The injustice over vaccines is being replayed: as rich countries deny billions access to lifesaving COVID-19 treatments

Harry Bignell Health, Influencing, Rights

The World Trade Organisation decision in June – far from being the comprehensive waiver we campaigned for – outrageously omitted life-saving tests and treatments, says Harry Bignell. Now the UK and other rich countries must unblock access to medicines and diagnostics, or risk devastating global consequences

Campaigners have been calling for a TRIPS waiver to support global access to vaccines, tests and treatments since it was first proposed by the governments of India and South Africa in 2020. (Picture: People’s Vaccine Alliance)

This autumn, the UK government has a chance to remove critical intellectual property barriers to life-saving pandemic health tools for billions of people. Did reading that feel like déjà vu? That’s probably because it is.

Back in June, members of the World Trade Organisation agreed a deal on vaccines in response to ongoing calls for a waiver on patents and other intellectual property to facilitate widespread manufacture of COVID-19 vaccines, tests and treatments. The June ‘decision’ has been widely criticised as not going far enough and the negotiations that led to it described as ‘exclusionary’ and ‘unrepresentative’.

For all its faults, and there really are many that limit its impact on vaccine access, I want to highlight one other glaring and potentially devastating omission in the agreement: the failure even to include COVID-19 tests and treatments.

Still waiting for health justice

Over a million people have already died of COVID-19 in 2022, with hundreds of thousands more still diagnosed daily. COVID-19 therapeutics and tests are vital, alongside vaccines, in keeping the pandemic under control and preventing further loss of life. But supplies of all three remain grossly inadequate in lower-income countries. Less than 20% of people in the poorest countries are fully vaccinated. And now, high-income countries have bought up three quarters of total known supplies of all existing COVID-19 treatments, including almost all of the 30 million courses of the most strongly recommended anti-viral, Paxlovid. Official reports indicate that developing countries remain unable to access this or other therapeutics. 

‘We have requested 3000-plus courses, but we got only 300… In a country with a population of 15 million people, I don’t think it is enough.’

Dr Mamunur Rahman Mal, WHO Representative for Somalia

Dr Mamunur Rahman Mal, WHO Representative for Somalia, reported, “We wanted to ensure that even a critically ill patient in Somalia should have access to those advanced therapeutics like any other countries in the world…We have requested 3000-plus courses, but we got only 300 courses…In a country with a population of 15 million people, I don’t think it is enough in terms of managing the critical care for COVID-19 patients.”

It is astonishing then that, more than two-and-a-half years into the pandemic, pharmaceutical companies, governments, academics and civil society are still locking horns over intellectual property rules.

Civil society, Nobel Laureates and former world leaders along with many others have been calling for a temporary waiver on Trade Related Aspects of Intellectual Property (TRIPS) relating to COVID-19 vaccines, tests and treatments ever since it was first proposed by the governments of South Africa and India in October 2020.

‘It should never be that human life is granted only to the highest bidder, but the current pharmaceutical system relies upon exactly this model to pursue unimaginable profits’

Just Treatment patient leader Imtiaz Somii, who lost his mother to COVID-19.

After several deadly false starts and delays, a text on COVID-19 related patents was agreed at the World Trade Organisation (WTO) in June. That text falls well short of a full intellectual property waiver: it largely restates existing TRIPS flexibilities, allowing countries to override patents to produce vaccines without threat of being sued, but with some temporary relaxation of restrictions on exporting these to other countries.

Without a comprehensive waiver of other intellectual property rules crucial to the manufacturing of vaccines the June decision will likely have limited impact on vaccine inequality. However, experts agree, even in its inadequate form, if the same decision was applied to therapeutics in particular, it could make a significant difference. Without any justification however, the decision on whether to do just that was postponed for a period of up to six months. Member states are still debating the issue.

New treatments that could save millions of lives blocked by patents

Newly developed COVID-19 treatments have the potential to save millions of lives around the world, especially in low- and middle-income countries with lower vaccine coverage. But they are not available or are too expensive.

Pharmaceutical companies Merck and Pfizer have successfully developed treatments for COVID-19 marketed as Molnupiravir and Paxlovid respectively. They have also secured patents to stop other capable manufacturers making generic versions of them at cheaper prices.

UK Prime Minister Liz Truss supports voluntary agreements by pharma firms to supply poorer countries but these have failed during the pandemic to redress deadly inequality in access. They leave all control over who gets access to corporations whose mandate is to maximise profit. For example, whilst Merck and Pfizer have entered into ‘voluntary’ licenses with the Medicine Patent Pool to meet a portion of low- and middle-income country demand for their COVID-19 treatments, these agreements are geographically limited, excluding hundreds of millions of people from middle-income countries. Pfizer’s licence excludes most of Latin America, including Brazil which has significant manufacturing capacity. Many of the countries with the highest death toll from COVID-19 are simply left with no access.

‘Ensuring access to affordable COVID-19 tests and treatments around the world would be an immediate and enduring win; saving lives and preventing the emergence of future, more voracious variants’

To protect public health, countries have rights to issue compulsory licences which override patents to allow the production or import of generic versions of medicines. However, lower income countries that have tried to do this during the pandemic have met with strong opposition. Pfizer resisted attempts by the Dominican Republic to issue a compulsory licence for Paxlovid for example, stating paradoxically that such a move violated the company’s ‘human right’ to intellectual property. 

Imtiaz Somji, a volunteer leader at UK patient led-organisation Just Treatment which is calling for curbs on the power of pharma firms, lost his mother Leila Somji, who was living in Tanzania, to COVID-19 in February 2021. “It was a horrible time in Dar-es-Salaam, Tanzania,” he says. “Everyone was scared, scrambling for tests which were not available, scarce masks were being sold to the highest bidder. Contracting the virus almost certainly meant a dire health outcome, but the means to protect ourselves – through the supply of tests, masks, and PPE – was equally precarious. Doctors were prescribing antibiotics, dexamethasone and oxygen, all of which were in short supply.

‘It should never be that human life is granted only to the highest bidder, but the current pharmaceutical system relies upon exactly this model to pursue unimaginable profits. What happened then was wrong, and it should never happen again.’

It is as if nothing has been learnt from the catastrophic failure to prevent extreme vaccine inequality. Low- and middle-income countries are once again at the back of the queue, unable to plan for robust test-and-treat programs because of uncertainty about supply, affordability, and equitable distribution of therapeutics. All the power lies in the hands of the pharmaceutical corporations until governments agree to step in.

The UK must act now – and not repeat past mistakes

The death toll from COVID-19 is already four times higher in lower income countries than rich ones. To prevent more unnecessary devastating loss of life, COVID-19 therapeutics and diagnostics, as well as vaccines, must be accessible to all. The argument for extending the WTO deal to include tests and treatments is clear. Yet the UK government has so far failed to support this extension.

Oxfam GB is joining civil society partners in urging new UK Minister for Trade Kemi Badenoch to support extending the WTO agreement to include COVID-19 tests and treatments as one of her first priorities.

Amid so many complex global and domestic challenges, ensuring access to affordable COVID-19 tests and treatments around the world would be an immediate and enduring win; saving lives and preventing the emergence of future, more voracious variants. 

Millions of people around the world remain at risk. For the UK, the threat of new disruptive and deadly variants remains ever present. The time to act is now.


Harry Bignell

Harry Bignell is Health Policy Adviser at Oxfam GB

Visit the People’s Vaccine Alliance website to take action to support the rights of everyone, everywhere to get access to COVID-19 vaccines, tests and treatments.