Global vaccine inequity reflects deeper issues within our market-driven global health system that fixates on innovation, intellectual property and the individual good as the solution, argues Tahir Amin. To end COVID-19 and achieve real progress, we need to incentivize the collective good instead of clinging to the current system, which only fuels divisions.
The development of COVID-19 vaccines by the end of 2020 was nothing less than a triumph of science and innovation. Even with the record levels of public funding that have gone into developing COVID-19 vaccines, there is a view held by many that this was only possible because of the incentives that the intellectual property (IP) system provides for private investment in research that makes commercialization of new technologies possible. Those who ascribe to this line of thinking believe that, without IP, we would not have seen this speed of progress and innovation (especially in the emergence of mRNA vaccines).
Yet, despite all the technology and innovation now at our disposal, we have a stark divide in global vaccination. Seventy-two per cent of vaccine shots worldwide have been administered in high and upper-middle income countries as of January 2022, and only one per cent have gone to low-income countries (https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html). This global divide is likely to continue as wealthy countries insist on hoarding supplies in the race to roll out third and, inevitably, fourth booster shots, or we all have to re-administer the next generation of vaccines to protect against Omicron and whatever variant of concern emerges next. As 2021 showed us, the longer vaccine inequity persists, the longer we will remain in this cycle of one step forward and two steps back.
The only way to break this cycle of inequity is to suspend the IP on the vaccines and COVID-19-related treatments, while also compelling pharmaceutical companies to share their know-how to allow other potential manufacturers to scale up supplies. Over a year has passed since South Africa and India submitted a proposal requesting a waiver of IP under the World Trade Organization’s international Agreement on Trade Related Aspects of Intellectual Property Rights (more commonly known as the TRIPS waiver). The proposal is now being cosponsored by more than 60 developing countries and supported by many more. However, the EU and wealthy countries — including the USA, UK and Germany — that have hoarded vaccines, and the pharmaceutical companies that control supplies and the knowledge to make them, have either not pushed hard enough to make the TRIPS waiver happen and share the vaccine technologies, or have stonewalled the suggestion outright.
Market enthusiasts, who are against waiving IP, have made a variety of arguments to justify their reasoning — while simultaneously moving the goalposts as it suits them to deflect any counterarguments and facts. One of the key arguments made by countries and pharmaceutical companies blocking the TRIPS waiver is that there are no other manufacturers in the world that can make the vaccines — in particular, the new mRNA versions. However, thanks to investigative journalism at the New York Times (https://www.nytimes.com/interactive/2021/10/22/science/developing-country-covid-vaccines.html) and extensive research by AccessIBSA and Medicines Sans Frontieres that identified over 100 potential manufactures in the Global South that can potentially make mRNA vaccine, this has been dispelled (https://www.hrw.org/news/2021/12/15/experts-identify-100-plus-firms-make-covid-19-mrna-vaccines).
The ultimate argument that underlies resistance to waiving IP is the belief that doing so will harm innovation and future progress because pharmaceutical companies will be disincentivized to invest in future drug research and development. Here lies the crux of the issue if we are to address not only vaccine inequity, but also future pandemics and crises such as climate change. Western capitalism, and the hyper-financialized version of it we live in today, believes that the IP system is the best way to drive innovation and progress, including economic. It is a Faustian bargain that the system has made, cultivating a culture and belief that innovation and technological progress alone will solve all our problems. Those defending this bargain believe the individual good that the IP system incentivizes will benefit the collective good.
This pandemic has clearly shown us that the current IP system does not benefit the collective good. It only focuses on resolving part of the problem — that of innovation and technological progress. It does not solve the individualistic behaviour of nation states, corporations and humans generally, in terms of being incentivized to serve the collective good, unless there is some power and financial gain to be had. That it has taken this pandemic to see this even when many people in some of the richest countries struggle to pay for their medicines daily shows why vaccine inequity is a symptom of a larger problem within our market-driven global health system.
No amount of innovation and technology will change our morals and selfishness, and we live in a world in which leaders refuse to address this challenge. The idea of rewiring ourselves to think about the collective good is usually met with a shrug that it is our human nature to be selfish. It is time our leaders incentivized the collective good to address this pandemic and other impending crises, rather than clinging to the current system that only serves a few and fuels division. By doing so we may realize that everyone can win and be safe, including the economy — which is what the defenders of the IP system and market enthusiasts care most about.
The cultural critic Neil Postman once said “there is no escaping from ourselves. The human dilemma is as it has always been, and we will solve nothing by cloaking ourselves in technological glory”. This quote captures the problem with our IP system, not only in this pandemic but also in other areas. Instead of just fixating on innovation and newer technologies, we also need to rewire ourselves so we use them for the collective good if we are to achieve real progress.
The author declares no competing interests.
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Amin, T. Innovation alone won’t end COVID-19. Nat Hum Behav 6, 172–173 (2022). https://doi.org/10.1038/s41562-022-01298-7
Nature Human Behaviour (2022)