Sacred Headwaters #36: Vaccine Apartheid
Locking vaccine production down with intellectual property restrictions is devastating the Global South and driving mutation. Everyone seems to agree. So why aren't we waiving them?
Sacred Headwaters is a bi-weekly newsletter that aims to guide a co-learning process about the existential issues and planetary limitations facing humanity and about how we can reorient civilization in a way that will enable us to thrive for centuries to come. If you’re just joining us, consider checking out the first issue for some context and head over to our table of contents to browse the whole library. The newsletters are not strictly sequential, but this exploration is meant to build on knowledge and understanding over time. Subscribe below if you haven’t already, and please share with friends, family, and colleagues who may be interested:
Table of Contents
Sacred Headwaters has a table of contents intended to allow readers to “catch up” more effectively, to facilitate using Sacred Headwaters as a reference, and to give a better picture of what the newsletter is about for those who are just joining.
Issue #36: Vaccine Apartheid
At this point, most of us have probably seen the Economist graphic that’s floated around or at least are familiar with its message:
They state the message quite clearly in the figure’s header: “Rich countries will get access to coronavirus vaccines earlier than others.” With Canada as a slight exception, western and northern Europe and the United States — effectively, the Global North — will be fully vaccinated this year, while the rest of the world waits as much as two more years.
There are a variety of fairly obvious implications. Vaccine scarcity is engendering humanitarian disasters like India’s currently unfolding crisis — and of course, it’s happening along the exact same geographic lines as the devastation of the last 500 years of colonialism and imperialism and the ever-worsening impacts of the climate crisis. We have a clear moral imperative to do whatever we can in the north to mitigate and rectify these disasters.
But even from a sort of realpolitik perspective, it makes sense for northern countries to pull out all the stops to provide vaccine access to the rest of the world. The nature of our global civilization implies that a pandemic isn’t over anywhere until it’s over everywhere. Even worse, the longer the virus circulates en masse, the more likely it is that variants will develop that are more infectious, more deadly, or more likely to escape current vaccines.
In short, there is both a moral case and a pragmatic case for doing everything we can to make vaccines available globally, as soon as possible. This case is so strong that even traditional bastions of liberalism like the New York Times editorial board have come out imploring the Biden administration to do far more to support vaccine rollout in the Global South.
We don’t typically read about things that the Times editorial board supports in this newsletter because the Times is, in many ways, the voice of power, predominantly arguing in favor of the status quo and against the kind of radical change we need to thrive in the face of global ecological crisis. But that’s why I think this is worth diving into: even the powerful appear to support a radical democratization of vaccine technology, for what are practical and virtually incontrovertible reasons. I haven’t seen a single argument against suspending vaccine intellectual property (IP) rights that didn’t come directly from a pharmaceutical executive, which is remarkable. But somehow, despite a few rumblings in the right direction from the Biden administration, we’ve seen no progress on this front from the countries blocking global efforts to expand vaccine production. Why?
In an effort to understand this and to understand where the effective leverage points may be, this issue will explore what the international mechanisms limiting global vaccine supply are, where and when they came from, and what’s stopping them from being suspended, even temporarily. Is this global intellectual property framework a keystone for global capitalism without which the entire modern system of pharmaceutical innovation would fall apart? Or was it deliberately architected by industry executives just a few decades ago and propagated worldwide using the forceful arm of the US government? (Spoiler alert, it’s the latter). It is hard to observe what’s happening and to hear the blunt way that Pfizer executives talk about its pandemic profits and not come away with the grotesque suspicion that pharmaceutical companies may be deliberately creating the conditions for vaccine escape in order to secure an indefinite stream of profits from extorted governments.
I should note that most of you live in the countries that are actively blocking the relaxation of IP restrictions and the sharing of vaccine technology: US, UK, Canada, and a few others. Please consider contacting your representatives and supporting campaigns that are fighting for this, for all of our sake.
The World Needs Many More Coronavirus Vaccines (10 minutes)
The New York Times Editorial Board
As I mentioned in the introduction, over the weekend, the Times editorial board published a piece calling for a variety of measures geared towards increasing vaccine supply and making vaccines available for the Global South. They are rather late to this game — South Africa and India petitioned the WTO to waive TRIPS, the pertinent piece of international intellectual property regulation — six months ago, but the piece is succinct and summarizes many of the issues at play and gently but clearly points out some of the ways that companies like Pfizer are driving the scarcity crisis. They give relatively short shrift to the TRIPS issue and we’ll go into that in a bit more detail below, but some of their other points stuck out. First, “liability protections” are hindering vaccine rollout both because the US government’s contract with Pfizer has prevented it from distributing surplus vaccines to other countries and because Pfizer is forcing Global South governments into truly remarkable arrangements in order to get vaccines. The Bureau of Investigative Journalism found that in at least one case, Pfizer’s demands delayed a country’s vaccine deal for three months, and in others, they have prevented a deal from being reached at all. Second, the US used the Defense Production Act to block exports of certain raw materials that are used in vaccine production and those embargoes are still in place (though they’ve been partially lifted as of the time of writing on Sunday morning).
I can’t resist pointing this out, too: in reference to Africa and Latin America’s lack of vaccine production, the Editorial Board writes, “The reasons for this shortcoming are complex — a longstanding underinvestment in regional capacity combined with an overreliance on multinational corporations.” It’s a remarkable hand-wave that makes no effort to interrogate the causes or the culpability of institutions like the Times in having propagated the global development paradigm over the last seven decades.
WTO COVID-19 TRIPS Waiver Proposal: Myths, realities and an opportunity for governments to protect access to medical tools in a pandemic (20 minutes)
Médecins Sans Frontières / Doctors Without Borders
TRIPS is a piece of international intellectual property regulation built into the World Trade Organization (WTO). South Africa and India requested a waiver on TRIPS — a protocol built into the agreement for situations just like this one — in October 2020 in an effort to democratize access to vaccine technology (and other COVID-19-related public health products). In this report, Doctors Without Borders identifies a number of claims made to advocate against the TRIPS waiver and explains why they’re wrong. It includes a number of frankly disgusting examples of pharmaceutical companies and manufacturers leveraging intellectual property law to block development of or even shut down existing production of medical technologies, including a sort of hilariously awful example in Italy last year: in the face of shortage, 3D printers built replacement valves for ventilators and were threatened with legal action by the patent-holders. It’s also remarkable to read that the pharmaceutical industry has refused to engage with C-TAP, the WHO’s technology sharing initiative. There are a lot of moving parts to the international intellectual property regime, but the summary here is this: a handful of wealthy Global North countries are blocking the exercise of a mechanism created specifically for circumstances like this one and, in so doing, they are limiting global vaccine manufacturing capacity.
Expanding Intellectual Property's Empire: the Role of FTAs (15 minutes)
Peter Drahos. Sections 1 + 2.
This is where things start to get rather interesting. What is TRIPS, and frankly, how did we come to have a comprehensive global governance structure for intellectual property rights? This question is particularly important in this context. It’s clear that waiving TRIPS would help scale up vaccine production around the world. But surely TRIPS and the broader global IP regime is an integral part of the system that has enabled the innovative capacity of Western medicine? The previous reading provides one answer to this by pointing out that, like much of modern technology (at least according to economists like Mariana Mazzucato), medical innovation is largely funded by public sources. But TRIPS, as the first foray of international trade agreements into IP regulation, provides a fascinating window into another answer: that the international IP regime is both recent and predominantly a result of regulatory capture, architected by the very companies that are profiting from it today.
I’ll try to hit a few of the key points here, but I would highly recommend reading the piece itself as it’s fascinating. In the run-up to the eight-year trade negotiations that ultimately created the WTO (in 1994), a group of US companies, prominently including Pfizer, led a broad lobbying effort to push for the inclusion of intellectual property protections in trade negotiations — something that had not been on the table because of the implied infringement on national sovereignty that would bring. As Drahos notes, this went well beyond what we traditionally understand as lobbying (and don’t worry, Pfizer is doing plenty of that). The Pfizer CEO sat on the Advisory Committee on Trade Negotiations created by the US Congress; the Pfizer President was on President Reagan’s Council on Competitiveness; Pfizer’s General Council Chaired the Intellectual Property Committee of the US Council for International Business; and Pfizer International’s President was Chair of an advisory committee to the OECD. Pfizer and other US chemical and pharmaceutical manufacturers (like DuPont) worked on an international basis to lobby key players in international trade negotiations to support including IP protection as part of the next round of trade agreements. Ultimately, Pfizer created another Intellectual Property Committee that wrote a draft agreement on IP that informed TRIPS.
TRIPS was just the beginning, and in the nearly three decades since, the US has leveraged trade policy to strengthen intellectual property protections — protections that apply predominantly to US-produced knowledge — around the world, and companies like Pfizer continue to lobby for stronger-still IP protection.
This is a remarkable story and it speaks to a few issues. First, it’s a clear example of how global capitalism represents not the global application of a “free market” ideology, but rather, the creation of markets through the use of state power and regulation. You could argue this is a unique situation, but that leads me to the second issue, which is how plainly this story lays out the influence of private companies on governance. The author calls it “nodal governance” which he defines in another paper as, “an elaboration of contemporary network theory explaining how a variety of actors operating within social systems interact along networks to govern the systems they inhabit.” Basically, that we are not actually governed by government, but by a complex interaction of many actors (including government) — in this case including Pfizer and a cadre of other large corporations. Whatever you call it, the fact that a small handful of pharmaceutical companies are today making massive excess profits by restricting vaccine supply during a global pandemic explicitly because of a set of international agreements that they helped write seems like a very strong signal that we’re not doing this governance thing right.
PODCAST: Global Vaccine Apartheid with Achal Prabhala (1:50 hours)
The Dig. Astra Taylor interviews Achal Prabhala.
Prabhala has been working on international access to medicine through reforming intellectual property regimes for a long time and brings a broader context to the coronavirus vaccine question. We’ve mostly focused on how international IP regimes limit access to medicine in the Global South and Prabhala pulls no punches on that front, but he also makes it clear how IP regimes can restrict access for poor people in the Global North (remember when Bernie Sanders took a bus of diabetics to Canada to buy insulin?). He also makes compelling connections to the HIV/AIDS crisis and explores how IP regimes cause harm both to people in the US and around the world in that crisis.
He and Taylor’s conversation covers most of what we’ve already read about in this issue from the unjust lines of the international vaccine rollout to Pfizer’s role in the development of TRIPS and the refusal by Global North countries to waive TRIPS during the pandemic. It also touches on a few other things including the role Russia and China’s vaccines are playing and the faltering mechanics of the global vaccine sharing initiative, COVAX. This episode really covers the breadth of the inequity — and, frankly, inefficiency — of global IP regimes and expresses the urgency that the current crisis begets.
Action Resources
The People’s Vaccine campaign
Public Citizen’s “Making medicine affordable” campaign
Doctors Without Borders’s “Access Campaign”
Other Notable Resources
Like what you’re reading here?
Sign up now so you don’t miss the next issue and consider forwarding this email to a friend or colleague.
Curious if you have read Rigged by Dean Baker? I've only read an excerpt that addresses innovation and patents/copyrights. He makes the case that although U.S. intellectual property law has gotten stronger over the years, it hasn't actually resulted in more innovation/growth, with a particular focus on the medical and software industries.