Chart of the Week: Triaging the Global Vaccination Effort

By Samantha Igo

As of late 2021, nearly 60 percent of the United States has been fully vaccinated against COVID-19, with similar levels of inoculation across the European Union and other wealthy nations. In stark contrast, just 5 percent of people across all low-income countries have received at least one dose of a COVID-19 vaccine.

Amid this disparity in global vaccination, trade ministers and other senior officials were set to convene this week in Geneva, Switzerland for the 12^th World Trade Organization (WTO) Ministerial Conference (MC12), where discussions on waiving intellectual property rights for the COVID-19 vaccine were highly anticipated. However, the discovery of the new COVID-19 Omicron variant led WTO officials to indefinitely postpone the conference –the second time it has been delayed due to the pandemic.

Decisive action is needed to ramp up global vaccination, but as a recent policy brief from the Boston University Global Development Policy Center underscores, a focus on distribution alone eludes a deeper problem: the world is simply not making enough vaccines.

This Chart of the Week, featuring Figure 1 from the policy brief, explains how meeting the global vaccination challenge will require attention to three distinct pillars of vaccine equity, all of which must be advanced simultaneously:

A comprehensive TRIPS waiver

In October 2020, South Africa and India drafted a proposal for waiving certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) at the WTO. Advocates argue traditional intellectual property protection shouldn’t matter in a global pandemic, particularly when every vaccine candidate benefited from varying degrees of public investment in their development. This proposal now has the backing of nearly every WTO member, including the US, though the European Union, the United Kingdom, Switzerland, Singapore and Norway have not supported the waiver to date.

The EU has put forward their own proposal that seeks to clarify and expand rules around compulsory licensing, arguing that this approach would provide the necessary policy space to address patent obstacles. However, these licenses must be issued on a case-by-case, patent-by-patent basis. Not only could this obstruct coordination across jurisdictions, but it would also result in a complex network of licenses around every aspect of the vaccine and its production – all but ensuring the process could not expediently increase vaccination rates worldwide.

While gaining support from a wide array of members is a huge success, there must still be a consensus needed to secure the waiver. Negotiating a comprehensive text remains a crucial step to combatting vast vaccine inequity, as well as ensuring that all COVID-19-related products are widely available. A broader waiver that includes such products, as well as vaccines, would free producers in developing countries from fear of patent infringement lawsuits, provide the opportunity for accelerating production and offer better care to patients around the world.

Technology transfer

However, lifting intellectual property rights from vaccines and COVID-19 products alone would not automatically ramp up production around the world. To make the best use of an expansive TRIPS waiver, vaccine originators need to actively engage in technology transfer, granting licenses with a global scope to all relevant knowledge and equipment needed for product manufacturing.

With a record number of successful, relatively cheap and fast technology transfers already undertaken during the pandemic, the mRNA technology of the COVID-19 vaccine is a particularly suitable candidate. Despite criticism from pharmaceutical companies that building up capacity is too difficult, the WHO have identified 19 manufacturers from more than a dozen countries in Africa, Asia and Latin America that have expressed interest in ramping up mRNA vaccine production, but lack access to the technology. Many of these firms are in countries that are severely under-vaccinated, such as Vietnam and Bangladesh, where additional facilities could help resolve local and regional vaccine equity.

Robust financing

The third component to a global vaccination strategy that can make sure a TRIPS waiver and technology transfer lead to increased production is financing. Robust financing is needed to support the necessary technology transfer, production and distribution. Oxfam estimates vaccine monopolies have made the global vaccination effort at least five times more expensive than it could be if products were sold at cost price and have kept global vaccine access out of reach. Should the international community continue on this path, the International Chamber of Commerce estimates it could cost the global economy $9.2 trillion.

In contrast, Public Citizen estimates it would cost $23 billion to upgrade facilities and produce 8 billion additional doses by the summer of 2022 – enough to vaccinate 80 percent of the people in low- and middle-income countries.

Rapid investment in upgrading and retrofitting available facilities for production with the help of a TRIPS waiver and technology transfer would not only be a globally transformative strategy, but also financially sound compared with the alternative.

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While there are no simple solutions for ending the pandemic, there are routes to immediately alleviate it. Alone, none of these initiatives would be sufficient to meet the needs of the moment, a comprehensive approach that advances on all three fronts could transform the outlook for vaccine equity for a drastically different 2022.