key: cord-0901655-ipc833tv
authors: Meijer, Marianne; Verschuuren, Marieke; Weggen, Ella
title: COVID-19 vaccines a global public good? Moving past the rhetoric and making work of sharing intellectual property rights, know-how and technology
date: 2021-09-02
journal: Eur J Public Health
DOI: 10.1093/eurpub/ckab144
sha: 5914ca0b59df4fafdbd2e11559761a4e349ceb81
doc_id: 901655
cord_uid: ipc833tv

nan

T he current global response to the COVID-19 pandemic is insufficient in curbing the pandemic; the world is in the midst of a third wave and new strains of the virus are constantly developing. Vaccines are vital to overcome this crisis, but their supply is scarce and the worldwide distribution both inadequate and unequal. Whilst some countries await first vaccine batches, others warm up for potential third doses. In spite of the fact that vaccines were soon crowned 'global public goods', 1 little came of it in reality, and lowincome countries are dependent on inadequate donation-based systems. Key in changing the tide is to ensure better global access, for which more vaccines must become available. To this end, Intellectual property (IP) rights, know-how and technology must be shared to maximize vaccine production.

An effective global vaccine roll-out requires at scale production, affordable pricing, global allocation and wide deployment. Today, all these intertwined dimensions are compromised. High-and upper-middle-income countries purchased abundant quantities, enabling them to vaccinate their population up to five times. 2 Some of those vaccines expire soon, without having been to anyone's benefit. Simultaneously, high-income countries leave the pooled procurement initiative COVID-19 Global Vaccine Access Facility (COVAX), which aims to provide global and equal access to vaccines, underfunded. COVAX only shipped 208 million doses so far, and thus remains off track in reaching the initial target of administering 2 billion doses worldwide before 2021 ends. 3 In a pandemic, nobody is safe until everyone is safe. However, considering the present global dissemination of vaccines, this basic notion seems to be neglected. Consequently, the continuous mutation of the virus poses a risk for everyone, underlining the urgency for a fast and equitable global vaccine roll-out. However, at the current rate, vaccinating 70% of the world population (as required for global protection) would only be achieved by 2023. 4 To bring this date forward, equitable vaccine distribution is a prerequisite. To achieve this, better exploitation of existing production capacities is a necessity.

Vaccine production is controlled by a small group of powerful pharmaceutical companies and predominantly takes place in highincome countries. IP rights play a vital role in this regard. Patents (a form of IP rights) protect companies' manufacturing platforms from competition, contributing to high prices and reduced access. Fundamentally, existing application of IP rights exacerbates both global and domestic inequalities during this pandemic.

Scaling up production through voluntary licensing agreements is the most expeditious remedy. However, several offers by vaccine manufacturers to help scale up production were not taken up by the pharmaceutical companies holding the IP rights. Furthermore, WHO initiatives for voluntary sharing of IP rights, know-how and technology, like the COVID-19 Technology Access Pool (C-TAP), remain unutilized. Therefore, there seems to be no other solution than to move towards involuntary production upscaling.

On 2 October 2020, India and South Africa filed a proposal at the World Trade Organization (WTO), which encompasses a Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver ceding protections for some IP rights and a call for the global sharing of technology and know-how related to the manufacturing of COVID-19 products (not solely vaccines). 5 The waiver permits WTO member states to suspend certain TRIPS sections on IP to increase production and thus supply. The waiver provides opportunity for legal certainty, as it enables third parties to produce vaccines without risking legal repercussions. The waiver, backed by over 100 countries, was given additional force with the support of the US' Biden administration, albeit for vaccines only.

However, the waiver has been blocked by different governments and the European Commission by arguing that, rather than IP, manufacturing expansion forms the obstacle. Essentially, they fail to recognize the two are interwoven, as efficiently ramping up production does not only involve sharing IP rights, but of know-how and technology as well. All three are vital to assure the safety and quality of vaccines. Consequently, the waiver is no holy grail for accelerated vaccine supply, as industry cooperation (e.g. through C-TAP) remains essential for obtaining associated know-how and technology. Notwithstanding, against the backdrop of rising inequalities, the waiver proposal opened the door to discuss whether TRIPS constitutes a fair compromise between trade and public health.

High-income countries alongside a small group of pharmaceutical companies dominate both production and distribution of COVID-19 vaccines. Such power disparities undeniably cause inadequate and unequal access to vaccines, bypassing the pledge of global common goods and neglecting the adage that nobody is safe until everyone is safe. To change the tide, production must be scaled up, everywhere. As such, the dependency of low-income countries on donation schemes can be reduced, enhancing their self-sufficiency and resilience. To accomplish this, IP rights, know-how and technology must be shared. If dominant private actors refrain from voluntary action to do so, public institutions must prepare involuntarily ways to realize sufficient supply fast and reconsider whether current international regulatory frameworks contain sufficient safeguards to reduce inequalities.

Conflicts of interest: None declared.

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