It was heartwarming to see 90-year-old Briton Margaret Keenan becoming the first patient in the world to get the SARS-CoV2 vaccine in early December.
But there was a bitter sense of deja vu for many watching on television from Africa. Those of us who lived through the HIV pandemic of the 1980s and 1990s recalled the time when life-saving antiretroviral medicine was available in Western countries yet unaffordable for us. We knew that people we loved would die as a result.
Last week, a UK initiative called Arm-in-Arm was launched to encourage people who have been vaccinated against COVID-19 to donate to the WHO COVID-19 Solidarity Fund to help pay for vaccines for people in poorer countries. It is supported by the universities of East Anglia and Essex, as well as Sarah Gilbert, the co-creator of the Oxford/AstraZeneca vaccine.
Acts of solidarity involving ordinary people, particularly between the Global North and South, are always important, morally and psychologically. During the height of the worldwide struggle for access to effective HIV drugs, HIV-positive people in the north donated their medicines to those in the south. Activists, sympathetic flight attendants, and many others helped to smuggle these donated drugs to those who couldn’t afford them, and this undoubtedly saved lives.
But while people living with HIV in the US and Europe could get access to antiretroviral drugs from 1996, it took another ten years before these life-saving medicines were widely available in Africa.
The most fundamental stumbling block to vaccine access is that private pharmaceutical companies, motivated by profit, are in control, and rich countries are enabling them.
At times last year, it looked as if global solidarity against COVID-19 was possible. The World Health Organization (WHO), together with the vaccine alliance GAVI and the Coalition for Epidemic Preparedness, set up the COVAX Facility to “accelerate the development and manufacture of COVID-19 vaccines, and guarantee fair and equitable access for every country in the world”.
Why cash for COVAX won’t solve the problem
COVAX aims to vaccinate 20% of people in low- and middle-income countries by the end of 2021 – a modest ambition, to UK ears. Late last week, COVAX was boosted by additional donations from the US, UK and European Union. But COVAX and the low-income countries that depend on it are still on the back foot. Despite wealthy countries’ apparent support for COVAX, most have raced to clinch bilateral deals with pharmaceutical companies, “pre-ordering” vaccines even before efficacy trials had been completed – and there is a global shortage of vaccine stock.
The WHO director-general, Dr Tedros Adhanom Ghebreyesus, told the body’s recent executive board that 44 bilateral deals had been done in 2020 and a further 12 this year. Canada, for example, has pre-ordered nine doses per citizen. The US has pre-ordered 7.3 doses per citizen and the UK 5.7.
“Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue. This is wrong,” said Tedros.
Most manufacturers, Tedros said, have prioritised regulatory approval in rich countries where the profits are highest, rather than submitting full dossiers to WHO to get emergency use listing approval. COVAX requires this approval before it can allocate vaccines to countries that need them.
Tedros slammed the fact that young people in wealthy countries were being vaccinated before vulnerable groups, including the elderly and health workers, in poorer countries.