In the global race to break free of the COVID-19 pandemic, a handful of rich countries have bought themselves a head start. Countries representing less than 20 per cent of the world’s population have secured 60 per cent of the world’s vaccine supply, according to Tedros Adhanom Ghebreyesus, director-general of the World Health Organization. Canada is at the front of the pack, having bought the most doses per capita in the world.
You wouldn’t guess Canada was a vaccine hoarder by the public statements of its politicians. Last July, Prime Minister Justin Trudeau, along with other world leaders, penned an op-ed saying, “we must urgently ensure that vaccines will be distributed according to a set of transparent, equitable and scientifically sound principles. Where you live should not determine whether you live.” He later signed a G20 Leaders’ Declaration calling mass immunization a “global public good.”
Months later, it’s unclear how Canada plans to act on this promise, or even whether it wants to. The government boasts about how many vaccines it has bought, while refusing to say what it will do with a surplus — an outcome International Development Minister Karina Gould describes as “hypothetical.”
The COVID-19 Vaccine Global Access Facility (or COVAX) is the international mechanism intended to facilitate, among other things, the distribution of doses to countries that lack supply. Established last year as part of international efforts to overcome the pandemic, COVAX sought to consolidate vaccine procurement plans from around the world into a common financing system. The idea then was to build a strong and unified pool of funds that would diversify the portfolio of vaccine candidates available to all COVAX members and ultimately help fund and distribute vaccines to at least 20 per cent of the population in low- and middle-income countries.
The plan, however, soon collapsed, and so too did the sandcastle that Canada and its international partners built on slogans like “building back equal.” Countries that had the means cut to the front of the queue and negotiated their own deals with pharmaceutical companies by paying more than what COVAX was offering. The move crippled the world’s bargaining power with vaccine makers and has allegedly exposed countries in the Global South to what one government health official described as “high-level bullying” as they negotiate unfair contracts with manufacturers to secure vaccine doses at all costs for their population. It has also undermined global solidarity for pandemic recovery at a time when it was needed most.
As a result, despite a continued stream of piecemeal financing commitments — including significant contributions from Canada — COVAX continues to be set back by shortfalls in funding and delays in the rollout of even its first doses. Bewilderingly, Canada has opted to take 1.9 million vaccine doses from the global distribution mechanism, leaving fewer jabs available for countries that are entirely reliant on COVAX. Such a move might have been understandable had all rich countries merged their vaccine procurement efforts into COVAX, as initially hoped. Under current conditions, however, the avarice cannot be more apparent.
One attempt to overcome this “me first” attitudes on the part of the rich countries is the call by South Africa and India, supported by over 100 mostly low- and middle-income countries, for a temporary waiver of the intellectual property rights set out in the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property (TRIPS Agreement). Under the TRIPS Agreement, companies that develop new medical products including drugs, vaccines and devices, have up to a 20-year monopoly on the product. The result is that, until the patent expires, no one else can make the same product unless the company owning the patent agrees. With a waiver in place, the number of plants producing vaccines could increase.
According to a report from the Associated Press, there are factories on three continents that could make the vaccines within three to four months if the large pharmaceutical companies shared the necessary knowledge. But the proposed waiver is being blocked by a handful of wealthy countries, including Canada, that argue flexibilities already incorporated into the TRIPS Agreement make it unnecessary. But these flexibilities can only be applied on a country-by-country basis, slowing down the process and delaying the production and delivery of a vaccine to the countries that need it the most.
Waiving intellectual property rights is only part of the equation. We cannot increase vaccine supply without worldwide expansion of production capacities. One way to facilitate this is through the COVID-19 Technology Access Pool (C-TAP), formally launched in May by the World Health Organization. The overall aim of C-TAP is to promote open innovation, pooling not only research outcomes and intellectual property rights but also manufacturing processes and other kinds of “know-how.” C-TAP has the backing of 40 countries, but Canada is not one of them. No pharmaceutical company has donated to C-TAP and one industry CEO called the concept “nonsense” and “dangerous” because C-TAP challenges the system of incentivization that the industry regards as vital to its existence.What gets left out of these alarmist statements is the upfront public investment and risk-sharing that spurred industry innovation on COVID-19 vaccines in the early stages of the pandemic. By one conservative estimate, vaccine makers received up to $US10 billion from the public and non-profit sectors last year.
At the upcoming Council for the TRIPS Agreement on March 10–11, Canada has an opportunity to lead by example to equitably steer the world out of the current crisis, setting a new precedent for solidarity in the face of pandemics that lie around the corner. Instead, it has opted for complacency, in line with its historical tendency to remain neutral at best whenever the world has faced a tension between corporate interests on one hand and access to medicines and collective security on the other. Viewed from this perspective, being one of the world’s top donors to COVAX seems less like a badge of honour and more like an alternative to the hard work of changing the rules of the game. The game-changing scenario for the Global South, in the words of one diplomat, is not to receive “second-hand vaccines set to expire soon” but to ramp up capacities for significant local production.
Making haste to inoculate the world doesn’t just test the international community’s moral compass — it is also smart science. As the newly appointed head of the World Trade Organization, Ngozi Okonjo Iweala, has explained, ongoing mutations of the virus mean that “no country can feel safe until every country has taken precautions.” Variants will continue to spawn so long as the virus is circulating unchecked in any part of the world, and vaccine-resistant variants are a near-term possibility. Sooner or later, those mutations will make their way back to Canada, and if they have changed enough, the current vaccines may not be enough to protect us.
Global vaccine equity also makes economic sense. The global economy stands to lose as much US$9 trillion — with half of this cost borne by wealthy countries like Canada — if we fail to end this health crisis expediently for all countries in the world. To do so, Canada should support the TRIPS waiver that aims to remove intellectual property barriers to global vaccine equity, and it should endorse the COVID-19 Technology Access Pool that facilitates knowledge-sharing for local production capacities. These will only be the first steps to deliberate and committed diplomatic action on vaccine equity.
It is impossible to win a race if one is confused about who the competitors are. Rather than compete with other countries, Canada should realize that it is in a race against time that can only be won with bold political will, international collaboration and solidarity. This race won’t be won when most Canadians are vaccinated. It will be won when most everyone in the world is.
Roojin Habibi is a fellow at the Canadian International Council. Joel Lexchin is a professor emeritus in the School of Health Policy and Management at York University.