The Poor and the Covid vaccine

Achal Prabhala and Leena Menghaney in The Guardian

As the UK’s vaccination programme was “knocked off course” due to a delay in receiving five million doses of the AstraZeneca vaccine from India, a far more chilling reality was unfolding: about a third of all humanity, living in the poorest countries, found out that they will get almost no coronavirus vaccines in the near future because of India’s urgent need to vaccinate its own massive population.

It’s somewhat rich for figures in Britain to accuse India of vaccine nationalism. That the UK, which has vaccinated nearly 50% of its adults with at least one dose, should demand vaccines from India, which has only vaccinated 3% of its people so far, is immoral. That the UK has already received several million doses from India, alongside other rich countries such as Saudi Arabia and Canada, is a travesty.

The billions of AstraZeneca doses being produced by the Serum Institute in India are not for rich countries – and, in fact, not even for India alone: they are for all 92 of the poorest countries in the world.

Except they’re now being treated as the sovereign property of the Indian government.

How did we get here? Exactly one year ago, researchers at Oxford University’s Jenner Institute, frontrunners in the race to develop a coronavirus vaccine, stated that they intended to allow any manufacturer, anywhere, the rights to their jab. One of the early licences they signed was with the Serum Institute, the world’s largest vaccine manufacturer. One month later, acting on advice from the Gates Foundation, Oxford changed course and signed over exclusive rights to AstraZeneca, a UK-based multinational pharmaceutical group.

AstraZeneca and Serum signed a new deal. Serum would produce vaccines for all poor countries eligible for assistance by Gavi, the Vaccines Alliance – an organisation backed by rich countries’ governments and the Gates Foundation. These 92 nations together counted for half the world – or nearly four billion people. India’s fair share of these vaccines, by population, should have been 35%. However there was an unwritten arrangement that Serum would earmark 50% of its supply for domestic use and 50% for export.

The deal included a clause that allowed AstraZeneca to approve exports to countries not listed in the agreement. Some countries which asked for emergency vaccine shipments from Serum, including South Africa and Brazil, were justified: they had nothing else. Rich countries like the UK and Canada, however, which had bought up more doses than required to vaccinate their people, to the detriment of everyone else, had no moral right to dip into a pool of vaccines designated for poor countries.

Paradoxically, when South Africa and India asked the World Trade Organization to temporarily waive patents and other pharmaceutical monopolies so that vaccines could be manufactured more widely to prevent shortfalls in supply, among the first countries to object were the UK, Canada and Brazil. They were the very governments that would later be asking India to solve their own shortfalls in supply.

The deal did not include restrictions on what price Serum could charge, despite AstraZeneca’s pledge to sell its vaccine for no profit “during the pandemic”, which led to Uganda, which is among the poorest countries on Earth, paying three times more than Europe for the same vaccine. (An AstraZeneca spokesperson told Politico that the “price of the vaccine will differ due to a number of factors, including the cost of manufacturing – which varies depending on the geographic region – and volumes requested by the countries”.)

As it became clear that the western pharmaceutical industry could barely supply the west, let alone anywhere else, many countries turned to Chinese and Russian vaccines. Meanwhile, the Covax Facility – the Gavi-backed outfit that actually procures vaccines for poor countries – stuck to its guns and made deals exclusively with western vaccine manufacturers. From those deals, the AstraZeneca vaccine is now the only viable candidate it has. The bulk of the supply of this vaccine comes from Serum, and a smaller quantity from SK Bioscience in South Korea. As a result, a third of all humanity is now largely dependent on supplies of one vaccine from one company in India.

Cue the Indian government’s involvement. Unlike western governments, which poured billions into the research and development of vaccines, there is no evidence that the Indian government has provided a cent in research and development funding to the Serum Institute. (This did not stop it turning every overseas vaccine delivery into a photo-op.) The government then commandeered approval of every single Covax shipment sent out from Serum – even, according to one well-placed source within the institute, directing how many doses would be sent and when.

The Indian government has not publicly commented on its involvement in the vaccine shipments and has refused requests for comment.

Last month, faced with a surge in infections, the Indian government announced an expansion of its domestic vaccination programme to include 345 million people, and halted all exports of vaccines. About 60m vaccine doses have already been dispensed, and the government needs another 630m to cover everyone in this phase alone. One other vaccine is approved for use – Bharat Biotech’s Covaxin – but it is being produced and utilised in smaller quantities. As more vaccines are approved, the pressure on Serum might decrease. For now, however, the bulk of India’s vaccination goals will be met by just one supplier, which faces the impossible choice of either letting down the other 91 countries depending on it, or offending its own government.

The consequences are devastating. To date, 28m Covax Facility doses have been produced by Serum for the developing world – 10m of which went to India. The second largest shipment went to Nigeria, which received 4m doses, or enough to cover only 1% of its population. Given the new Indian government order of 100m doses, further supplies to countries like Nigeria may be delayed until July. And given the Indian government’s need of 500m more vaccine doses in the short run, that date could surely be pushed out even further.

This colossal mess was entirely predictable, and could have been avoided at every turn. Rich countries such as the UK, the US, and those of the EU, and rich organisations such as Covax should have used their funding of western pharmaceutical companies to nip vaccine monopolies in the bud. Oxford University should have stuck to its plans of allowing anyone, anywhere, to make its vaccine. AstraZeneca and Covax should have licensed as many manufacturers in as many countries as they could to make enough vaccines for the world. The Indian government should have never been effectively put in charge of the wellbeing of every poor country on the planet.

For years, India has been called “the pharmacy of the developing world”. It’s time to rethink that title. We will need many more pharmacies in many more countries to survive this pandemic.