The great vaccine heist: The procurement contracts veil of secrecy violates transparency and public interest

For previous articles on this topic by Fatima Hassan, read here and here.

In early 2020, many of us in the access to medicines movement warned that it is neither prudent to rely on the market alone, nor just charity in the face of the Covid-19 pandemic. It would not be sustainable. We argued that this approach of commodifying essential life-saving interventions, vaccines in particular, despite significant public funding and socialised risk supporting accelerated vaccine research (about $100-billion of funding), would result in the public not getting timely and enough access to the fruits of publicly funded and supported research.

In the months to follow, the Vatican, the WHO’s director-general, 170 former heads of states and Nobel Laureates, scientists, researchers, and many others have echoed our growing concerns.

We mourn the 3.5 million people who have already died within the space of just more than a year and the many, many more that are likely to follow. Yet, we have multiple safe and effective vaccines that could be used to save millions of lives. But, according to recent data, only 21.8% of the world population has received at least one dose of a Covid-19 vaccine. This means that 2.7 billion doses have been administered globally, and about 38 million doses are now administered each day across multiple countries. But, just under 1% of people in low-income countries have received at least one dose.

For Africa, the data indicate that less than 3% of people have been vaccinated, one of the worst faring continents for vaccine access and coverage. And if one compares the number of vaccines available, delivered, and administered, versus what has been promised or ordered, they are two massively different sets of numbers.

According to the director-general of the WHO, the world urgently needs 11 billion doses to contain the pandemic. But, in a “grotesque” display of vaccine inequality, only about 20 places in the world have administered enough vaccines to cover 40% of their population, while the tools and technologies exist to speedily change this number.

It is also reported that the wealthiest 27 nations globally have a quarter of the world’s vaccine supplies. Bloomberg’s vaccine tracker estimates that 2.59 billion doses of vaccines have been administered, for about 16.9% of the global population across 180 countries. The UK has reached 46% (fully administered) vaccine coverage, while in the US it is about 45% (this does not reflect state-by-state vaccine access disparities in the US).

We also argued in the early days of the pandemic, that based on past experience of how private pharmaceutical corporations behave in epidemics, that in this pandemic, it is not a good strategy to only rely on a handful of manufacturers to make safe and effective vaccines or even therapeutics. This is because when billions of doses are needed at the same time, limiting manufacturing to just a few companies, with export bans and other restrictions, creates scarcity, requiring rationing and prioritisation based on risk profile.

This means that while everyone, everywhere should be eligible for a vaccine at the same time, certain at-risk groups must be prioritised, first based on public health factors, ethics and equity principles. This is why, for example, the WHO called early on in 2021 for healthcare workers around the world to be prioritised along with elderly people before others. This did not materialise.

We also argued that in addition to supporting the Trips waiver governments themselves should also take compulsory measures against companies that are unable to meet demand, mainly because they limit the number of manufacturing partners in a pandemic. This reduces the ability to scale up supplies to those in need. This is called artificial scarcity. And because CEOs are not elected leaders, they should not be in the driving seat in a pandemic.

In South Africa for a long time, and especially this past year, we have been waiting for Parliament and all political parties to urgently attend to passing the Patent Amendment Bill despite the Covid-19 pandemic showing the havoc that patent monopolies create. The tabling of the bill has stalled and is being blocked by certain political parties, we believe, to protect vested private interests. This could undermine future efforts to ensure that we access life-saving medicines and vaccines in affordable and sustainable ways.

Regrettably, global mechanisms that were touted as the solution to securing “equity” in and for the global South, with a promise of fair prioritisation in the allocation of available global supplies, relied only on volunteerism and cooperation. These mechanisms mainly still refuse to address market failures and intellectual property’s stranglehold on equity. Also, it cannot properly address the pressing need for vaccine supplies around the world right now. This includes Covax — which is now facing a massive shortfall in supplies for 2021. According to its most recent forecast, there is a real possibility that it will not be able to help even more than a quarter of vulnerable populations in low-income countries by the end of 2021. Neither will the WHO’s voluntary pooling mechanism called “C-TAP”, which so far does not have a single brand name vaccine manufacturer joining.

Locally, for several reasons, also to do with the SA government’s vaccine selection choices and timing of those decisions, the impact of the Covid-19 crisis in India coupled with the AstraZeneca/Oxford University/Serum II narrow licensing terms for that supply pipeline, Covax will deliver a first shipment of just Pfizer vaccines for South Africa before end June 2021.

Granted, both these initiatives (C-TAP and Covax) have been hamstrung by the tactics of very powerful and profitable companies alongside certain governments, especially G7 states. They have been unwilling to broadly share vaccine know-how or technology; unwilling to compel that transfer; nor fully support the entire Trips waiver proposal while millions of people are now at risk of dying, needlessly.

But information sharing also means transparency, which sadly there has been very little of. For months the Health Justice Initiative has been asking for all the 2021 MAC Vaccine Advisories to be made public, on the Department of Health’s website, even before the special leave of the minister of health took effect. Despite repeated requests, this has not been forthcoming, leaving everyone to speculate in a pandemic on vaccine selection decisions, supplies, deliveries and other relevant details.