COVAX

The COVAX initiative as a patch for true solidarity

The COVAX initiative as a patch for true solidarity

A commentary on the ill-concealed vaccination nationalism of industrialised nations

03.06.2021

Map showing WTO members‘ agreement to the TRIPS waiver.
green = supporter, red = opponent, yellow = co-sponsor
Data and illustration from Médecins Sans Frontières, https://msfaccess.org/nopatents

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A very small percentage of people can have seizures when exposed to certain visual stimuli, such as letters whose composition reflects the failure of global policies to the detriment of many people. Even people with no history of seizures can have an undiagnosed condition that causes what are called „tantrums“ when reading such texts.

If you experience any of these symptoms, stop reading immediately and see a doctor or your constituency representative.

Symptoms of these seizures include dizziness, altered perception, eye or muscle twitching, trembling in the arms or legs, disorientation, confusion and brief loss of consciousness. During a seizure, there may also be a feeling of fainting or convulsions, which can lead to hopelessness and despair.

We have all heard of COVAX. It’s a global initiative in which richer industrialised nations and other donors provide Covid 19 vaccines to people in poorer countries around the world. It is a sign of solidarity and a ray of hope for many people whose countries could hardly afford to buy the vaccines themselves. Germany is one of the most generous donor countries and has so far pledged more than EUR 2 billion for this purpose.1 Time and again, politicians present the German population with the platitude that the pandemic cannot be over until it is over everywhere.2 By constantly citing this apology, they admit that international solidarity must be justified by self-interest. That’s a shame, but if it at least helps, I won’t be bothered by it any further.

What COVAX is supposed to do

As part of the Access to Covid19 Tools Accelerator (ACT)3 of the WHO, EU Commission and France, a larger pandemic response framework, COVAX is designed to ensure access to Covid vaccines for people in all corners of the world, regardless of their financial status. Since the pandemic situation was declared, the initiative has been supporting research and production of the vaccines and other relevant products, raising funds from governments, industry, foundations and private individuals and using these to buy vaccines from manufacturers. In this way, poorer countries are supposed to benefit from doses that are free of charge for them and do not have to enter into negotiations with pharmaceutical companies themselves. Richer countries also sometimes use this collective bargaining option, but pay for all the funds they receive themselves (e.g. Canada). The core idea is that the initiative buys the vaccines collectively and sometimes gets good conditions due to economies of scale. Subsequently, the substances are distributed fairly to all participating countries according to a population key. Everyone receives their percentaged deliveries at the same time and can thus vaccinate at the same rate. Everyone gets something and there is no competition. So far, so good and simple. Sounds great, but it doesn’t really work out:

What has become of it

Already in the implementation of these ideas one can read that some countries will be more equal than others:

Self-financing countries will be guaranteed sufficient doses to protect a certain proportion of their population, depending upon how much they buy into it. Subject to funding availability, funded countries will receive enough doses to vaccinate up to 20 per cent of their population in the longer term.4
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Dr. Seth Berkley
CEO of Gavi

It seems, our solidarity is only lasting for 20% of the people from the poorest countries. Financially strong countries, i.e. those that pay for their COVAX doses themselves and do not receive donations, on the other hand, are not capped in the delivery of goods for the time being. Later in the same text, these industrialised nations are even promised a 10-50% vaccination quota, the doses of which they can order through COVAX.

20% is a good start, one could say, if there were no direct reference to the expected delay, which is not mentioned for the rich countries. Besides, the German Health Minister Spahn said in November that about 30-40% of the german population are considered to be in the risk group for severe disease progression in case of infection.5 Nevertheless, we expect that in other countries this may be a maximum of 20%.1 So the doses still to be donated are not enough to protect all the most vulnerable people, and certainly not enough to establish herd immunity with a vaccination rate of around 80%. But isn’t that exactly what we need to defeat the pandemic, and to do so everywhere? If we assume that some countries cannot afford 20% of the required vaccines, where are they supposed to get the other 60% for the assumed herd immunity?

Also, ideally, countries should not enter into parallel bilateral supply contracts with the vaccine manufacturers, as these compete with COVAX, i.e. increase demand in the market with limited supply, thus driving up the price. The manufacturers can sell their few products more expensively when demand is diversified. So COVAX could buy even fewer vaccine doses for the money it has painstakingly collected. Well, we all know that is exactly what happened. The EU, collectively for its members, and other rich countries buy their own vaccines past COVAX, and the initiative remains empty-handed. The industrialised nations are supplied first, the invisible hand lies protectively over us.

The idea of a fair and cooperative community joining forces to defeat the virus globally has in the end turned into another hierarchical aid project with familiar power imbalances and without sufficient effective resources.

Incidentally, the insightful quote on the misplanning of the initiative is dated 03/09/2020, written by Dr Seth Berkley, CEO of Gavi, the vaccination alliance that co-manages COVAX. Their biggest fan and lobbyist, and even he admits to these inequalities. On the 3rd September last year, not a single vaccine had been licensed in the EU, and it is easy for me to indict mistakes today from the perspective of history afterwards. But even at that time, there were already many actors who drew attention to these and other problems. And even better: they proposed solutions!

How it should have gone

Many organisations are calling for more genuine solidarity, for example the ONE WORLD campaign recently called on the EU not to vaccinate 70% of its own population before giving vaccines to other countries, as it is currently planning. It had also calculated that 1.7 billion of its ordered doses would be left over after industrialised nations had supplied their vaccine-ready populations with second jabs.6 One of the most important advances, however, was that India and South Africa officially requested a waiver from the TRIPS agreement on 2 October 2020.7 Sounds complicated, but it’s simple: TRIPS is a WTO agreement to protect intellectual property in global trade. 8 It guarantees the validity of patents in the international arena and, in particular, American interests by facilitating/enforcing international market access for patent holders. But more on this in another place. The Agreement has a mechanism whereby patents and other safeguards can be suspended for specific reasons: e.g. during national distress or other circumstances of an emergency nature. One could now make the vague claim that a pandemic with already more than 3.5 million deaths might fall under this category. Since India and South Africa certainly hold this avant-garde view and further believe that certain articles of the TRIPS Agreement impede the global production and supply of medical products,7 they requested a suspension of its provisions while the pandemic continues. The consequence of this would be that companies would not be allowed to continue licensing construction manuals for ventilators, formulas for test substances or vaccinations and technologies for mask production as well as many other things. This is because up to now other companies with licensing permission, i.e. under fee, only produce on their behalf. Euphemistic lobbyists call this knowledge-transfer. With the waiver, the patents would instead be freely available to everyone in the world, and could be used for production everywhere, even without the patent holders having to agree to it and earn money from it. According to the calculations of India and South Africa, this would decisively counteract the problems experienced in supply chains and the persistently low number of urgently needed medical products in almost all countries. And it would do so legally and easily. However, the WTO decides by consensus. And one will not have to guess long to come up with which group of countries rejected the requested waiver at the time (hint: they are the same ones where big pharmaceutical companies avoid their taxes). An overwhelming majority of member countries now support the motion, but it will never be adopted without the industrialised nations joining in. In a much-publicised change of direction, the US recently announced that it now (more than half a year after its proposal) shares the same core opinion as the proposers after all.

An up-to-date overview of the countries‘ positions and much more information can be found on the action page of Médecins Sans Frontières (and on the very top of this commentary), which, unsurprisingly, is also in favour of enforcing the proposal. After all, there are historical examples that would speak to the success of such a measure, such as the polio vaccine, on which there has never been a patent, and AIDS treatments and tests, which have become enormously cheaper and more available since patents were suspended. Despite broad civil society support and overwhelming arguments against the profits of the pharmaceutical industry and for the health of the world’s population, this path will not be taken as things stand, because Germany and all the rest of Europe (except the Vatican and Ukraine) continue to oppose it. At least, after the US gave in, the EU holds out the prospect of introducing a compromise proposal in June that could provide for a simplification of licensing. Radical help is undesirable: the focus is on licensing, the so-called transfer of technology under the control of the patent-owning companies. The main arguments that politicians have adopted from lobbyists (and my responses to them) are:

We must be able to ensure the enduring quality of vaccines

So far, most vaccines of any kind have been produced outside the industrialised nations; India is referred to as the pharmacy of the world.

Manufacturing is complex and requires challenging supply chains.

The supply chains are only challenging because various intermediate products are patented and protected. Most of it could be produced anywhere in the world, if only you were allowed to.

A release of the patents will not lead to a single dose more on the market.

It takes only 6 months in the prioritised procedure to set up and approve a clean laboratory with production, as has already been done.

Without profit incentives, research will no longer be carried out in the future.

The research on mRNA vaccines was carried out at universities with a lot of dedication and little money. The pharmaceutical industry only jumped on board when it came to production, this is where greed comes into play.

The funniest thing about the waiver is the following:

It is a CAN formulation. The TRIPS Agreement obliges ratifying countries to provide patent protection for the respective products for at least 20 years. The waiver proposes that states no longer have to apply this rule. So they CAN suspend patent protection if they WANT to. Germany, or anybody else for this matter, would not have to do this at all if they did not want to, even if the waiver were adopted. This is because patent rights apply nationally, whereas the WTO has no legislative power. All existing laws continue to apply until they are changed. The waiver only offers permission to change them without having to fear WTO sanctions. By refusing to negotiate on this, however, the German government is also preventing this voluntary solidarity for all other states that would like to suspend their patents. That is absolutely absurd.

Hey, but how does the Federal Foreign Office put it so nicely? „Germany is committed – to multilateral solutions instead of vaccine nationalism“.9 Meaning the reality certainly can’t be that bad, can it? In the paragraph under this heading it says „[Germany] advocates for a fair, transparent and affordable access to Covid 19 vaccines, medicines and diagnostics worldwide in all international bodies.“ Maybe the German WTO delegation and our Chancellor should be informed of that statement, surely they just didn’t read it yet. After all, they have a lot to do with self-portrayal all day long; something as substantive as this can sometimes get lost; it’s not a shame.

What we are left with

So the fact that at least an imperfect COVAX was agreed upon in the initial shock of the pandemic remains our only consolation. It is a sad truth that without COVAX, some countries would still have received fewer or no vaccines at all. The initiative has even been able to deliver to areas of violent conflict such as Libya and Syria. But the results are unfortunately far from the initial euphoria and rhetoric about global solidarity and fairness. In the meantime, it has even had to lower its delivery forecasts by 190 million doses,15 as India, the main supplier, is currently exporting less itself for understandable reasons and the USA has also long imposed an export ban on critical commodities.10
  • The first injections were administered in Germany on 27.12.2020. The first COVAX jab did not enter an arm until 01.03.2021, 9 weeks later.11
  • COVAX only signed a contract with Pfizer/BioNTech in January. It provides for the supply of 40 million doses, which is only 3% of the planned 2021 production.12
  • At the time I am writing this post (02.06.2021), Germany, as a single country, was administering about 51.5 million jabs,13 COVAX was allowed to deliver just 77 million to 127 participating countries.14 By June, it was probably going to be 330 million doses to 145 countries (at least according to original plans). Even that would only have been enough to vaccinate 3.3% of the recipient populations.12 By that time, Germany will have lifted vaccine prioritisation and people like me, who are not at increased risk, will already be getting their second jab. In most countries around the world, not even essential health workers will be fully protected by the same date.
  • Because our states have been so incredibly selfish, solidarity is being re-shouldered onto the population: for a donation of 6 euros on gogiveone you can buy a single vaccine dose for the COVAX initiative. This definitely helps, but in the end these funds go to pharmaceutical companies who, without the blocking attitude of the industrialised nations, would no longer have any right at all to take the lives of the poorest on our planet hostage for their profit.

Solidarity can perhaps only be shown by those who have power. Maintaining the power imbalance was and is an active decision of the industrialised nations by not supporting the waiver.
The current circumstances in India, Southeast Asia and South America are hardly the result of the rejection of the waiver. But one can state that every aid mission now brings in symbolic solidarity capital to the governments of said countries, based on a gap in ability to industrially fight pandemics through the availability of medical products, which the waiver wanted to equalise. Similar capital should be brought in by the COVAX initiative, if it were to work. These handouts would not have been so profitable for the upcoming elections if the entire capacity of the world was really used to fight this pandemic. For as hard as it seems to be for some to believe, these capacities also exist outside Europe and the USA.

So the next time you hear someone talking about how the EU has bought too few vaccines and how Germany is vaccinating terribly slowly, please draw the attention of the person you are talking to to these circumstances. As has been the case for a long time, our welfare means the suffering of others. Because true solidarity would also have required sacrifice.

Author:
Marian

Sources

  1. deutschland.de: Covax – eine Initiative für alle (11.03.2021), retrieved from https://www.deutschland.de/de/topic/politik/deutschland-unterstuetzt-covax-2-milliarden-euro-fuer-impfstoff. Last accessed on 25.05.
  2. e.g. press conference 19.2.2021, retrieved from https://www.bundesregierung.de/breg-de/themen/buerokratieabbau/pressekonferenz-von-kanzlerin-merkel-nach-der-g7-videokonferenz-1860056. Last accessed on 28.04.
  3. WHO: The Access to COVID-19 Tools (ACT) Accelerator (2020), retrieved from https://www.who.int/initiatives/act-accelerator. Last accessed on 28.04.
  4. Gavi: COVAX explained, abgerufen unter https://www.gavi.org/vaccineswork/covax-explained. Last accessed on 28.04.
  5. ZDF: Spahn: 30 bis 40 Prozent sind Risikogruppe (09.11.2020), retrieved from https://www.zdf.de/nachrichten/politik/coronavirus-spahn-risikogruppen-100.html. Last accessed on 28.04.
  6. ONE: Wie steht es um die globale Verteilung der COVID-19-Impfstoffe? (02.03.2021), retrieved from https://www.one.org/de/blog/verteilung-covid-19-impfstoffe/. Last accessed on 28.04.
  7. WTO: Council for Trade-Related Aspects of Intellectual Property Right, IP/C/W/669, retrieved from https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W669.pdf&Open=True. Last accessed on 28.04.
  8. WTO: TRIPS — Trade-Related Aspects of Intellectual Property Rights, retrieved from https://www.wto.org/english/tratop_e/trips_e/trips_e.htm. Last accessed on 28.04.
  9. German Federal Foreign Office: Corona gemeinsam und solidarisch bekämpfen: Deutschland unterstützt weltweite Pandemie­bekämpfung mit weiteren 1,5 Mrd. EUR (19.02.2021), abgerufen unter  retrieved from https://www.auswaertiges-amt.de/de/aussenpolitik/themen/gesundheit/covax/2395748. Last accessed on 25.05.
  10. Wall Street Journal: Why Covid-19 Vaccination in Poorer Nations Has Slowed, Posing Global Risks (19.04.2021), retrieved from https://www.wsj.com/articles/why-covid-19-vaccination-in-poorer-nations-has-slowed-posing-global-risks-11618826934. Last accessed on 28.04.
  11. TIME: The First COVID-19 Vaccines Shipped Through COVAX Were Administered in the Ivory Coast (01.03.2021), retrieved from https://time.com/5942715/ivory-coast-covax-first-shots/. Last accessed on 28.04.
  12. euronews: Was ist COVAX und hilft es armen Ländern an Corona-Impfstoffe zu kommen? (26.02.2021), retrieved from https://de.euronews.com/2021/02/26/was-ist-covax-und-hilft-es-armen-landern-an-corona-impfstoffe-zu-kommen. Last accessed on 28.04.
  13. RKI: Tabelle mit gemeldeten Impfungen bundesweit, data status 02.06. 8:00 o’clock, retrieved from https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Daten/Impfquotenmonitoring.html. Last accessed on 02.06.
  14. Gavi: COVAX vaccine roll-out, Dashboard data status 02.06., retrieved from https://www.gavi.org/covax-vaccine-roll-out. Last accessed on 02.06.
  15. UNICEF: The COVAX Facility will deliver its 65 millionth vaccine dose this week. It should’ve been at least its 170 millionth. The time to donate excess doses is now (17.05.2021), retrieved from https://www.unicef.org/supply/press-releases/covax-facility-will-deliver-its-65-millionth-vaccine-dose-week-it-shouldve-been. Last accessed on 25.05.

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