Lesson of the Day: ‘Rich Countries Signed Away a Chance to Vaccinate the World’ - Digital Promise Verizon Innovative Learning Schools

Lesson of the Day: ‘Rich Countries Signed Away a Chance to Vaccinate the World’

A protest in Johannesburg in March demanding that companies share vaccine technology and calling for governments to suspend Covid-19 vaccine patent rules. (Joao Silva/ The New York Times)

April 2, 2021 | By Jeremy Engle

Lesson Overview

Featured Article: excerpt from “Rich Countries Signed Away a Chance to Vaccinate the World” by Selam Gebrekidan and Matt Apuzzo

Less than a year after Covid-19 was identified, some leading pharmaceutical companies produced lifesaving vaccines much more quickly than had been thought possible. Currently, 10 different vaccines are being administered around the world. That includes the Pfizer-BioNTech vaccine, found to be 95 percent effective at reducing coronavirus infections, that is being used in 80 countries.

However, the wealthiest countries in North America and Europe locked up orders for most of the supply — enough to vaccinate two and three times their populations — leaving poor countries scrambling to secure their share.

As of March 29, more than 552 million vaccine doses had been administered worldwide. and roughly three-quarters had gone to only 10 countries. At least 30 countries had not yet injected a single person and many developing countries, from Bangladesh to Tanzania to Peru, will most likely have to wait until 2024 before fully vaccinating their populations.

In this lesson, you will learn about the stark gap between vaccination programs in different countries and what is being done to address it. In a Going Further Activity, you will make a recommendation to President Biden about how to tackle global vaccine inequity.

Questions for Writing and Discussion

1. What is a patent? Why do some people believe that a pending new patent might be “the last best chance” for the United States to exert leverage over the drug companies producing Covid-19 vaccines and pressure them to expand access to less affluent countries?

2. What role have governments played in the rapid development of Covid-19 vaccines? Why does the partnership between government and pharmaceutical companies represent a “great triumph,” according to the authors?

3. The rapid development of Covid-19 vaccines in the West has also created “stark inequity.” Give at least two examples of inequality cited in the article.

4. Why are a growing numbers of health officials and advocacy groups worldwide calling on Western governments to use aggressive powers to force companies to publish vaccine recipes? Why do others believe that pressuring companies to share patents could undermine innovation? Which arguments do you find most persuasive?

5. Along with patent restrictions, what other challenges do developing nations face in trying to solve the global vaccine imbalance? Which do you believe is most significant?

6. What steps has the Biden administration taken to address inequalities in global vaccine access and supply? How has President Biden made it clear that his focus is at home, according to the article?

7. What is your reaction to what you have read in this article? How does it help you to better understand the factors creating vaccine inequalities around the world? What questions do you still have?

Going Further

Option 1: Learn more about the human impact of global vaccine inequality

In the related article “Some Nations Could Wait Years for Covid Shots. That’s Bad for Everyone.” Abdi Latif Dahir and Benjamin Mueller write that while richer places, such as the U.S., hope to vaccinate most of their citizens within months, poorer countries, like Kenya, expect to reach just small fractions of their populations in that time:

NAIROBI, Kenya — The nurse lay in bed this month, coughing, wheezing and dizzy with fever.

It was three months after rich countries began vaccinating health workers, but Kenyans like the nurse, Stella Githaiga, had been left behind: Employed in the country’s largest public hospital, she caught the coronavirus on an outreach trip to remote communities in February, she believes, sidelining her even as Kenya struggles with a vicious third surge of infections.

Ms. Githaiga and her colleagues are victims of one of the most galling inequities in a pandemic that has exposed so many: Across the global south, health workers are being sickened and killed by a virus from which doctors and nurses in many rich countries are now largely protected.

Read the entire related article (see full text below), then tell us your reaction: What are the political, economic and health impacts on developing countries that are unable to get access to vaccines, such as Kenya? What is the toll on continents, like Africa, which has 17 percent of the world’s people but so far has administered roughly 2 percent of the vaccine doses given globally? How did reading more on this topic add to your understanding? Did it change your perspective on the featured article? Share three takeaways from what you learned with your class.

Option 2: Make a recommendation to President Biden

The Biden administration pledged $4 billion to the global vaccination drive. In addition, it plans to send millions of doses of the AstraZeneca vaccine to Mexico and Canada and is partnering with Japan, India and Australia to expand global vaccine manufacturing capacity. Do you think America is doing enough to address vaccine access across the world? Or should it be doing more?

If you were advising Mr. Biden, what would you recommend that he do to address the stark inequalities in the global distribution of Covid-19 vaccines? Should he pressure pharmaceutical companies to expand access to less affluent countries? Or is there a better way to close the global gap?

FEATURED ARTICLE

“Rich Countries Signed Away a Chance to Vaccinate the World” (Excerpted)
By Selam Gebrekidan and Matt Apuzzo
March 21, 2021
The New York Times

In the coming days, a patent will finally be issued on a five-year-old invention, a feat of molecular engineering that is at the heart of at least five major Covid-19 vaccines. And the United States government will control that patent.

The new patent presents an opportunity — some argue the last best chance — to exact leverage over the drug companies producing the vaccines and pressure them to expand access to less affluent countries.

The question is whether the government will do anything at all.

The rapid development of Covid-19 vaccines, achieved at record speed and financed by massive public funding in the United States, the European Union and Britain, represents a great triumph of the pandemic. Governments partnered with drugmakers, pouring in billions of dollars to procure raw materials, finance clinical trials and retrofit factories. Billions more were committed to buy the finished product.

But this Western success has created stark inequity. Residents of wealthy and middle-income countries have received about 90 percent of the nearly 400 million vaccines delivered so far. Under current projections, many of the rest will have to wait years.

Growing numbers of health officials and advocacy groups worldwide are calling for Western governments to use aggressive powers — most of them rarely or never used before — to force companies to publish vaccine recipes, share their know-how and ramp up manufacturing. Public health advocates have pleaded for help, including asking the Biden administration to use its patent to push for broader vaccine access.

Governments have resisted. By partnering with drug companies, Western leaders bought their way to the front of the line. But they also ignored years of warnings — and explicit calls from the World Health Organization — to include contract language that would have guaranteed doses for poor countries or encouraged companies to share their knowledge and the patents they control.

“It was like a run on toilet paper. Everybody was like, out of my way. I’m gonna get that last package of Charmin,” said Gregg Gonsalves, a Yale epidemiologist. “We just ran for the doses.”

The prospect of billions of people waiting years to be vaccinated poses a health threat to even the richest countries. One example: In Britain, where the vaccine rollout has been strong, health officials are tracking a virus variant that emerged in South Africa, where vaccine coverage is weak. That variant may be able to blunt the effect of vaccines, meaning even vaccinated people might get sick.

Western health officials said they never intended to exclude others. But with their own countries facing massive death tolls, the focus was at home. Patent sharing, they said, simply never came up.

“It was U.S.-centric. It wasn’t anti-global,” said Moncef Slaoui, who was the chief scientific adviser for Operation Warp Speed, a Trump administration program that funded the search for vaccines in the United States. “Everybody was in agreement that vaccine doses, once the U.S. is served, will go elsewhere.”

President Biden and Ursula von der Leyen, the president of the European Union’s executive branch, are reluctant to change course. Mr. Biden has promised to help an Indian company produce about 1 billion doses by the end of 2022 and his administration has donated doses to Mexico and Canada. But he has made it clear that his focus is at home.

“We’re going to start off making sure Americans are taken care of first,” Mr. Biden said recently. “But we’re then going to try and help the rest of the world.”

Pressuring companies to share patents could be seen as undermining innovation, sabotaging drugmakers or picking drawn-out and expensive fights with the very companies digging a way out of the pandemic.

As rich countries fight to keep things as they are, others like South Africa and India have taken the battle to the World Trade Organization, seeking a waiver on patent restrictions for Covid-19 vaccines.

Russia and China, meanwhile, have promised to fill the void as part of their vaccine diplomacy. The Gamaleya Institute in Moscow, for example, has entered into partnerships with producers from Kazakhstan to South Korea, according to data from Airfinity, a science analytics company, and UNICEF. Chinese vaccine makers have reached similar deals in the United Arab Emirates, Brazil and Indonesia.

Addressing patents would not, by itself, solve the vaccine imbalance. Retrofitting or constructing factories would take time. More raw materials would need to be manufactured. Regulators would have to approve new assembly lines.

And as with cooking a complicated dish, giving someone a list of ingredients is no substitute to showing them how to make it.

To address these problems, the World Health Organization created a technology pool last year to encourage companies to share know-how with manufacturers in lower-income nations.

Not a single vaccine company has signed up.

“The problem is that the companies don’t want to do it. And the government is just not very tough with the companies,” said James Love, who leads Knowledge Ecology International, a nonprofit.

Drug company executives told European lawmakers recently that they were licensing their vaccines as quickly as possible, but that finding partners with the right technology was challenging.

“They don’t have the equipment,” Moderna’s chief executive, Stéphane Bancel, said. “There is no capacity.”

But manufacturers from Canada to Bangladesh say they can make vaccines — they just lack patent licensing deals. When the price is right, companies have shared secrets with new manufacturers in just months, ramping up production and retrofitting factories.

It helps when the government sweetens the deal. Earlier this month, Mr. Biden announced that the pharmaceutical giant Merck would help make vaccines for its competitor Johnson & Johnson. The government pressured Johnson & Johnson to accept the help and is using wartime procurement powers to secure supplies for the company. It will also pay to retrofit Merck’s production line, with an eye toward making vaccines available to every adult in the United States by May.

Despite the hefty government funding, drug companies control nearly all of the intellectual property and stand to make fortunes off the vaccines. A critical exception is the patent expected to be approved soon — a government-led discovery for manipulating a key coronavirus protein.

***

RELATED ARTICLE

Some Nations Could Wait Years for COVID Shots. That’s Bad for Everyone.
By Abdi Latif Dahir and Benjamin Mueller
March 22, 2021
The New York Times

NAIROBI, Kenya — The nurse lay in bed this month, coughing, wheezing and dizzy with fever.

It was three months after rich countries began vaccinating health workers, but Kenyans like the nurse, Stella Githaiga, had been left behind: Employed in the country’s largest public hospital, she caught the coronavirus on an outreach trip to remote communities in February, she believes, sidelining her even as Kenya struggles with a vicious third surge of infections.

Githaiga and her colleagues are victims of one of the most galling inequities in a pandemic that has exposed so many: Across the global south, health workers are being sickened and killed by a virus from which doctors and nurses in many rich countries are now largely protected.

That is just the most visible cost of a rich-poor divide that has deepened in the second year of the pandemic. Of the vaccine doses given globally, roughly three-quarters have gone to only 10 countries. At least 30 countries have not yet injected a single person.

Scientists have long warned that such unfair treatment could not only haunt poorer countries, but also rich ones, if the continued spread of the virus allows it to mutate in ways that undermine vaccines. But the greatest human costs will almost surely be borne by less wealthy nations.

Already, unvaccinated doctors and nurses have died this year in countries including Kenya, Mozambique, Nigeria and Zimbabwe, depleting health systems that can ill afford to lose any more workers and threatening to diminish the level of care in nations overrun by variants.

The toll in Africa could be especially profound. The continent has 17% of the world’s people, but so far, it has administered roughly 2% of the vaccine doses given globally.

“I don’t think we have the capacity, as a country and even as Africa, to treat our own,” said Hazel Miseda Mumbo, vice chancellor of the Great Lakes University of Kisumu in Kenya, who has studied the country’s health system. “While these countries in the West are still scrambling for vaccines, Africa will have to wait. It may be a sad situation.”

In a worrisome sign of how uneven distribution is, even Kenya, one of the continent’s wealthier countries, is faring badly.

The first million COVID-19 vaccine doses arrived just before midnight March 2. The elated health minister, Mutahi Kagwe, said that the country had “been fighting this virus with rubber bullets,” but now had finally acquired the metaphorical equivalent of “machine guns, bazookas, and tanks.”

But that arsenal was not all it appeared to be. The doses were a month late, and a quarter of what had been promised. India recently stepped in with a relatively small, but welcome, addition of 100,000 doses. Kenya has no idea when exactly the next batch of vaccines will arrive.

Even under the best of circumstances, the country is expecting to inoculate only 30% of its people, or about 16 million out of almost 50 million, by the middle of 2023. When the rest of the population will get their shots is anybody’s guess.

The initial shipment of doses is being doled to health care workers and other essential workers.

For the health workers who have been trying to manage a tenfold increase in daily cases since late January, the initial shots arrived only after the illness did. Githaiga watched from her sickbed as the news media showed health officials and fellow nurses and doctors receiving their shots.

“There was so much shock and anxiety dealing with this virus in the past year,” said Githaiga, who was recently released after a week in the hospital. “So how ironic that I was sick on the day the vaccine rolled out. I felt left out.”

For wealthy countries, Kenya’s inoculation timeline is unthinkable. Waiting months seems hard enough, especially with dangerous variants circling the world. President Joe Biden has promised to have vaccines for all adults in the United States by the end of May. Israel has vaccinated 60% of its people, and Britain has inoculated 41%.

Like many developing countries, Kenya is relying on the global mechanism for procuring and distributing vaccines known as COVAX. The program was built on the idea that many countries, including richer ones, would use it to purchase shots as a way of spreading their bets across vaccine makers. Instead, dozens of wealthy nations bought doses straight from pharmaceutical companies, elbowing the international effort out of the way and delaying shipments to the developing world.

Still, analysts said, poorer countries are in a stronger position than they would have been without the effort. COVAX is aiming to cover at least 20% of people in participating countries by the end of the year.

In Kenya, stringent restrictions — lockdowns, curfews, flight suspensions and school shutdowns that eventually forced children to repeat the school year — kept the virus from overwhelming the country last year, as did its relatively young population.

But control measures like lockdowns, available to rich and poor countries alike, are no longer the best defense against the coronavirus. The most valuable currency is now vaccines, opening a yawning gap between those that can afford them, and those that cannot.

The pandemic has worsened in Africa since a variant first seen in South Africa, shown to be able to reinfect people, began driving up cases in southern parts of the continent.

“Before that, it was believed that Africa had escaped this pandemic,” said Tulio de Oliveira, a geneticist at the Nelson Mandela School of Medicine in South Africa. “Unfortunately, it didn’t.”

With cases soaring in Kenya, vaccine delays will cost more lives. The number of reported COVID-19 cases — more than 120,000 infections that have led to around 2,000 deaths — is thought to be an undercount.

The country was expecting more vaccine doses from COVAX. But its health officials had also hoped that the country’s close security and trade relations with the European Union and Britain would help it secure vaccines. Kenya had also ignored other countries’ worries about being used as “guinea pigs” and participated in vaccine trials, raising expectations for earlier shipments.

“The clinical trials resulted in vaccines,” said Dr. David Ngira, a postdoctoral researcher in global health law at Cardiff University, who has been tracking vaccine rollouts in Africa. “And on this premise, the Kenyan participants, as well as the surrounding communities and country at large, should have been given some priority in vaccine access.”

But that has not happened. Even Kenya’s low expectations have been scaled back: A promised 4.1 million doses from COVAX by May has been cut to 3.6 million doses. The country has ordered a total of 24 million doses.

Health officials say they are grateful, but even COVAX shots come with a hitch. Vaccines covering the first 20% of Kenya’s population were free, but only on the grounds that the government pay for enough doses to cover another 10% of its people.

For Kenya, that bill is expected to run close to a budget-straining $130 million.

An African Union vaccine task force is trying to lighten the burden by helping countries access enough doses to vaccinate 60% of the continent’s population by mid-2022.

Vaccine delays are expected to cause economic devastation far beyond those countries that are short on doses. In the most dire scenario envisioned by one group of researchers, with poorer countries largely shut out from vaccines this year, the global economy could suffer losses exceeding $9 trillion, nearly half of which would fall on rich countries like Britain, Canada and the United States.

In Africa, though, the costs of the slow rollout to people and to health systems are already soaring.

In late January, a heart specialist in Zimbabwe — a mentor to younger doctors and a pillar of the country’s health system — was killed by COVID-19. That same month, a senior doctor in northern Nigeria died from the virus, confined to an isolation center.

Kenya’s health system was already hobbled last year by mistreatment of doctors and nurses. Many health workers, unpaid for months in some cases and often given inadequate protective equipment, walked off the job, forcing some hospitals to go months without nurses. One had to close its COVID-19 isolation unit and send patients home. In December, a 28-year-old doctor died from COVID-19 after having worked without a salary for months.

“It’s a moral emergency to protect health workers worldwide,” Gavin Yamey, associate director for policy at the Duke Global Health Institute, said. “Sickness and death of health workers in systems that are already weak could exacerbate those problems even further.”

For Nyachira Muthiga, a public hospital doctor who worked on a COVID-19 ward in Nairobi last year, the arrival of Kenya’s first vaccines brought a sense of relief. But the crushing experiences of the last year have made her wary.

Before contracting the illness herself, she lost many patients. Substandard protective equipment left her vulnerable, she said. And reports of corruption that cheated hospitals of much-needed money, she said, broke something in her.

Though she got the vaccine last week, she worries that those same endemic problems in the health system — combined with vaccine hoarding by rich nations — could put shots out of the reach of ordinary Kenyans for much longer.

“I am still hopeful,” she said, “that the health of our citizens will be a high priority at some point.”

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