Vaccine inequality simmers at COP26

At a climate summit held under the shadow of COVID-19, rich countries are following a familiar path
Photo: Province of British Columbia
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As the COVID-19 pandemic continues to claim the lives of people around the world, political leaders have gathered for COP26, the latest international climate conference that is supposed to culminate in united action to tackle a deepening climate crisis.

Many heads of major emitting states, including Canadian prime minister Justin Trudeau, U.S. president Joe Biden, Indian prime minister Narendra Modi and Australian prime minister Scott Morrison, have shown up in person to the conference in Glasgow, Scotland. But some developing countries, hampered by pandemic restrictions and costs, have limited representation.

“Rich countries have continuously dragged their feet even as countries in the Global South have faced drought, famine, flooding and tropical storms.”

Although the United Kingdom provided COVID vaccines and free quarantine rooms for delegates in need, Climate Action Network Canada noted that negotiators, observers, journalists, scientists, and young people from developing countries still faced obstacles to obtaining visas, flights and accommodation.

“We’re holding a climate summit where those who are most impacted by the climate crisis and should be first heard at the COP find it extremely difficult to attend. They are also the ones who are going through the biggest hurdles in vaccinating,” Eddy Pérez, international climate diplomacy manager with Climate Action Network Canada, told Ricochet.

It’s no coincidence that the countries hardest hit by climate impacts are also those that have largely been left to fend for themselves when it comes to COVID-19.

There are clear parallels between the way rich nations have addressed the pandemic and their response to the climate crisis.

Hoarders

When it comes to cutting carbon emissions and providing climate funding to less-resourced countries, developed countries often delay acting on their promises and push deadlines.

“Rich countries have continuously dragged their feet even as countries in the Global South have faced drought, famine, flooding and tropical storms,” said Sudipta Saha, an organizer with youth-run Climate Justice Toronto. “Rich countries have blatantly disregarded the climate-related disasters that have killed so many around the world, prioritizing instead their own ability to continue to burn fossil fuels and maintain their wealth.”

Likewise, the richest countries, including Canada, have hoarded COVID vaccines while blocking other countries from being able to produce their own. Climate Justice Toronto has organized several campaigns asking the Trudeau government to free the vaccines from patents that mean only the wealthy can afford them.

“Rich countries behaved worse than anyone’s worst nightmares.”

“Of all the vaccine doses administered worldwide, less than 2 per cent have been in low-income countries,” said Saha, noting that at least three out of every four doses have been administered in high- and upper-middle-income countries.

Brittany Lambert is Oxfam Canada’s policy lead on vaccine inequality. “Rich countries are buying up the vast majority of the world’s vaccine supply and paying prices that make it impossible for low-income countries to compete,” she said. And not only is vaccine inequality killing people, but it is now undermining the COP negotiations and the world’s capacity to tackle the climate crisis.

“Climate justice and health justice are closely entwined,” emphasized Saha, pointing out that the wealth of the Global North is the product of extraction from the South, and these same processes of extraction have largely fuelled the climate crisis. A lack of understanding about how this inequality emerged from hundreds of years of colonial exploitation allows people in Canada to ignore the role that their country plays in upholding these unequal relationships.

“The same root causes behind the climate catastrophe — capitalism, colonialism, and white supremacy — are also driving the inadequate response to COVID-19 and the vaccine apartheid.”

A beautiful idea

The world’s wealthiest nations weren’t supposed to wind up with the bulk of COVID vaccines.

The COVAX initiative launched in 2020 was intended to make sure that vaccines reached all countries.

“It was a beautiful idea, born out of solidarity,” said Gavin Yamey, a professor at Duke University who was part of a working group that helped design COVAX, in an article in The Lancet.

But “rich countries behaved worse than anyone’s worst nightmares.”

The basic premise was COVAX would procure vaccines for all countries. Wealthy countries would pay into COVAX to buy their vaccines and provide grants for the poorest countries to receive vaccines at no cost. This would support vaccine research and development while also giving COVAX the bargaining power to bring prices down.

The problem is not just that Canada was taking vaccines from COVAX but that it was also competing with COVAX for scarce doses.

But instead, some wealthy countries didn’t participate in COVAX at all, while some, such as Canada, did buy some vaccines from COVAX but also made its own deals with vaccine manufacturers on the side. This effectively undermined the vaccine equity initiative.

Then, despite having made several bilateral deals with pharmaceutical companies, Canada went ahead and withdrew vaccines from its COVAX allotment early in 2021, which critics said was tantamount to stealing vaccines from poor countries.

This is not simply a story about charity flowing from high-income countries to lower income countries, according to Adam Houston, medical policy and advocacy officer with Doctors Without Borders’ Canadian office.

It is about high-income countries buying up more than their share of a limited supply of vaccines to the point that there are not enough vaccines for others — particularly low-income countries and COVAX — to purchase.

Competing with vaccine equity

COVAX was not intended just to provide vaccines to low-income countries. Houston explained that it was also meant to be a pooling mechanism to ensure that at least 20 per cent of participating countries’ populations (those at high risk, such as healthcare workers and people with comorbidities) would have vaccine access.

In September 2020, the Trudeau government committed approximately $220 million to COVAX to get vaccines for up to a fifth of its population. As a participating country, Canada was entitled to take vaccines from COVAX, which it did in the first round of distribution, receiving 972,000 doses of AstraZeneca in spring 2021. It was the only G7 country and one of the very few high-income countries that did so.

At the G7 Leaders’ Summit in June 2021, Prime Minister Justin Trudeau said that Canada would donate 13 million vaccine doses from its COVAX allocation to other countries.

Global Affairs Canada told Ricochet that the government has been involved in COVAX right from the start, investing to meet domestic needs and also the needs of developing countries.

“In total, Canada has committed over 40 million life-saving vaccines to be donated through COVAX for those who need them most,” a Global Affairs Canada representative said by email. “No doses will sit idle; the vaccines will be distributed to recipient countries as soon as possible.”

“The rule is very simple: no one is safe until everyone is safe.”

In practice, however, COVAX did not function precisely because countries like Canada were competing with it, Houston said. In particular, even after the World Health Organization requested that countries stop negotiating bilateral contracts outside of COVAX, Canada signed another vaccine agreement — its eighth — with the Serum Institute of India. This was the supplier COVAX was depending on to provide for low-income countries.

The problem is not just that Canada was taking vaccines from COVAX but that it was also competing with COVAX for scarce doses.

The consequences are obvious. While many countries are still waiting to receive vaccines they have paid for, wealthy countries like Canada were able to pay high prices to get to the front of the line. Now the Liberal government has secured over 10 doses per Canadian, which is more than enough to fully vaccinate everyone currently eligible.

Houston said Canada has also been slow to deliver on its belated commitment of actual doses to COVAX.

Drawing on data from recipient government sources and UN agencies, he found that of the roughly 40 million in-kind doses that the Trudeau government has pledged to COVAX, not a single dose was delivered until September, and thus far somewhere between two and three million, or just 5 to 7.5 per cent of its commitment, has been delivered.

“Voluntary and charitable approaches are failing,” said Oxfam’s Lambert. She highlighted that COVAX has delivered less than a third of the doses promised and that the vaccines are often close to expiry when received. Generally these are the less desirable vaccines (i.e., not the Pfizer-BioNTech or Moderna mRNA ones), restricting people’s ability to travel over the longer term since wealthy countries are insisting that foreign visitors must be vaccinated with particular products.

At last month’s G20 summit in Rome, Canada promised to donate millions more vaccine doses to COVAX.

People are dying, big pharma is making billions

Collectively the world is dependent on a handful of giant pharmaceutical corporations that have the power to decide how many vaccines get made, who gets them and at what price.

And that’s at the heart of today’s vaccine inequity, said Lambert.

Big pharma companies have received immense amounts in taxpayer money to help accelerate the development of COVID-19 vaccines. Yet they are exploiting their monopolies, charging up to 24 times the cost of production, a price that only rich countries can afford.

“Pfizer, Johnson & Johnson and AstraZeneca have paid out $26 billion in dividends to their shareholders in the past 12 months. This would be enough to pay to vaccinate at least 1.3 billion people, the equivalent of the population of Africa,” said Lambert. “Those CEOs are making billions in profit, at the cost of ensuring everyone is protected.”

Big pharma companies also refuse to share their vaccine formulations with manufacturers in the Global South. Some wealthy countries are blocking developing countries from producing their own vaccines by refusing to waive intellectual property rights, arguing that these rights are essential to preserving the incentive to innovate.

Waiving intellectual property rights would upset the pharmaceutical industry, and wealthy countries don’t want to do that until all their citizens are vaccinated. But given the exceptional public health emergency brought on by COVID-19, Lambert said special temporary measures are warranted.

Ultimately, there are just not enough vaccines being produced. Lower-and middle-income countries need to be able to manufacture their own vaccines to meet the needs of their populations.

India and South Africa have proposed a waiver of intellectual property laws — specifically, the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property (TRIPS) — for COVID-19 technologies. More than 100 low-income countries support relaxing the terms of TRIPS to help ensure a rapid, equitable and truly global public health response to COVID-19.

“This TRIPS waiver would be a crucial first step in allowing countries in the Global South to start manufacturing vaccines,” Saha said, noting that the Trudeau government has refrained from explicitly voicing support for the measure.

Bolivia has signed an agreement with a Canadian company, Biolyse Pharma, for the production of cheaper versions of the Johnson & Johnson vaccine, Saha added. But this agreement can only go forward if the Trudeau government grants Biolyse a compulsory licence under the Canadian Access to Medicines Regime, which allows the bypassing of patents in public health crises but is hardly used. So far, Trudeau has not indicated any support.

Climate Justice Toronto is demanding is that the government fully support the proposed TRIPS waiver — not just through a tweet as the Biden administration did, but in action at the World Trade Organization. Sticking to the middle ground while supporting “negotiations” or asking for more information, Saha said, amounts to little more than a stalling technique.

In a consensus-based system, passively blocking the waiver is still blocking the waiver, agreed Houston. Furthermore, Canada would be under no obligation to implement the waiver at home, so blocking it only serves to get in the way of the majority of countries who need action.

“What we should have done ... is make sure that we protect everyone as soon as possible, as quickly as possible. Because the rule is very simple: no one is safe until everyone is safe,” said Pérez.

As vaccine boosters enter the public conversation, Canadians should recognize that increasing the size of the pie, rather than carving a bigger slice for themselves, is the best option for everyone at home and abroad, according to Pérez. The worst outcome is for a vaccine dose to expire in a Canadian freezer rather than be used by someone who needs it.

As with the climate crisis, what happens in other parts of the world during a pandemic affects Canada. Poor access to vaccines elsewhere facilitates the emergence and spread of new COVID variants, which could render current vaccines ineffective, starting the cycle all over again.

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