While rich countries are struggling to vaccinate their own populations as quickly as possible and are fighting over global distribution, people in the developing world face the prospect that Covid-19 vaccinations may still be years away. The Biden administration must take immediate steps to fix this problem and bring the pandemic under control while gaining a moral and diplomatic victory, or it will face a presidential term defined by a pandemic that will not end.
As of November 2020, 14 percent of the world's population had bought up more than 50 percent of promised vaccine doses. By one best-case scenario, just 40 percent of doses might be left for the rest of the world at the end of 2021. This assumes rich countries don't increase orders and that all of the vaccine production candidates are actually approved.
This clearly inadequate supply raises the obvious question: Why isn't the developed world, especially the United States, doing more to help developing countries increase vaccine manufacturing capacity? Until everyone is safe, the United States is not safe, particularly in light of frightening mutations that may impact the effectiveness of current vaccines or increase the percentage of people needing to be vaccinated to reach herd immunity.
Many experts reasonably predicted that a vaccine would take at least 18 months to develop. That the timeline has proved to be shorter is due in large part to the more than $12 billion US taxpayer plan that sped vaccine development. Unfortunately, no requirements were put in place for public returns on this massive public investment—government agreements with manufacturers did not include provisions such as price ceilings or clauses to ensure equitable access around the globe.
Helping developing countries expand vaccine manufacturing capacity and access existing capacity are key areas where the Biden administration can assume a leadership role and are particularly important given the United States' current tattered global reputation. And US taxpayer investments give President Joe Biden incredible leverage.
For example, one of the taxpayer-funded vaccines uses new messenger RNA technology that will simplify production compared to traditional vaccines and make future needed changes to the vaccine easier to carry out. This vaccine, co-developed by Moderna and US government scientists, provides 95 percent effectiveness in blocking Covid-19 symptoms. US taxpayers (along with a small but important contribution from the musician Dolly Parton) funded nearly all of the $2.5 billion in development costs with heavy involvement from the National Institutes of Health. While the shot has come to be referred to as the "Moderna vaccine," it should rightly be known as the "NIH vaccine." And while pressure on Moderna has led to a pledge that it will not enforce patents around the globe during the pandemic, the pledge falls short of enabling middle- and low-income countries to manufacture the vaccine, as they would also need the "recipe," generally called the "know-how," to make use of the patents.
Many countries with fewer resources, particularly in Africa and Asia, have done remarkably well in their response—often due to years of collaboration with the US Centers for Disease Control and Prevention, which prepared them to address outbreaks even if the United States did not follow those prescriptions itself. After the United States had one of the worst responses in the world in terms of per capita infections and deaths, the Biden administration should proceed with humility, listening carefully to how developing countries have achieved success and what they are asking for in terms of assistance.
Many of these countries have signed on to COVAX, a World Health Organization-backed mechanism intended to ensure that even countries without purchase agreements can access vaccines and that offers subsidized prices for 92 developing countries. While the Biden administration has now joined COVAX, the effort is billions of dollars short of what it needs to provide vaccine doses in 2021. And even if fully funded, COVAX is not enough: Even in the best-case scenario, it will provide only 20 percent of needed doses, and it does not address the needs of upper-middle-income countries that face a huge disease burden and inadequate resources to vaccinate on their own. On top of this, there is a high chance that COVAX could fail, as noted by its own board, which would mean many people in developing countries might not even see a vaccine until 2024 at the earliest.
Increased support for COVAX is necessary, but additional measures are needed for developing countries to take on manufacturing themselves to reach the remaining 80 percent of their populations, specifically to provide vaccines and essentials such as treatments, diagnostics, and other medical countermeasures.
To address additional barriers to access, some countries have launched efforts beyond COVAX. South Africa and India, supported by Bolivia, Kenya, Eswatini, Mongolia, Mozambique, Pakistan, and Venezuela, are asking for a waiver from World Trade Organization requirements on patent rules, known as TRIPS, for vaccines, medicine, and other technologies needed to combat Covid-19 for the duration of the pandemic. If the waiver is approved, it would allow much greater flexibility in manufacturing patented inventions to fight the coronavirus.
Shockingly, the United States and European Union have stretched debate on the request for months, leaving developing countries out to dry while the Covid-19 death toll continues to climb, wasting precious time during which countries could be quickly building up manufacturing capacity to address the pandemic. The Biden administration must rapidly support the TRIPS waiver so countries that have been left to fend for themselves can quickly move to manufacture technologies to save their people. Such a move will also help countries better prepare themselves for future outbreaks by reducing reliance on rich-world manufacturers.
Unfortunately, even with a complete waiver of WTO-enforced intellectual property (IP) rights, more support is needed to expand vaccine production capacity. WHO's Covid-19 Technology Access Pool (C-TAP) is a final critical, complementary element. The aim of C-TAP is to collect intellectual property rights for technologies needed to fight Covid-19 to allow increased manufacturing, particularly in developing countries, and thus ensure adequate supplies for the entire globe. Critically, C-TAP aims to enable the proactive technology transfer of know-how—the recipe—and other IP, above and beyond patents, that will be needed to enable manufacturers to produce vaccines. To date, 40 countries, primarily from the global south, have signed on, but C-TAP is not fully operational due to a lack of political backing, funding, and participation from patent holders and vaccine manufacturers.
The Medicines Patent Pool (MPP) is one of the C-TAP partners, and it has a successful history of dramatically increasing production and lowering prices of medicines for HIV, tuberculosis, hepatitis C, and other maladies in developing countries using a model analogous to C-TAP. In its earliest days, the MPP was in a similarly precarious position. Fortunately, the Obama administration stepped forward to put US-owned patents into the pool while encouraging drug companies to work with MPP to improve access to their medicines in developing countries.
This early support from the United States was critical for the MPP's eventual success, saving billions of dollars while expanding access to treatments. The incoming Biden administration must champion C-TAP by putting the political heft of the US government behind the effort. It can commit the IP of vaccine technologies developed with US taxpayer dollars to the effort and push the heavily taxpayer-funded vaccine manufacturers to participate. Anthony Fauci, the United States' top infectious disease doctor, has already come out in support of this.
The success of C-TAP would mean a dramatic increase in global vaccine production capacity and create a level of autonomy for developing countries to address the outbreak and ongoing post-pandemic Covid-19 vaccination needs.
Unfortunately, the situation we find ourselves in is eerily similar to the AIDS crisis. Rich countries fought the pleas of the poor by forcing developing countries to respect "the rules" of international trade and protect pharmaceutical company profits while millions died. That happened even though the profits to be made in developing countries were minute since the population simply couldn't afford the drugs, many similarly developed with the support of US taxpayers. As the global economy faces trillions of dollars in losses and people are forced to stay home, are forced out of work, and are forced to be apart from dying loved ones, US leaders must recognize that maintaining the status quo benefits no one but pharmaceutical companies.
Many developing countries have responded with valor and efficacy to the pandemic while the West failed—but Western wealth and power have nevertheless given countries like the United States control of the final pieces to defeat the pandemic. The Biden administration has a golden opportunity to repair the country's reputation globally and meet the real needs of developing nations. Without action, the Biden presidency will be defined by Covid-19 and the economic and human ruin it will continue to create. With effective action, Biden's team will be a key player in bringing the pandemic under control and saving lives while rebuilding the United States' global standing.