Early in the Covid-19 pandemic, the leaders of wealthy countries pledged to respond with “global solidarity.” But when vaccines to prevent the disease were developed, those same leaders pushed low and middle-income countries to the back of the queue, outbidding poorer countries, as well as COVAX, a worldwide initiative developed to achieve equitable vaccine access, to secure vaccines for themselves.
That came as little surprise to those of us involved in the fight against the pandemic of HIV and AIDS. When governments of high-income countries belatedly responded to the threat, they sided with pharmaceutical companies that were extracting profits from a global health crisis. Millions died then — and continue to die today — without affordable access to HIV/AIDS treatments.
As the world awoke to the deadly toll of that ongoing pandemic, even the World Trade Organization resolved that intellectual property rules, which often prevent developing countries from manufacturing medicines, “should not prevent members from taking measures to protect public health.”
But nearly three years into this latest pandemic, the same thing is happening again. World leaders and pharmaceutical companies have failed to ensure equitable access to Covid-19 medicines. Countless lives have been lost. Communities have been devastated. And the worst impacts have been felt by the poorest people.
Once again, pledges of “equity” and “global solidarity” have been made, this time by the very pharmaceutical companies that prioritized selling high-priced doses of Covid-19 vaccines to the richest companies over saving lives in the Global South.
The “Berlin Declaration” is a proposal from the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) that vows to work toward “equitable access in pandemics.” The way I see it, the same pharmaceutical companies that created the inequity of the Covid-19 pandemic are proposing to fix it in the next pandemic.
The IFPMA proposes that governments will take a greater role to fund, support, de-risk, and provide data for drug research and development, but will then hand big pharmaceutical companies monopolies on the resulting drugs. Governments will even waive any liability for companies to ensure their products are safe. What will the pharmaceutical industry do in return? Not very much.
There is a long-established precedent in global health that the populations who provide samples of pathogens used in pharmaceutical research must have access to the therapies that result from the research. Big pharmaceutical companies, however, want this to become a one-way street, with a guarantee that governments will share pathogens but without the companies being obliged to share the resulting drugs and medical technologies in return.
Instead, the IFPMA makes general pledges that its members will ensure access for low- and middle-income countries through voluntary mechanisms like donations, selling doses at not-for-profit prices, and licensing drugs to be made by factories in the Global South. These are the very measures that utterly failed the Global South in the Covid-19 pandemic.
To be sure, voluntary measures can offer a lifeline to populations who benefit from them. But they are often too limited in scope. For example, when Viiv agreed to allow the Medicines Patent Pool to license generic versions of its new long-acting HIV antiretroviral medicines, the company excluded much of Latin America and Asia from the deal. The same can be said for deals for Pfizer and Merck‘s Covid-19 treatments. Or look to a deal struck by BioNTech to open vaccine manufacturing plants in Rwanda and Senegal. The companies will send ready-made factories in container ships, operated by a turnkey mechanism, along with scientists from the German company. It is an outpost of their monopoly, not a transfer of technology to African countries.
Donations, too, have proved utterly insufficient in this pandemic. Less than half of the vaccines promised to lower-income countries by G7 nations had been delivered by June of this year.
When doses do arrive, there is often a total disregard for the needs of local populations. As Dr. Saeed Mohamood from Somaliland’s Ministry of Health told the authors of a recent report, commissioned by The People’s Vaccine Alliance, the organization I co-chair, “Sometimes we will find out that the Somaliland shipment is on a plane in the air, en route, and we do not know when it’s going to expire and how much resources we will have.”
The pharmaceutical industry also promises to license more vaccines and treatments to companies in the Global South. But when asked to do this during the Covid-19 pandemic, they declined. The World Health Organization’s coronavirus technology sharing platform was boycotted and derided by big pharma. Pfizer’s CEO even called the program “nonsense, and …also dangerous.”
Covid-19 vaccine makers Moderna, Pfizer, and BioNTech have all refused requests from the World Health Organization to share technology with its project that will transfer mRNA vaccine technology to 15 low- and middle-income countries. Without the cooperation of these companies, it will take years longer before the project can start rolling out vaccines. Broad, overreaching patents filed by Moderna are threatening the program’s freedom to operate. And BioNTech has even hired a consultancy to lobby against the project.
In the ongoing fight against HIV/AIDS, relentless public pressure ultimately forced pharmaceutical companies to agree to voluntary measures to improve access to lifesaving drugs for people in developing countries. But relying on public pressure is neither a secure nor sustainable way to ensure that low- and middle-income countries can fight deadly threats. And these measures are often used as a last resort to protect companies’ profits, market share, and monopoly rights — not to mention frustrate generic competition.
With the “Berlin Declaration,” the pharmaceutical industry’s latest voluntary pledge comes after two years of international pressure to waive intellectual property rules for Covid-19 vaccines and treatments, a solution that would have allowed low- and middle-income countries to produce themselves the therapies needed combat the coronavirus, albeit at the expense of a portion of big pharma’s exorbitant profits.
And this declaration was made just as governments are negotiating a pandemic treaty — an international agreement that will decide how the world responds to future pandemics. The treaty could help to build the foundations for a fairer response to the next global health crisis. Or, if politicians listen to big pharma, it could bind future generations to the same approaches that sacrificed countless lives in the Covid-19 and HIV/AIDS pandemics for profit. That is why the People’s Vaccine Alliance has today published a comprehensive rebuttal of the misleading claims made in the Berlin Declaration.
If world leaders want the next pandemic to be different from Covid-19 and HIV/AIDS, they cannot accept kind words and voluntary pledges at face value. Big pharmaceutical companies are profit-driven entities. Their interests lie in securing monopolies for existing diseases and future pandemics. World leaders must ignore the siren calls of industry and instead build a fairer and more equitable system that guarantees the tools needed to combat pandemics to everyone, everywhere.
Winnie Byanyima is executive director of UNAIDS and co-chair of the People’s Vaccine Alliance.