Arkansas, Florida, Louisiana, Missouri and Nevada. "Among the unvaccinated polled by CBS, 53% said they don't want a shot because they are worried about the side effects. Fifty% cited not trusting the government as one of their reasons, and 45% said they don't trust the science." And then... there's this:

Frank Schaeffer: "What is inarguable is now that Republican evangelicals are refusing the vaccine in huge numbers evangelicals can now accurately be described as disease-spreading bio terrorists... It is unjust that vaccinated Americans should pay for those who refuse a free vaccine and endanger our entire country. Those who spread this illness and who cost our health care system are bio terrorists and should be treated as such."

Schaeffer, as usual, is a little ahead of his time. It won't be too long before most Americans agree with him. (And wait 'til you read what Noah has to say about them in the Midnight Meme later!) My twitter followers already agree with Schaeffer: