Assuring Global Equitable Access to COVID-19 Vaccines
Recently, the whole world has been engaged in a vaccine race, in the hopes of finally putting an end to the chapter of COVID-19 and become completely free from the norms of social distancing. However, because of the dire nature of the issue, it is inevitable to some extent that the scientific and technical aspects of the vaccine race will be overwhelmed by political and economic factors.
Nevertheless, it is essential for everyone to have access to a properly functioning vaccine, especially the elderly and the vulnerable, irrespective of their socio-economic status. In this article, I address the steps that can be taken to ensure universal access and the potential problems that this race could lead to.
- Prevent Vaccine Monopolization by Companies through Patents
It is reasonable to expect that the company that finds the vaccine first will seek a patent to protect its findings. A patent is a legal instrument that gives its holder the right to exclude others from manufacturing and selling a protected invention for a certain period of time. The patent holder could eliminate competition and set its desired prices, thereby curbing access and creating a public health issue.
Adding to the issue, Pharm-Tech companies in the past have indulged in an unethical process called ‘evergreening’, where the lifetime of a patent is extended after continuously making minor modifications to the invention. Such practices are said to have limited the accessibility to HIV-drugs in low and middle-income countries and even improved HIV drug resistance. Fortunately, there are legal provisions in many countries to override this exclusivity of patents, although at the same time the government must make sure to reward the vaccine finders in other ways.
Compulsory licenses can be issued by the government, which would allow other companies to produce the vaccine without the permission of the patent holder and thus, put an end to a potential monopoly. On the other hand, they should provide some kind of an incentive to compensate for this arrangement, such as a cash award.
2. Build An Efficient Global Distribution System
As of now, only 5 countries: India, the USA, UK, Russia, and China, are leading the vaccine race even though the pandemic has affected more than 200 countries. How the vaccine can be distributed from these countries once their domestic needs are met, is a big question.
The World Health Organization(WHO), partnered with GAVI, a public-private partnership aimed at increasing global access to immunization, had launched COVAX, a global initiative to ensure equal access to vaccines across the world. As part of the collaboration, 156 countries, out of which 79 are higher income, have agreed to support 92 lower-income countries such as Sudan, Philippines, that otherwise wouldn’t be able to afford the vaccines. In its Fair Allocation Framework, WHO plans to distribute through 2 phases. In the first, all countries would receive vaccines to cover 20% of their respective populations. This should be sufficient to immunize the vulnerable groups such as the elderly and the front-line health workers. The second phase of distribution would then consider country-specific factors such as the rate of disease spread, the vulnerability of health systems, etc..
Experts have critiqued that the vaccine should be given to countries that need it the most in the first phase itself, but the WHO, understandably, must have taken such a balanced approach to ensure adequate participation from member nations. There is also the risk of more powerful nations shying away from their global commitments by hoarding vaccines and restricting their supply to COVAX.
All in all, it needs to be understood that global distribution is not merely a charitable cause. In today’s connected world, where countries are highly dependent on each other for their economies, even if a country deals with domestic cases it would still be a prisoner within its own borders.
Fortunately, even amidst fears of ‘vaccine nationalism’, countries like India and South Africa have proposed the WTO to waive intellectual property rights on the vaccines and other technology related to COVID-19.
3. Keep Expectations Real and Compensate People for Vaccine Injuries
With everyone banking on the vaccine to be a panacea for all problems, it is important to keep the expectations in check. Although Oxford and Pfizer vaccines have advanced to phase 3 of clinical trials and showed positive results in all adult groups with minimal side effects, immunologists believe that the vaccine may only give temporary immunity, given that there have been cases of reinfection similar to the flu. Scientists are hoping for a vaccine with 75% efficiency, even though they may have to settle for a 50 or 60 % efficiency. Then there are always risks of viral mutations reducing the vaccine efficiency. Masks and social distancing norms will still be required to bring down the infection rates.
Vaccine makers such as Aztrazenca have been asking for legal protection and exemption from liabilities should the speedily developed vaccines have adverse effects on people. Most countries would be hesitant to provide such no-fault compensation schemes, firstly because it goes against manufacturing ethics, and secondly, due to the financial inability to cope with compensation claims from vaccine injuries, which is especially true for low and middle-income nations.
The WHO is currently planning an insurance scheme for the aforementioned 92 low-income countries, bearing in mind past events, such as the delay in the distribution of H1N1 swine flu vaccines a decade ago in many such countries due to the absence of clear liability. In the past, they have had such schemes for emergency situations that require recipient nations to indemnify the WHO, manufacturers, and health care workers in order to obtain compensation funds, but never to such a global scale as required now.
In building this maiden system that processes claims from all over the world, COVAX would definitely need the help of participant nations in maintaining post-market vigilance of adverse effects.
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