A recipe for hope: How to vaccinate the world and end the pandemic

There is new reason for hope in ending unequal vaccine access and finding a global resolution for the pandemic. Researchers at Baylor College in Texas have developed a vaccine based on established technology and common handling and refrigeration techniques. Best of all, they have no intention of filing a patent but have concrete plans for large-scale manufacturing in the Global South.  

While prior vaccine development occurred with stunning speed, supply has overwhelmingly favoured high-income countries and, as a result, lengthened the pandemic for all. This, despite research and development that has been heavily subsidized by the public, who have paid again and again for the end product. Moderna has been the recipient of billions of dollars from the U.S. government; the Pfizer-BioNTech vaccine counts the German public as a research sponsor.

Yet, despite the enormous sums of public money spent to support vaccine research and development, public health has not been the driver for distribution decisions.

It is a painful irony that a patent-free vaccine has been financially supported by private philanthropy while public funds have facilitated patented technology. Shouldn’t publicly funded products belong to the public? At a minimum, shouldn’t we temporarily waive intellectual property rights via the TRIPS waiver so that vaccines can be available to fight the global pandemic?

Protected by patents and controlled by a few large producers, the first vaccines were promised and sold to the highest bidders. Low- and middle-income countries have been an afterthought, despite organizations like the African Union and countries like Bolivia that are willing and ready to purchase vaccines themselves. Even when many high-income countries have engaged in charity-by-vaccine, doses are delivered just prior to expiry, without time for receiving countries to plan and communicate vaccination campaigns and resulting in enormous waste.

Wealthy countries are now undertaking fourth doses for some of their citizens, while fewer than 10 per cent of people in low-income countries have received at least a single dose. Canada has now administered more third doses than we have donated through COVAX, the global vaccine access mechanism. Yet, variants of concern emerge anywhere that the virus is replicating unabated – and threaten all of us.

Canada needs publicly funded development and domestic production facilities that can make the connection from innovation to patient-ready products with an emphasis on equitable access. Canada does not currently have its own capacity for vaccine production, resulting in our aggressive international buying spree. Geographically distributed manufacturing facilities are vital to provide insurance against local disaster and global monopolies. The purpose is public health; people-focused goals rather than competition and profit.

Let us be clear: To date, the current system has not delivered a public-health and equity-based solution. It has pitted countries against each other in a zero-sum game, outbidding one another, stockpiling vaccines and, when it suits them, charitably donating leftovers. The pharmaceutical industry has admitted its failure to provide global, equitable supply.

Thirty Canadian health organizations and more than 600 health professionals have called on the Canadian government to follow the recipe for hope started in Baylor College by:

• Supporting a TRIPS waiver, recognizing that public health supersedes intellectual property rights;
• Urgently supplying COVAX with adequate notice of quantities and logistical material;
• Reconsidering manufacturing facilities, transferring technical knowledge and creating mechanisms to ensure equitable public benefit of innovative medical technology.

The COVID-19 pandemic is not over. It will not be the last global health emergency we face together: The climate crisis is already here, disrupting supply chains and increasing the threat of zoonotic spillover events and future pandemics. As physicians, we know that providing health care through floods, fires and future pandemics will require the most stable and equitable pharmaceutical supply possible. This requires a new model for developing, producing and distributing drugs and vaccines that recognizes our common public health problems and the need for global solutions.

Addressing vaccine inequity head-on is a test of our ability to act on a grand scale to face other global health challenges. We can build hope and trust by delivering safe and effective vaccines to everyone in the world.