End vaccine apartheid before millions more die

Anis Chowdhury and Jomo Kwame Sundaram

SYDNEY & KUALA LUMPUR: At least 85 poor countries will not have significant access to coronavirus vaccines before 2023. Unfortunately, a year’s delay will cause an estimated 2.5 million avoidable deaths in low and lower-middle income countries. As the World Health Organization (WHO) Director-General has put it, the world is at the brink of a catastrophic moral failure.

Vaccine apartheid

The EU, US, UK, Switzerland, Canada and their allies continue to block the developing country proposal to temporarily suspend the World Trade Organization (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement to enable greatly increased, affordable supplies of COVID-19 vaccines, drugs, tests and equipment.

Meanwhile, 6.4 billion of the 12.5 billion vaccine doses the main producers plan to produce in 2021 have already been pre-ordered, mostly by these countries, with 13% of the global population.

Thirty two European and other rich countries also have options to order more, while Australia and Canada have already secured supplies enough for five times their populations. Poor countries, often charged higher prices, simply cannot compete.

Big Pharma has also refused to join the voluntary knowledge sharing and patent pooling COVID-19 Technology Access Pool (C-TAP) initiative under WHO auspices. Thomas Cueni, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General, snubbed the launch, claiming he was “too busy”.

Pfizer’s CEO dismissed C-TAP as “nonsense” and “dangerous”, while the AstraZeneca CEO insisted, “IP is a fundamental part of our industry”. Such attitudes help explain some problems of alternative vaccine distribution arrangements such as COVAX. According to its own board, there is a high chance that COVAX could fail.

Suppressing vaccine access

Despite knowing that many developing countries have much idle capacity, Cueni falsely claims the waiver “would do nothing to expand access to vaccines or to boost global manufacturing capacity”, and would jeopardise innovation and vaccine research.

Big Pharma claims manufacturing vaccines via compulsory licensing or a TRIPS waiver “would undermine innovation and raise the risk of unsafe viruses”. US Big Pharma representatives wrote to President Biden earlier this month claiming likewise.

Both Salk and Sabin made their polio vaccine discoveries patent-free, while many contemporary vaccine researchers are against Big Pharma’s greedy conduct only rewarding IP holders regardless of the varied, but crucial contributions of others.

Big Pharma’s price gouging

Vaccine companies require contract prices be kept secret. In return for discounts, the EU agreed to keep prices confidential. Nonetheless, some negotiated prices were inadvertently revealed, with a UNICEF chart listing prices from various sources.

Reputedly the cheapest vaccine available, Oxford-Astra Zeneca’s is sold to EU members for around US$2 each. Although trials were done in South Africa, it still pays more than twice as much, while Uganda, even poorer, pays over four times as much!

US negotiated bulk prices, for Moderna and Pfizer-BioNTech vaccines, are much higher, at US$15.25–19.50 per dose in several contracts, yielding 60–80% profit margins! Moderna will charge the rest of the world US$25–37 per dose.

Hypocrisy

Quite understandably, most developed countries opposing temporary TRIPS suspension have provisions in their own IP laws to suspend patent protection in the national interest and for public health emergencies.

Canada, Germany, France and others have recently strengthened their patent laws to issue compulsory licences for COVID-19 vaccines and drugs. European Council President Charles Michel announced that the EU could adopt “urgent measures” by invoking emergency provisions in its treaties.

Similarly, in the US, 28 US Code sec. 1498 (a) allows the government to make or use any invention without the patentee’s permission. To handle emergencies, the 1977 UK Patents Act (section 55) allows the government to sell a patented product, including specific drugs, medicines or medical devices, without the patentee’s consent.

When avian flu threatened early this century, the US was the only country in the world to issue compulsory licences to US manufacturers to produce Tamiflu to protect its entire population of over 300 million. The drugs were not used as the virus was not brought over either Pacific or Atlantic Oceans.

Biden must act

By helping developing countries expand vaccine manufacturing capacity and access existing capacity, US President Biden can earn much world appreciation overnight. US law and precedence enables such a unilateral initiative.

The Bayh-Dole Act allows the US government to require the owner or exclusive licensee of a patent, created with federal funding, to grant a third party a licence to an invention. Moderna received about US$2.5 billion from Operation Warp Speed, which dispensed over US$10 billion.

Moderna was founded in 2010 by university researchers with support from a venture capitalist. It has focused on mRNA technology, building on earlier work by University of Pennsylvania scientists with National Institutes for Health (NIH) funding.

The vaccine developer also used technology for previous coronavirus vaccines developed by the NIH. The NIH also provided extensive logistical support, overseeing clinical trials for tens of thousands. Moderna has already announced it will not enforce its patents during the pandemic.

Thus, POTUS has the needed leverage. The Bayh-Dole Act applies to Moderna’s vaccine, enabling the Biden administration to act independently and decisively against vaccine apartheid.

Sharing knowledge crucial

Developing countries not only need to have the right to produce vaccines, but also the requisite technical knowledge and information. Hence, the Biden administration should also support C-TAP, as recommended by Dr Anthony Fauci.

When the Medicines Patent Pool (MPP) was in similar trouble, the Obama administration came forward to put US-owned patents into the pool while encouraging drug companies to help improve developing countries’ access to medicines.

President Biden knows that early US support was critical for the MPP’s eventual success. It dramatically increased production and lowered prices of medicines for HIV, tuberculosis, hepatitis C and other infectious diseases in developing countries.

Nothing to Learn from East Asia?

Jomo Kwame Sundaram

KUALA LUMPUR: Covid-19 infection and death rates in the Western world and many developing countries in Asia and Latin America have long overtaken East Asia since the second quarter of 2020. Perhaps unsurprisingly, considering prevailing Western accounts of the Asian financial crises, there have been no serious efforts to draw policy lessons from East Asian contagion containment.

Lockdowns necessary?

Although most East Asian economies have successfully contained the pandemic without nationwide ‘stay in shelter lockdowns’, many governments have seen such measures as necessary. But lockdowns are blunt measures, with inevitable adverse consequences, especially for businesses and employment.

Many countries have thus imposed lockdowns, citing China’s response in Wuhan. But as the first WHO fact-finding mission to China noted, “The majority of the response in China, in 30 provinces, was about case finding, contact tracing, and suspension of public gatherings—all common measures used anywhere in the world to manage [infectious] diseases.

Lockdowns were limited to a few cities where contagion went “out of control in the beginning”. The key lesson from China was “all about…speed. The faster you can find the cases, isolate the cases, and track their close contacts, the more successful you’re going to be.”

To be sure, lockdowns ‘flatten the curve’ by temporarily preventing further contagion. But unless accompanied by appropriate complementary measures, undetected infectious individuals may cause silent community transmission that becomes evident only too late. Instead of lockdowns, it is far more prudent to find and isolate cases before numbers become unmanageable.

South Korean lessons

The Republic of Korea was the first country to dramatically reduce the number of Covid-19 cases and related deaths without nationwide movement restrictions. It checked the spread of Covid-19 infections without imposing lockdowns, even in Daegu its most infected city.

Mass testing has been key to its response, doing the most by mid-March. By late March, Korea’s newly confirmed cases had fallen from second to eighth place in the world. Meanwhile, Korean authorities urged physical distancing, personal hygiene and remote work while discouraging mass gatherings.

The government also had legal authority to collect phone, credit card and other data to expedite contact tracing, and initially only restricted incoming travellers from Hubei province, where Wuhan is, for precautionary reasons, and from Japan in political retaliation.

Just as China had rapidly identified pathogen characteristics using artificial intelligence and big data access, Korea innovatively deployed new technologies to expedite rapid responses to trace, test, treat and isolate those infected.

Lessons from Vietnam

Three months ago, a Vietnamese official described how “Vietnam is fighting Covid without pitting economic growth against public health”. Besides testing and contact-tracing, “the government has depoliticised the pandemic, treating it purely as a health crisis, allowing for effective governance”.

Hence, there is “no political motive for government officials to hide information, as they don’t face being reprimanded if there are positive cases in their authority area that are not due to their mistakes”.

He noted that “With the head of the Hanoi centre for disease control being arrested for suspected corruption in relation to the purchase of testing kits, and small traders getting fines for price-gouging face-masks, the government has also been clear that public health cannot be entangled with commercial interests”.

After China announced its first infections and deaths in January 2020, “Vietnam tightened its border and airport control of Chinese visitors. This wasn’t an easy decision, given that cross-border trade with China accounts for a significant part of the Vietnamese economy”.

Vietnam also “took precautionary measures above and beyond World Health Organization recommendations”. Preparations started “a week before the outbreak was officially declared a public health emergency of international concern, and more than a month before WHO declared Covid-19 a pandemic”.

The communist-led government also ensured “freedom of information on Covid-related matters”. “Lockdown and isolation are more selective” from the outset, without resorting to nationwide lockdowns, as has happened elsewhere without much benefit.

Vietnam is one of the few countries with “positive GDP growth” in 2020; “the supposed trade-off between the economy and public health… looks to be something of a false choice”.

In their war, Vietnam is believed to have lost over three million people compared to 58,209 US lives. In fighting the virus, Vietnam, with 97 million people, has lost 35 lives so far, while the US, with a 332 million population, has lost almost four hundred thousand.

Mass testing crucial

After a year of living with Covid-19, all governments can learn a great deal from critical evaluation of their own country experiences, other experiences as well as accumulated, especially new knowledge relevant to feasible policy options.

Thus far, appropriate East Asian policy measures for rapid early detection, isolation and contact tracing, while protecting the most vulnerable and treating the infected, have succeeded in flattening the curve.

More reliable, cheaper methods (e.g., ‘lateral-flow’ antigen tests) allow more frequent mass testing. As undetected cases are more likely to spread infection, such tests enable more frequent, faster and easier testing and quicker results, and facilitate faster, more efficacious actions.

This can help check contagion by identifying more of those infected earlier, thus reducing transmission. Even though less accurate than supposed ‘gold standards’, lower costs allow more widespread and frequent testing to identify many more of those infected.

Easier to administer and delivering results more rapidly, such cheaper, simpler and quicker tests more speedily detect the infected, especially among the asymptomatic, in time for appropriate and timely action.

As SARS-CoV-2 transmission peaks several days after infection, together with the viral load, more frequent testing is necessary to check contagion. More frequent mass testing is probably going to detect many more of those infected much earlier, while they are still infectious.

Look East

In the early 20th century, a young Cambridge-trained doctor, Wu Lien Teh returned to practice in the British colony of Penang where he mobilised thousands against the opium trade. The authorities arrested him, forcing him to seek employment outside the British empire.

He eventually found work with China’s Ching emperor in Manchuria where a plague was raging, eventually claiming 60,000 lives. Recognising it as pneumonic, Wu recommended use of multi-layered masks he designed to protect users against airborne infection, now recognised as forerunner of the N95 mask.

His later analysis of the socio-behavioural determinants of zoonotic transmission of the epidemic was also pioneering. Sadly, a famous French doctor Gerald Mesny, who rejected Wu’s mask advice as diagnostically wrong, died of the plague soon after arrival.

Over a century later, and over two decades after the 1997-1998 Asian financial crisis exposed the systemic financial fragility creating conditions for the 2008-2009 global financial crisis, the reluctance to learn from the East continues, ignoring Prophet Muhammad’s advice to ‘seek knowledge, even unto China’.

2021: Year of living dangerously?

Jomo Kwame Sundaram

KUALA LUMPUR: Goodbye 2020, but unfortunately, not good riddance, as we all have to live with its legacy. It has been a disastrous year for much of the world for various reasons, Elizabeth II’s annus horribilis. The crisis has exposed previously unacknowledged realities, including frailties and vulnerabilities.

For many countries, the tragedy is all the greater as some leaders had set national aspirations for 2020, suggested by the number’s association with perfect vision. But their failures are no reason to reject national projects. As Helen Keller, the deaf and blind author activist, noted a century ago, “The only thing worse than being blind is having sight, but no vision.”

After JFK’s assassination in November 1963 ended US opposition to Western intervention in Indonesia, President Sukarno warned his nation in August 1964 that it would be ‘living dangerously’,vivere pericoloso, in the year ahead. A year later, a bloody Western-backed military coup had deposed him, taking up to a million lives, with many more ruined.

Further economic slowdown

Lacklustre economic growth after the 2009 Great Recession has been worsened in recent years by growing international tensions largely associated with US-China relations, Brexit and slowing US and world growth although stock markets continued to bubble.

Economic growth has slowed unevenly, with Asia slowing less than Europe, Latin America and even the US. With effective early pre-emptive measures, much of East Asia began to recover before mid-2020. Meanwhile, most other economies slowed, although some picked up later, thanks to successful initial contagion containment as well as adequate relief and recovery measures.

International trade has been picking up rapidly, accelerating rebounds in heavily trading economies. Commodity prices, except for fossil fuels, have largely recovered, perhaps due to major financial investments by investment banks and hedge funds, buoying stock and commodity prices since late March.

Very low US, EU and Japanese interest rates have thus sustained asset market bubbles. Meanwhile, new arbitrage opportunities, largely involving emerging market economies, have strengthened developing countries’ foreign reserves and exchange rates, thus mitigating external debt burdens.

Unbiased virus, biased responses

The pandemic worsened poverty, hunger and vulnerability by squeezing jobs, livelihoods and earnings of hundreds of millions of families. As economic activities resumed, production, distribution and supply barriers, constrained fiscal means, reduced demand, debt, unemployment, as well as reduced and uncertain incomes and spending have become more pronounced.

While many governments initially provided some relief, these have generally been more modest and temporary in developing countries. Past budget deficits, debt, tax incentives and the need for good credit ratings have all been invoked to justify spending cuts and fiscal consolidation.

Meanwhile, pandemic relief funds have been abused by corporations, typically at the expense of less influential victims with more modest, vulnerable and precarious livelihoods. Many of the super-rich got even richer, with the US’s 651 billionaires making over US$1 trillion.

On the pretext of saving or making jobs, existing social, including job protection has been eroded. But despite hopes raised by vaccine development, the crisis is still far from over.

Don’t cry for me, says Argentina

Meanwhile, intellectual property blocks more affordable production for all. Pharmaceutical companies insist that without the exhorbitant monopoly profits from intellectual property, needed tests, treatments and vaccines would never be developed. Meanwhile, a proposed patent waiver for Covid-19 vaccines has been blocked by the US and its rich allies at the World Trade Organization (WTO).

Hence, mass vaccination is likely to be very uneven and limited by intellectual property, national strategic considerations (‘vaccine nationalism’), prohibitive costs, fiscal and other constraints. Already, the rich have booked up almost all early vaccine supplies.

The main challenge then is fiscal. Economic slowdowns have reduced tax revenues, requiring more domestic debt to increase spending needed to ensure the recessions do not become protracted depressions. Meanwhile, rising debt-to-GDP ratios and increased foreign debt have long constrained bolder fiscal efforts.

But despite the urgent need for more fiscal resources, we are told that if the richest are required to pay more taxes, even on windfall profits, they will have no incentive to ‘save’ the rest of us. Nevertheless, new wealth taxes have just passed in Argentina.

This time is different

As the pandemic economic impacts began to loom large, International Monetary Fund Managing Director Kristalina Georgieva quickly offered debt relief for low-income countries on terms much better than the G20’s miserly proposal.

Unlike well-meaning debt-fixated researchers and campaigners, even new World Bank chief economist, erstwhile debt hawk Carmen Reinhart has urged, “First you worry about fighting the war, then you figure out how to pay for it”.

Nobel laureate Amartya Sen is concerned that “in the policies against the present pandemic, equity has not been a particularly noticeable priority… Instead, the focus has been on drastic control and sudden lockdowns…with little attention paid to labourers who lose their jobs or the many migrant workers, the poorest of the poor, who are kept hundreds of miles from their homes”.

COVID-19 may still bring major reforms, such as Roosevelt’s New Deal response to the Great Depression. But now, it seems likely to usher in a world where insecurity and unpredictability define the new normal. While professing to protect victims’ interests, ethno-populism blames ‘Others’ as the enemy responsible.

Still, many hope for a silver lining. Sen suggests that “a better society can emerge from the lockdowns”, as happened after World War Two, with greater welfare state provisioning and labour protections in much of the West and agrarian reforms in East Asia. But there is nothing to guarantee a better ‘new normal’.

Beyond neoliberalism?

For many, Joe Biden’s election to succeed Trump is being celebrated as a resurgent triumph for neoliberalism, enabling the US and the rest of the world to return to ‘business as usual’.

Incredibly, another Nobel laureate Michael Spence has even called for structural adjustment programme conditionalities for countries seeking help from the Bank and Fund, repudiating the Bank’s Growth Commission he once chaired, i.e., which found that seemingly fair, often well-intentioned conditionalities had resulted in “lost decades” of development.

But thankfully, there is widespread recognition that all is not well in the world neoliberalism and Western dominance created. Incredibly, Klaus Schwab, transnational capitalism’s high priest, has conceded, “the neoliberalist … approach centers on the notion that the market knows best, that the ‘business of business is business’...Those dogmatic beliefs have proved wrong”.

Instead, he advised, “We must move on from neoliberalism in the post-COVID era”, recognising: “Free-market fundamentalism has eroded worker rights and economic security, triggered a deregulatory race to the bottom and ruinous tax competition, and enabled the emergence of massive new global monopolies. Trade, taxation, and competition rules that reflect decades of neoliberal influence will now have to be revised”.

Will we ever learn?

The philosopher Santayana once warned, “Those who cannot remember the past are condemned to repeat it.” Hegel had observed earlier that history repeats itself, to which Marx added, “the first time as tragedy, the second time as farce”. Nevertheless, hope remains an incurable disease that keeps us all striving and struggling.

As FDR reminded his supporters, no progressive policies will come about simply by relying on the goodwill of those in authority. Instead, they will only be enacted and implemented thanks to popular pressure from below. As Ben Phillips has put it, “the story of 2021 has not yet been written: we can write it; we can right it”.