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The promise and reality of vaccination

28 March 2021

The roll out of vaccination programmes across the world has raised hopes that the end of the Covid pandemic may be in sight.  There are a number of vaccines currently in use – and more awaiting approval – that have proven to be effective and safe.  Mass vaccination on a global scale has the potential to dramatically reduce rates of transmission as well as serious illness and death.  It won’t eliminate the virus completely but it will greatly assist in moving to a stage in which the pandemic is under control and some form of normality can return to society.

Inequality

This the best-case scenario but it is not the only one.  The opening paragraph of this article outlined the potential of mass vaccination.  However, that potential is being seriously undermined by a number of factors.  The most glaring of these are the massive global disparities in the roll out of vaccination programmes.   According to the United Nations 75 percent of all COVID-19 vaccine doses administered to date have taken place in just 10 countries.  In 130 countries vaccination hasn’t even begun.  Despite rhetoric on international co-operation the wealthiest countries have focused almost exclusively on securing vaccines for their own populations.   International initiatives such as the Access to COVID-19 Tools (ACT) and COVAX - the multilateral mechanism created by the World Health Organization together with the Coalition for Epidemic Preparedness Innovations and Gavi, the vaccine alliance to ensure that vaccines reach all people everywhere - have received limited support.  COVAX is struggling to purchase enough doses to cover just 20 percent of the population of lower-income countries by the end of 2021.  On current trends most wealthy countries will fully vaccinate their population this year, while lower-income countries may not achieve mass immunisation until 2024.

Vaccine nationalism

This approach to the pandemic has been described as “vaccine nationalism”.   This occurs when governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries.  Moreover, vaccines are being hoarded by a small number of states that have purchased volumes of vaccines well in excess of what is required to vaccinate their populations.  The US has ordered 1.1 billion vaccine doses, almost double what is required to vaccinate the US population. The EU has agreed to purchase 600 million doses from Pfizer, 160 million from Moderna, 400 million from AstraZeneca, 400 million from Curevac, another 400 million from Johnson & Johnson, and 300 million from Sanofi — a total of 2.26 billion doses. This is almost three times the total population of the 27 EU countries.  The UK, Japan, Canada, and Australia have also ordered more doses than needed to protect their populations.  These states hold about 56 percent of the world’s COVID-19 vaccine supply despite making up only 16 percent of the global population.  This hoarding has restricted the supply of vaccines and also increased prices for poorer countries. For example, South Africa paid double what the European Union did for the AstraZeneca vaccine.

What has followed from vaccine nationalism is vaccine imperialism in which the supply of vaccines is bound up with geo-political rivalries.   This was demonstrated in the recent initiative by G7 leaders to boost supplies to COVAX.  However, this display of “internationalism” wasn’t all that it appeared.  First of all, it was completely inadequate with the G7’s proposals coming nowhere close to meeting what is required.  Secondly, the offer of vaccine donation amounted to nothing more than offloading surplus doses at a point the future when it was absolutely certain they were no longer needed.  On closer inspection it was not even a donation with lower income countries being expected to pay for these cast offs.

The motivations for such a proposal are utterly cynical.   One is to counter the influence of countries such as China and Russia who are distributing their own vaccines globally.  The G7 fear losing the current diplomatic battle and their power over the Global South being diminished in the longer term.   The other motivation is to deflect outage over vaccine inequality that has seen growing support from governments and health experts for the proposal by India and South Africa to scrap patents on COVID-19-related medicines and allow them to be produced on a much wider scale.   The G7 leaders are stalwart supporters of the intellectual property system which benefits the pharmaceutical industry, and they’re determined to see off anything that would diminish its profits.

Patents

The issue of patents and intellectual property (IP) doesn’t get much attention but it is a key element in limiting production and restricting access to vaccines.   A transfer of technology and IP would enable poorer countries to scale up vaccine production.  The proposal submitted by South Africa and India to the World Trade Organization (WTO) would have allowed a temporary waiver of provisions of the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS) for COVID-19-related technologies.   Despite the waiver proposal being supported by nearly 100 countries it was vetoed by the EU, US, UK, Japan and several other states.  The rejection of such a modest proposal demonstrates the degree to which states and trade blocs are intertwined with the commercial interests of the pharmaceutical industry.  Another example of this was the refusal of the government of Finland to support research on the development of a patent free vaccine.  The medical necessity for mass vaccination on a global scale is overridden by the capitalist imperatives of private ownership and profit maximisation.

The increasing dependence of the pharmaceutical industry on patents and IP to maintain profitability is part of the broader trend of financialization that has been taking place within the capitalist economy for the lost forty years.  This has seen a shift away from production towards rent seeking activities.   In the pharmaceutical industry copyrights and the licensing of products are the primary mechanisms for this.  Another – common across all sectors - is the inflation of stock through buy backs.  Last year pharmaceutical industry executives made half a billion dollars selling rapidly inflating corporate stock.

A consequence of all this is a reduction in the productive capacity of the industry as investment is diverted into non-productive areas.  This is the main reason for the supply problems we have seen with vaccines.  Companies have taken orders for vaccines that they have been unable to fulfil (this is the at the bottom of the dispute between the EU and AstraZeneca).   As it stands manufacturers are producing only a fraction of these products which are needed so desperately.

Capitalist myths

Despite the many problems attached to vaccine production we are continually told that it a testimony to the dynamism of the capitalist economy and the innovation of corporations.   British PM Boris Johnson has credited the “energy of capitalism” and “greed” for the relative success of the UK’s vaccination rollout.

However, such a presentation as capitalism as the savoir of humanity is far from reality.  It can only be advanced by the perpetuation of a number of myths.  The first one is that private enterprise is the only effective source of innovation.   This is a dubious proposition for many sectors of the economy but especially so in relation to the pharmaceutical industry. In the decades prior to the current pandemic vaccine development had a low priority because it was an area that was seen as insufficiently profitable.  For example, despite repeated outbreaks of Ebola virus in West Africa there were no serious efforts to develop a vaccine against it until after the epidemic of 2014. In this period companies were mostly focusing on the application of the mRNA technology in drugs rather than vaccines. The rapid development of Covid-19 vaccines came only in the wake of significant financial investment by governments.  Moderna received $2.5 billion in government assistance.  The Pfizer vaccine is based on applications of public research developed by the German firm BioNTech.  In addition to ongoing support the company received $450 million from the German government specifically to work on a Covid vaccine.

State intervention was the key driver of vaccine development.  Public funding of research; legal indemnities; guaranteed prices and sales have created an environment in which pharmaceutical companies can launch a new product with greatly reduced costs and zero risks.   While this level of intervention may have expanded during the pandemic it is not really a departure from the norm.   What falls under the banner of “private” pharmaceutical research has been majority public funded for a long period of time.  Just consider the funding that goes into universities, scientific institutions, education, and basic research.  It is this store of public knowledge that underpins innovation.

The second myth is that unregulated markets are best at managing supply and demand and achieving an optimal disruption of goods.  However, the experience of the pandemic has shown that this is not the case.  This was evident in early 2020 when countries started to outbid each other for vital medical equipment, such as PPE and ventilators.  Despite demand being high across the world supply only went to the few at the cost of many lives.   It is the same with vaccines.  As described earlier in this article the supply of these products has been restricted and their distribution has been very unequal.  Amid severe undersupply of vaccines, governments are scrambling to secure enough doses for national use.  This has resulted in populations at most risk from the virus being the least protected.  In medical terms this is not an optimal distribution.

The end of the pandemic?

Vaccines alone will not bring and end to the pandemic but - in combination with other public health measures - they can be a powerful tool in bringing the virus under control and greatly reducing deaths and serious illness.   However, this potential is being distorted and undermined by the dynamics of capitalism; by chauvinistic nationalism; and by imperialist intrigue.

All of this has created a “vaccine apartheid” which threatens to undo any advances that have been achieved.  The national approach adopted by many governments misses the way pandemics actually develop. The rapid spread of Covid-19 from its origins in China to the whole of the globe deconstrues that no nation can insulate itself.  Even countries that have achieved high levels of vaccination are not safe.  If there are large population pools where the virus is still spreading and mutating there is a real risk that vaccine resistant variants could emerge.  We have already seen this trend with the emergence of more contagious strains that quickly became the dominant in wide regions of the world (for example the so-called Kent mutation is now dominant across Europe).

The emergence of vaccine resistant strains is a worst-case scenario. But if even this does not prevail Covid 19 will continue to be a feature of life for the foreseeable future.  The most likely scenario is that it becomes an endemic coronavirus that gives rise to large numbers of seasonal infections.  People who have been vaccinated or previously infected will have some measure of immunity and their infections will be mild.  Unvaccinated people and those whose immunity isn’t protective may become seriously ill.  Elderly people and those with certain underlying condition will need a regular booster.   While this sounds similar to the annual flu it should not be dismissed lightly. (for example, in the UK a bad flu season can result in the death of up to 30,00 people).

Solidarity

In the current situation the left should be arguing for the maximum degree of co-operation between nations in order to bring and end to the pandemic.  In terms of vaccination the call should be for an international approach that coordinates a vaccine rollout across every continent at the same rate.  However, we must also recognise that there are powerful forces pushing against this.  We must therefore raise broader demands around ownership and control that challenge capitalism and imperialism.  In the pandemic crisis we have glimpsed the potential of medical science to service humanity.  Yet within the current system that potential will only be partially realised at best.   For humanity to advance socialism and solidarity must prevail over capitalism and greed.
 

Sources

A call for global vaccine justice
https://www.aljazeera.com/opinions/2021/2/24/a-call-for-global-vaccine-equity

What the vaccine debacle tells us about predatory capitalism
https://www.aljazeera.com/opinions/2021/2/21/the-vaccine-debacle-shows-the-predatory-nature-of-capitalism

System change, not charity, will end the vaccine apartheid
https://www.aljazeera.com/opinions/2021/2/26/system-change-not-charity-will-end-the-vaccine-apartheid

Finland Had a Patent-Free COVID-19 Vaccine Nine Months Ago — But Still Went With Big Pharma
https://www.jacobinmag.com/2021/02/finland-vaccine-covid-patent-ip

Vaccine nationalism will leave everyone more at risk of coronavirus
https://www.newscientist.com/article/mg24933201-800-vaccine-nationalism-will-leave-everyone-more-at-risk-of-coronavirus/

'Vaccine nationalism' echoes the disastrous mistakes made with HIV
https://www.theguardian.com/commentisfree/2021/feb/02/vaccine-nationalism-hiv-covid

Against Capitalist Irrationality: For the Abolition of Patents, and Vaccines for All
https://www.leftvoice.org/against-capitalist-irrationality-for-the-abolition-of-patents-and-vaccines-for-all

Eeek!
https://www.lrb.co.uk/the-paper/v43/n05/rupert-beale/eeek
 


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