Addressing Vaccine Inequality in the Commonwealth: An Interview With Key Experts in the Field

Published 07 June 2021

One priority of the G7 summit, taking place on 11-13 June 2021, is “leading global recovery from the coronavirus while strengthening resilience against future pandemics”. However, whilst some countries in the Commonwealth are beginning to think about recovery from COVID-19, others are still in the depths of deadly waves of infection. In turn, there have been growing calls for greater global collaboration in the form of sharing COVID-19 vaccines, treatments, and diagnostics. Two Commonwealth countries and guests to this year’s G7, India and South Africa, have proposed a temporary waiver of a range of intellectual property (IP) under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement of the World Trade Organisation (WTO). Other G7 countries, including the UK, have argued that there are more time efficient ways to meet the urgent need for vaccines and treatments, through donations and increasing global manufacturing capacity.

In this article, CPA UK interviewed four experts on vaccines, IP, and global health to share knowledge and expertise on the most effective and efficient way to achieve global vaccination. As Commonwealth parliamentarians, you will find information and practical guidance on what you can do ahead of and following the G7 to build global solidarity.  

Context of Vaccine Inequality 

Professor Andrew Pollard, Director of the Oxford Vaccine Group, explained the immense scientific achievement of the development of the COVID- 19 vaccines: at this current moment we have good evidence that vaccines are effective in providing protection. When the global scientific community began to embark on creating a vaccine, Professor Pollard described that the aim was to save lives by preventing people from dying and saving healthcare systems from collapsing. It is a huge achievement that one year on this is beginning to be achieved in certain countries, with the UK reporting 0 daily COVID deaths on the 1 June 2021. However, whilst in the UK 70% of the adult population is vaccinated, there is vast inequality across the Commonwealth, with some countries being unable to access vaccines for their vulnerable, elderly, or healthcare workers.  

The inequality in access to COVID-19 vaccines and treatments has a wide range of impacts for every region of the Commonwealth. Ms Leena Menghaney, South Asia Head at the Médecins Sans Frontières (MSF) Access Campaign, explained that the global inequality in access to COVID-19 vaccines, diagnostics, and treatments are resulting in deadly infection waves in hot spots and conflict zones. The most marginalised people are those who cannot socially distance, the homeless, refugees, and people living with HIV/ AIDs and TB. The elderly and health care workers have no access to vaccines or treatments in many developing countries. In these areas where health care systems have limited to no oxygen or intensive care units, the inequality means that we “are going to lose people who would otherwise be hospitalised”.  

Professor Pollard signposted the data from the Institute for Health Metrics and Evaluation, which has predicted 9 million COVID-19 deaths globally by September 2021. This preventable loss of life was compared with “the same mistake we made with HIV/AIDs” by Dr Philippa Whitford, UK Member of Parliament and Chair of the All-Party Parliamentary Group on Vaccinations for All.  

Countries within the Commonwealth with a high rate of vaccination also face risks from vaccine inequality, such as the emergence of variants. Professor Pollard explained that new variants arise wherever the virus is spreading. As we do not currently have sufficient vaccine supply to stop the virus from spreading, he argued that it is simplistic to say that “if only we had given more vaccine to other countries, we wouldn’t have variants”.  

It is true, however, that in the medium term having more people vaccinated globally will reduce the spread and reduce the risk of variants. Overall, Dr Whitford argued that “the failure to take a global view will mean the pandemic will continue for several years longer than would have been otherwise if we had taken a real international response to it”. This will in turn have an inevitable impact on the international economy. Dr Whitford proposed that failure to control the spread of the pandemic globally will result in disruption to export and import supply chains from Low-and Middle-Income Countries (LMICs). Finally, from a security perspective, this inequality in global health has the potential to spark unrest between communities with high and low levels of vaccination.  

There are multiple intersecting reasons as to why global vaccine inequality is currently so stark. Professor Pollard explained that the scientific complexity of creating and developing vaccines does play a role as it “takes time to create a product which is reproducible and safe at scale”. The sharing of these complex molecules then currently faces two key bottlenecks: constrained supply in the short to medium term matched with a failure of distribution of doses to those in greatest need, and in the longer term, IP protection and technology transfer of manufacturing capability. Ms Menghaney explained that developing countries do not have access to the vaccines produced in advanced economies as they do not have sufficient finance to do advance purchases.  

Overall, there has been a shift away from the initial objective of vaccines, to protect health care systems and reduce deaths to COVID-19, to a focus on national resilience. There is a possibility that this inequality will continue to get worse. In the instance that vaccines are developed for new variants or boosters, Professor Pollard expressed his concern that current manufacturing capacity will next be used for 3rd doses, reducing the number of first doses available even further for LMICs. 

Potential Solutions to Vaccine Inequality 

Two Commonwealth countries, India and South Africa, have spearheaded a proposal to the WTO to waive patent protections on the COVID-19 vaccine, as well as all intellectual property on treatments, preventions, and vaccines. A waiver of intellectual property and facilitation of technology transfer to developing countries could enable an increase in the manufacturing capacity of LMICs. Dr Siva Thambisetty, Associate Professor of Law at the London School of Economics, said that a temporary waiver on all kinds of IP, not just patents, would enable governments to intervene to mandate the disclosure of manufacturing and technical know-how, trade secrets and other kinds of undisclosed information, enabling technology transfer. She stressed that the IP waiver is not just about a technicality, but part of a wider reimagining of legal and political levers that are needed to generate opportunities for collaboration based on good will. 

A spokesperson for the UK government has told The Guardian that “we are engaging with the US and other WTO members constructively on the TRIPs waiver issue, but we need to act now to expand production and distribution worldwide”.[1] Professor Pollard stressed that a larger challenge to this expansion of production than the IP waiver is the transfer of technology and expertise to third-party manufacturing sites, to ensure efficient upscaling and the quality of the final product. He shared a key example of how this is already taking place: the Oxford AstraZeneca not-for-profit agreement, which has partnered with more 20 manufacturing sites around the world to increase production. Dr Thambisetty proposed that the temporary waiver on IP would enable governments to intervene to mandate the disclosure of manufacturing knowledge, making these partnerships more commonplace.

Ms Menghaney also argued that one of the biggest challenges is the lack of transparency on the agreements that institutions like Oxford have entered into with pharmaceutical corporations and their ability to determine who can produce the vaccine. She called for these agreements to be made public for scrutiny. In turn, as asserted by Dr Thambisetty, Commonwealth countries such as India, Bangladesh, and many countries in Africa have manufacturing capacity which could be better utilised. This would improve manufacturing and productive capacity of developing countries and increase resilience to deal with this and future pandemics. She emphasised that countries that are helped to generate productive capacity now can be expected over time, to improve their ability to innovate and participate in the global knowledge- economy, a key element of the overall bargain of the TRIPS agreement. 

Critics of the waiver argue that it could result in a reduction in quality, safety, and efficacy of vaccines, as well as reduce capital investment in innovation. In response, Dr Whitford highlighted that vaccines had been funded nearly entirely by public money, and that all vaccines given to the public required intense checks by the World Health Organisation (WHO) for safety.  

Removing the barriers to production through an intellectual property waiver and transfer of technology and expertise could provide a solution in the medium to long term. Professor Pollard, however, stressed that this would take a minimum of six months to achieve. Therefore, what is required in this current moment is an urgent redistribution of vaccine supply from stockpiles to those countries which need them today. Professor Pollard deemed it “morally wrong” to extend vaccine programmes to children in some Commonwealth countries, with a risk close to zero of going to hospital once infected, whilst other countries do not have sufficient vaccines for high-risk older adults and healthcare workers.  

The UK government have recently called on the G7 to vaccinate the world by the end of 2022. This could be possible by the donation of vaccine doses through the COVID-19 Vaccines Global Access Facility (COVAX). The UK have stated that they have provided a significant financial contribution of £548 million to COVAX, making it one of the largest donors. Oxford-AstraZeneca doses have also made up 96% of the 80 million doses donated to COVAX. [2]

Whilst Dr Thambisetty, accepted that COVAX is fulfilling an “immediate need”, she held “grave misgivings about relying on solely on philanthropy to overcome a crisis of this nature”. For Dr Thambisetty, the need for COVAX is an “devastating indictment” of the fact that more than 25 years after the TRIPS agreement, advanced economies have not partnered with developing countries to help improve innovative and productive capacity for vaccines and medicines. Ms Menghaney shared these concerns, reiterating that most countries “do not want charity” but the “capacity to produce their own vaccines”. Further, she stressed that the donation promises made to COVAX are currently only to be fulfilled after donor countries’ populations have been fully vaccinated. These donations will therefore currently come too late, at the end of 2021- 2022, and in insufficient quantity.  

All the interviewees were in mutual agreement that these solutions should be pursued simultaneously. Global vaccination will require a combination of intellectual property sharing, an increase of manufacturing capacity in developing countries, and a redistribution of vaccines for lives to be saved. Dr Whitford summarised this dual approach: to redistribute doses right now to vaccinate the 20% most vulnerable, whilst increasing the world’s vaccine production capacity overall.

 

[1] https://www.theguardian.com/global-development/2021/may/20/britain-in-talks-to-waive-covid-vaccine-patents-to-improve-global-access-to-jabs

[2] https://www.g7uk.org/prime-minister-calls-on-g7-leaders-to-vaccinate-the-world-by-end-of-next-year/

What Commonwealth Parliamentarians Can Do 

  1. Advocate for global equality in access to COVID-19 vaccines via the above suggest solutions ahead of the G7.   
  2. Produce a Commonwealth parliamentarian resolution, similar to the Commonwealth Health Ministers Statement. 
  3. Make the case to the public for global vaccination of the vulnerable to build support.  
  4. Use opportunities to establish regional collaboration as an antidote to vaccine nationalism. Research and survey the productive capacity for vaccines that exist regionally and work with the WHO to develop manufacturing capabilities.  
  5. Work across parties to gain government support to a more globally equitable approach. Parliamentarians can also work within parliamentary groupings, such as the UK APPG on Vaccines for All.  
  6. Establish robust parliamentary mechanisms for receiving scientific advice. One example is the UK Joint Committee on Vaccines and Immunisation, an independent committee which gives the government advice on how to best use the vaccines that are available. The WHO has recommended that all countries adopt a similar system.  
  7. Support and invest in global health organisations, particularly the WHO, COVAX, and GAVI. Professor Pollard argues that, “a vacuum comes out of lack of global recognition of international institutions, and the result is national immunisation”.  
  8. Support and invest in independent scientific research and advice.  
  9. Be an advocate for vaccines in your community. Dr Whitford shared the case study of Scotland, where there was low uptake of vaccines in care homes due to vaccine misinformation. This was tackled by offering vaccines to care home staff at the same times as residents to build solidarity; and running a Q&A on vaccine with experts to challenge misinformation with data on the effectiveness of vaccines in reducing deaths.  
  10. Ask for transparency in current vaccine manufacturing partnerships to open them up to scrutiny.

Andrew Pollard is Professor of Paediatric Infection and Immunity at the University of Oxford and Honorary Consultant Paediatrician at Oxford Children’s Hospital. He chairs the UK Department of Health and Social Care’s Joint Committee on Vaccination and Immunisation and the European Medicines Agency scientific advisory group on vaccines and is a member of WHO’s SAGE. He is the Director of the Oxford Vaccine Group and the Chief Investigator on the University of Oxford COVID-19 Vaccine trails.  

Ms Leena Menghaney is the South-Asia Head for Médecins Sans Frontières’ Access Campaign. She is a lawyer with a focus on public health, intellectual property and access to treatment. Leena works with the Indian government and civil society to analyse policies and laws related to access to essential medicines and diagnostics, drug pricing and competition in pharmaceuticals.   

Dr Philippa Whitford is a Member of Parliament for Central Ayrshire, Scotland, and Health spokesperson of the Scottish National Party in the UK House of Commons. Dr Whitford is Chair of the All-Party Parliamentary Group on Vaccinations for All which works to raise the political profile of the importance of vaccinations around the world and within the UK.  

Dr Siva Thambisetty is an Associate Professor of Intellectual Property Law at the London School of Economics, where she researches and teaches comparative international patent law with a particular focus on emerging technologies, including biotechnology. She holds a BCL and DPhil from the University of Oxford and completed her BA:LLB (Hons) at the National Law School of India. She has recently published a paper in support of the TRIPS intellectual property waiver proposal. 

Useful links: