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Vaccine inequities expose fault lines in North-South collaboration

Ernest Aryeetey, Eivind Engebretsen, Åse Gornitzka, Peter Maassen and Svein Stølen  

The gigantic global scientific efforts to develop a vaccine to mitigate the devastating impact of COVID-19 on societies have reached a point where the mass production and use of effective vaccines are a reality. But, in the subsequent race that is unfolding to produce and purchase vaccines, the gross global inequalities in the access to vaccinations, as well as in the science that makes that possible, have been exposed.

Currently, high-income countries have bought most of the doses of COVID-19 vaccines that will be produced in 2021. For example, Canada has obtained enough doses of various vaccines to vaccinate its entire population of 37.9 million people up to five times, which is at the top of the country list in terms of vaccines per capita, according to a data analysis compiled by Duke University. In comparison, according to the People’s Vaccine Alliance, only one out of 10 people in nearly 70 low-income countries are likely to get vaccinated in 2021.

We raised our concerns about the vaccine and scientific inequities in a letter published on 9 December in the medical journal The Lancet. We also offer a way forward: the strengthening of the research capacity at universities in low-income countries, especially in Africa, as a moral, economic and scientific imperative.

World Trade Organization waiver

It is in this context of global scientific inequity that we should look ahead at the General Council meeting of the World Trade Organization (WTO) expected to take place on 17 December and consider the various arguments for and against a proposal for a waiver from certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement for the prevention, containment and treatment of COVID-19.

To make sure that all countries and their citizens would have equal access to approved vaccines, South Africa and India, supported by Eswatini and Kenya, have formally proposed the waiver to the WTO. Acceptance of the proposal would imply that all countries would be allowed to produce their own COVID-19 vaccine.

Currently, around 100 of the 164 WTO member states, the World Health Organization, UNAIDS and more than 300 civil society organisations worldwide support the proposed waiver. In addition, the proposal is supported by academics and researchers from around the world.

However, various high-income countries, including the United States, the United Kingdom, Australia, Brazil, the European Union and Norway, oppose the waiver proposal. The main formal argument expressed by these countries is that they do not want to allow for very broad exceptions to the existing WTO system when it comes to the protection of intellectual property rights, even in an exceptional crisis such as COVID-19.

Instead, they prefer voluntary agreements between individual countries and pharmaceutical companies, as has been the practice so far. The impact of this practice is obvious when we see that through voluntary agreements 96% of the candidate vaccine developed by Pfizer/BioNTech in 2021 and 100% of the Moderna vaccine have already been bought by high-income countries in bilateral agreements.

At the same time, the COVID-19 vaccine produced by the University of Oxford and AstraZeneca will be available on a non-profit basis, implying a low price, with 64% of the 2021 production estimated to be sold to low- and middle-income countries.

Still, taking into account the maximum production capacity of Oxford University-AstraZeneca, this implies, according to Dr Mohga Kamal Yanni from the People’s Vaccine Alliance, that: “Rich countries have enough doses to vaccinate everyone nearly three times over, whilst poor countries don’t even have enough to reach health workers and people at risk.”

Vaccine politics

The negotiations about the proposal are expected to continue at least until the 17 December meeting of the WTO’s General Council. While the debates about waiving global intellectual property rights for COVID-19 medicines have hitherto dominated the COVID-19-related discussion about global vaccine inequality, another set of arguments used more informally is that the COVID-19 vaccine is difficult to produce, with demanding production lines and storage requirements.

Obviously, producing, distributing, storing and using billions of doses of vaccines require appropriate human, academic and technological capacity. Many low-income countries apparently do not have the required capacities for producing the COVID-19 vaccines, and from that perspective, waiving intellectual property rights to allow these countries to produce the vaccine for their own population would be almost meaningless in practice.

There are, for example, only a few countries in Africa that have the required scientific capacity to do research on, produce and store the COVID-19 vaccines (at least the Pfizer-BioNTech and Moderna ones, both being mRNA vaccines that are complicated to produce and need to be stored under very cold conditions).

Consequently, even if governments and pharmaceutical companies would reach the kind of voluntary arrangements the high-income countries prefer over a general patent waiver in the WTO, the lack of a high-quality academic community (and the required scientific capacities) would form an important additional barrier for any country to produce, store and use (first generation) COVID-19 vaccines.

Scientific inequality

Many countries in Africa are in this position as a result of structural national underfunding and political marginalisation. In this, low-income countries have generally followed the focus of bilateral and multilateral donors on primary and lower-secondary education (with children from six to 15 years). As a consequence, most universities on the African continent are lagging behind the rest of the world, especially when it comes to their research capacity and productivity.

This is why we argued in our commentary in The Lancet, titled “A step backwards in the fight against global vaccine inequities”, that the conservative position taken by high-income countries is a step back in the campaign against global vaccine and immunisation inequalities and forms a powerful reminder of the need to support and strengthen appropriate knowledge and technology developments in low-income countries.

This implies that, in accordance with the UN’s Sustainable Development Goals, supporting the development of strong research institutions in the Global South that operate on the knowledge frontier and are equipped to absorb and adopt new technology should be an absolute priority in North-South cooperation agreements.

From our perspective, this is particularly relevant in the global knowledge sector collaboration with Africa. The traditional focus on primary and lower-secondary education implied, for higher education, science and innovation, that collaboration was limited to educational and administrative capacity building, short-term bilateral collaboration projects, especially in the areas of healthcare and agriculture, and scholarships for individual students.

The latter has given selected individuals important personal development and career opportunities but has also contributed to a massive brain drain from the African continent.

Strategically focused investments

Therefore the 36 member universities of the African Research Universities Alliance (ARUA), and the Guild of European Research-Intensive Universities have taken the initiative to convince the African Union and the European Union, and national governments in Europe and Africa, to develop a joint long-term strategy aimed at seriously strengthening African universities through focused investments (of at least €1 billion or US$1.2 billion per year) in their research capacity in five priority areas, that is, public health, the green deal, digital transformations, public governance, and inequality.

The 36 universities have drafted a detailed proposal arguing for the need to strengthen intra-African and joint African-European research activities, the research infrastructure at African universities, and joint doctoral education and postdoctoral programmes that ensure career opportunities for African research talents on their own continent.

With this initiative, the participating universities want to give a clear message to all public authorities involved: for African-European cooperation to become more strategic and mutually beneficial, measures to develop knowledge systems as a whole must be prioritised that include all levels, from kindergarten and primary school to university.

If the necessary increase in the production and use of advanced knowledge is to take place in more African countries, strengthening research universities on the African continent should be prioritised.

The challenges of vaccine and immunisation inequalities clearly illustrate the fundamental need for this type of long-term investment in African universities as the continent’s key knowledge institutions. This is not least necessary to avoid in the future that a relatively weak scientific and technology capacity is used as an argument for vaccines not being produced, for example on the African continent.

We cannot accept the basic inequality that arises when the most resourceful nations of the world take and continue to claim an unreasonably large share of the global pharmaceutical capacity, as in the case of the production and purchase of the COVID-19 vaccines.

Ernest Aryeetey is professor of economics of development, University of Ghana, and the secretary-general of the African Research Universities Alliance (ARUA). Eivind Engebretsen is a professor of medicine and the vice-dean of the faculty of medicine at the University of Oslo, Norway. Åse Gornitzka is a professor of public policy and public administration and the vice-rector of the University of Oslo. Peter Maassen is a professor of higher education research at the University of Oslo in Norway and extraordinary professor at the DSI-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Stellenbosch University, South Africa. Svein Stølen is a professor of chemistry and rector of the University of Oslo. They write in their personal capacity.

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