When the masks come off

Finally, it all comes down to numbers, contracts and, yes, intellectual property (IP). The delay in Covid-19 vaccine supplies to several countries has exposed an inconvenient truth that would have, in normal times, unfolded behind closed boardroom doors or in diplomatic channels. But in pandemic times, the stress points have erupted in full public gaze and the masks have pretty much come off.

The last few days have seen governments and regional heads call for export bans on Covid-19 vaccines from their countries, or the raw materials needed to make them. There have even been threats to over-ride patents so that other companies could make the vaccines and ensure local supplies. The cross-country saga involving a mix of contracts and nationalism has, however, not surprised public health campaigners.

This is precisely the situation they had warned about last year, when the vaccines were being developed and countries were falling over each other to woo companies and put money “at risk” on producing them and procuring them, if and when they were ready to use. While no one faults countries for being prepared for the worst, what they should have also done was to have frameworks that allowed greater access to the Covid-19 tools — medicines, vaccines and medical technologies.

Discussions that should have outlined sharing technology so that low and middle income countries (LMIC) received vaccines, just as the affluent nations did.

Stress in the system

But the early signs of stress in the system showed up when the UK indicated it had received just half of its 10 million consignment of AZ Oxford vaccines — made by the Serum Institute of India (SII). The ostensible reason was that India held onto its vaccine stocks, as coronavirus cases began to surge in the country.

AZ, meanwhile, was already locked in another controversy raging in Europe, with the European Commission taking a stern view of supplies falling short of the original commitment. As Europe faced a rising wave of cases, Italy held back an export consignment to Australia. But the final straw was when EC President Ursula von der Leyen indicated measures that included overriding patents and imposing more export bans.

Eventually, the statement from the EC was a tad tamer, though firmly rooted in protecting health in the region. Pointing out that 4.1 per cent of Europe had received two doses, she said, “But of course, we all know, we could have been much faster if all pharmaceutical companies had fulfilled their contracts.”

“AstraZeneca has committed to a lower number of doses than was contracted. Here, AstraZeneca has committed to 70 million doses instead of the contracted 180 million doses,” she said.

Pointing out that her efforts were to ensure that Europe got its “fair share” of vaccines, she added, they were fervent supporters of global cooperation. And on the controversial export ban and suggestions for more, she explained, “Our track record speaks for itself — and it was good to create this transparency: Since the start of the mechanism on February 1, more than 380 export requests to 33 different countries have been granted. And only one has been stopped.”

Last week also saw the World Health Organization-supported Covax facility caution of supply delays in March and April. Covax seeks to ensure equitable distribution of vaccines across countries. It had been supplied 28 million doses of the AZ-Oxford vaccine and was expecting an additional 40 million doses in March, and up to 50 million doses in April, the WHO said.

India’s Serum Institute too brought up concerns of shortages that could arise if the US invoked the Defense Production Act and prevent raw materials from being shipped out of the country to vaccine-makers across the globe. In the past too, during the anthrax scare after the 9/11 attacks, the US had threatened to “break” the patents of Bayer’s Ciprofloxacin, the medicine needed at that point.

Health advocacy groups working for better access to medicines for HIV/AIDS, tuberculosis, hepatitis C, cancer, and so on, have always had to deal with the fallout of watertight contracts and stringent IP protection outlined by companies from the very regions that are now blocking exports and threatening overriding patents.

Countries with a high population of patients needing these medicines have had to rely on donations and patient-support programmes, a dependence that is not healthy. The suggestion of allowing more producers to make the drug with adequate compensation to the innovator is not seen favourably. And, it goes without saying that most of these patients live in low and middle-income countries.

But it takes a pandemic to bring home some truths. And so it has been witnessed with the access issues in developed countries over Covid-19 vaccines from different companies. While there is little disagreement that companies should be encouraged to work on innovative medicines to tackle diseases, the access planning needs to start much earlier, to be able to get innovative medical products across to more people and with the least barriers of any sort.