Quad great platform for US to end vaccine apartheid by forcing big pharma to transfer tech, augment supply

Quad great platform for US to end vaccine apartheid by forcing big pharma to transfer tech, augment supply

Quad great platform for US to end vaccine apartheid by forcing big pharma to transfer tech, augment supply

American quest for global leadership is being tested by a virus. Since the Joe Biden administration seeks to claim leadership in global health security and has committed to spearheading a multilateral effort to contain the pandemic, the virus that originated in China and is now ravaging the world presents it both with a threat and an opportunity. Biden now has a chance to steer US response away from Donald Trump’s ‘America First’ isolationism to leading a global vaccination effort, and the Quad could prove to be a consequential platform for that endeavour — at least in the immediate term.

Ensuring that its Quad partners are vaccinated on priority — extending it even to the Quad-plus grouping— will reinforce American commitment to the framework and direct resources and efforts to a corner of the globe (not just India) that is right now the epicenter of the pandemic, affecting one-fifth of all humanity. If the vaccine initiative is expedited and executed, it may — as Dhruva Jaishankar of ORF and Tanvi Madan of Brookings Institution point out in a related argument for Foreign Affairs — “help the Quad demonstrate its practical and normative value as an alternative to Chinese hegemony.”

The diplomatic and geopolitical benefits for the US, which is best suited now to lead such an effort, would of course be considerable. Washington may even earn back some of the soft power it has allowed to erode.

The world already knows about the devastation that a mercurial second wave has left in its wake in India. From a country that earned grudging respect for its handling of the pandemic in the first wave to suffering a meltdown in the second, India’s experience holds lessons for the world.

A virulent variant is fueling a ferocious surge, forcing India to surpass all records in cases of infection and mortality. The healthcare system, rickety at normal times, has collapsed under the weight of Covid with hospitals running out of oxygen, medicines, critical care equipment and even beds. Many are dying without access to medical attention as the virus makes its way to the rural areas. Crematoriums are scenes of overflowing human tragedy.

India is the global leader in vaccine manufacturing but the failure to foresee the severity of the second wave has resulted in ad-hoc policymaking, and right now demand is far outstripping supply. The country that supplied 66 million doses to the world when demand was low at home and competed with China in vaccine diplomacy, is now finding it difficult to inoculate its citizens as the twin manufacturers Serum Institute of India (that produces Covishield) and Bharat Biotech (that manufactures Covaxin) struggle to keep up with the demand.

Vaccine stocks, that were totally exhausted by 1 May, may be ramped up to the desired levels only by July. India’s rate of vaccination, therefore, will decline at a time when mass inoculation should be at its peak to break the chain of second wave and reduce chances of a third. India has sought to import vaccines to mitigate the crisis at home, but the effort so far has drawn a blank. Pfizer’s deal with India is stuck over indemnity clauses while Moderna has said it has no extra supplies till year-end. Both US drugmakers have ignored the requests from Indian states for direct supply, clarifying that they will deal only with the Centre. This is where the US can help.

While India struggles, Quad partner Japan is no better. Tokyo Olympic Games are inching closer, but Japan, the world’s third-largest economy, is facing a massive healthcare crisis. Prime minister Yoshihide Suga had canceled a trip to India in April due to rising cases in Tokyo. Now Osaka, Japan’s second-largest city, is crumbling.

Reports say Osaka has witnessed a more than five-fold jump this week over the corresponding period three months ago and just 14 percent of the prefecture’s 13,770 Covid patients have been hospitalised, leaving the majority to fend for themselves. AP reports that about 35,000 Japanese citizens — twice the number of those in hospitals — must stay at home with the disease, often becoming seriously ill and sometimes dying before they can get medical care. The US can help here too.

However, when the world needs the US to step up, it has demonstrated what Jonathan Cohen, director of Open Society Foundations, calls “scarcity thinking”. The Biden administration has continued with Trump’s America First policy and has been accused of hoarding vaccines at the cost of impoverishing the world.

Even at the beginning of May, when cases were exploding in India and the US was sitting on a stockpile of AstraZeneca vaccines that it won’t even use, Biden was saying “if we have a surplus, we’re going to share it with the rest of the world… We’re going to start off making sure Americans are taken care of first, but we’re then going to try and help the rest of the world.” One non-profit organization reckons that Washington has secured 550 million more doses than it needs to cover every American.

South China Morning Post reports that the US alone accounts for nearly 20 per cent of the nearly 1.4 billion jabs given worldwide so far, while Africa’s three most populous countries — Nigeria, Ethiopia and Egypt, home to more than 400 million people — each account for just 0.1 percent.

This has led to World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus flagging the vaccine inequality as a “catastrophic moral failure,” whose price “will be paid with lives and livelihoods in the world’s poorest countries.”

The Biden administration has, of course, rushed in to help India after early missteps, dispatching planeloads of aid worth over $100 million including critical equipment, medicines and oxygen. It has also promised to supply critical raw materials — paucity of which affected vaccine production in India — by diverting its own supplies. It has also pledged to send “80 million US vaccines to help countries battling the pandemic by the end of June 2021.”

In March, during the first Quad leaders’ summit featuring Biden, Suga, Narendra Modi and Scott Morrison (Australian PM), the Quad agreed on what was called ‘Quad Vaccine Partnership’, pledging to “produce at least 1 billion doses of COVID-19 vaccines by the end of 2022” by harnessing India’s manufacturing prowess with the technical knowhow, logistical help and funding from other partners.

A joint op-ed in Washington Post penned by the four leaders read: “Together, we pledge to expand and accelerate production in India of safe, accessible and effective vaccines. We will partner at each stage to ensure that vaccines are administered throughout the Indo-Pacific region into 2022. We will combine our scientific ingenuity, financing, formidable productive capacity and long history of global-health partnership to surge the supply of life-saving vaccines, in close collaboration with multilateral organizations including the World Health Organization and Covax Facility.”

A senior-level ‘Quad Vaccine Experts Group’ was formulated, comprising scientists and officials to give shape to and oversee the vaccine initiative.

But the Quad vaccine initiative was stitched up at a time when India had not yet been waylaid, and it is evident that neither the Indian government nor its Quad partners could anticipate the ferocity and suddenness of the second wave. With the benefit of hindsight, one may claim clairvoyance that was missing in early March, but the fact remains that the vaccine initiative announced by the Quad partners — that reportedly remains on track to deliver doses by end-2022 — is not only inadequate, but inconsequential in the changed scheme of things.

When the virus vetoes calculations, world leaders should be heading to the drawing board and adapt their policies to changed circumstances — the failure of which led Biden administration appear so leaden-footed in responding to the unfolding catastrophe in India.

The enormity of the crisis, and the unpredictability of the virus and its mutations, therefore, require quick thinking and a fundamentally different approach — one that focuses on capacity building instead of making other countries reliant on American handouts.

As Cohen writes in the Foreign Affairs column mentioned earlier, “Biden should consider… urging American pharmaceutical companies to share licenses through the COVID-19 Technology Access Pool (CTAP), a globally coordinated mechanism proposed by Costa Rica and started by the WHO last year.”

This is where the rubber hits the road. US drugmakers Pfizer and Moderna have flatly refused to take part in CTAP, and driven by a monopolistic profit motive, have militated against the Biden administration’s decision to waive intellectual property protections for COVID-19 vaccines. They have resisted calls for technology and knowledge transfer and are furiously lobbying the Biden administration to prevent any moves towards even a temporary waiving of patents.

In April, big pharma lobbyists in the US have “warned in private meetings with US trade and White House officials that giving up the intellectual property rights could allow China and Russia to exploit platforms such as mRNA”. This month, Pfizer CEO Albert Bourla said “waiving the patents of Covid-19 vaccines would unleash a scramble for scarce raw materials and discourage innovation in the pharmaceutical sector.”

Though the US has backed access to vaccine patents for poor countries, that matters little because it would require months of negotiations at the WTO for all 164 members to hammer out a consensus. The virus won’t allow us that time. A more effective solution would be setting up ‘tech-hubs’ with WHO-designated partner manufacturers who could develop vaccines on the mRNA platform under the guidance of big pharma and pay them royalties. The mRNA vaccines are rapidly scalable unlike viral vector vaccines that, for instance, are available in India, and the technology can be swiftly adapted to fend off new strains.

As LA Times points out in a report, quoting Mariangela Simao, WHO’s assistant director general for Access to Medicines, Vaccines and Pharmaceuticals, this is where CTAP (COVID-19 Technology Access Pool) could provide a “a win-win solution,” by allowing “for expansion of manufacturing… and at the same time, offering holders of IP a middle-ground option.”

Pfizer, however, has called the CTAP initiative “nonsense” and “dangerous” (https://www.youtube.com/watch?v=0wMMwDshed0) and the Biden administration appears unwilling at endorsing it.

According to Joseph E Stiglitz, a Nobel laureate in economics and professor at Columbia University, “even with a WTO waiver, the vaccine makers stand to make heaps of money.” Writing for Project Syndicate, he points out, “the problem for the pharmaceutical industry is not that drug manufacturers will be deprived of high returns on their investments; it is that they will miss out on monopoly profits, including those from future annual booster shots that doubtless will be sold at high prices in rich countries.”

This is where the Biden administration must step in and through incentivization and coercion, force the big pharmaceutical companies to part with the technology through licensing partnership with other manufacturers such as in India who have the experience and capability. Unlike the WHO, the US has unique leverage over the pharma giants, having funded the development of the mRNA vaccines in return for doses under the Donald Trump administration’s Operation Warp Speed initiative.

As Ro Khanna, Democratic lawmaker from California points out in Foreign Affairs, “Washington has tremendous leverage to push these companies to share mRNA vaccine technology with manufacturers in India and around the world. After all, American taxpayers have invested in the vaccines’ development from the start… When American taxpayers invested in the development of this vaccine, they did so in order to keep Americans safe — not to line the pockets of big pharmaceutical companies.”

The virus, which respects no boundaries, won’t give us the luxury of prevarication or indecisiveness. It is also myopic to focus on the profit motive. If it is allowed to persist and infest population elsewhere, eventually it will return to the shore from where it was banished with a more virulent strain that resists vaccines. The Biden administration must, therefore, double down on building capabilities around the world with special focus on India which will play a decisive role in this battle.