On May 5 the Biden administration did the truly unexpected. Bucking the gigantic pharmaceutical lobby in Washington, it sided with low- and middle-income countries (LMICs) by supporting a waiver provision to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) that would set aside some intellectual property rights in order to expand the production of Covid-19 vaccines, which are now manufactured primarily by only a handful of companies in the world’s richest nations.
While this TRIPS waiver alone will not be sufficient to ramp up vaccine production to immunize everyone on the planet, it is a crucial first step. We also need tech transfer; companies like Moderna, Pfizer, and Johnson & Johnson must step up and help manufacturers in LMICs set up facilities and processes to make the vaccines the world needs. Think of it this way: The TRIPS waiver says the “recipe” must be shared; tech transfer is Julia Child coming to your house to show you how to make that very complicated new dish. In addition, we’re going to need adequate resources to get this work done—getting truly global vaccine production on line will require subsidies by richer nations. Luckily, $16 billion is sitting unused in the US Treasury right now, appropriated in the American Rescue Act for vaccine-related efforts just like this.
The TRIPS waiver has been vociferously opposed by the pharmaceutical industry and its allies in the Biden administration and in Congress, like Democratic Senator Chris Coons. It has also been criticized by some in the US global health establishment, a few legal scholars and economists. They have all made essentially the same arguments: Patents are not the problem; these vaccines are too complicated for others to make; and a waiver risks killing the innovation goose that laid the golden egg. Sharing this intellectual property, they claim, will destroy any incentive for companies to develop vaccines in the future.
Where have we heard all this before? A little over 20 years ago, when those in LMICs struggling to save lives during the AIDS epidemic suggested that poorer countries should be allowed to break patents in order to import and export generic versions of antiretroviral drugs, the Clinton-Gore administration sided with the pharmaceutical industry, putting one of those countries—South Africa—on the Special 301 Watch List of countries under scrutiny for possible intellectual property violations. Others claimed that providing AIDS drugs to Africa was impossible not because of the complexity of their manufacture but because of the primitive nature of the health systems on the continent, suggesting that Africans couldn’t tell time or adhere to medication schedules. When Thailand indicated that it would invoke a compulsory license on patented antiretroviral drugs, allowing the import of their generic equivalents, the pharmaceutical industry’s allies hyperventilated, arguing that this move would end medical innovation: If this trend grows, they warned, the world can say goodbye to the next AIDS cure.
How have those claims held up? South Africa now has the world’s largest HIV treatment program, the US pharmaceutical industry is thriving, and generic medications are the mainstay of AIDS drug supplies in LMICs.
Those facts won’t stop this latest victory of need over greed from being met with howls of protest from the industry. Big Pharma will act to tilt the negotiations over the TRIPS waiver to its advantage at all costs. We must keep an eye on the drafting of those documents to ensure they are transparent and open to public scrutiny. However, we are at the start of a race to vaccinate the entire world, and there are larger tasks to accomplish—particularly a massive tech transfer and industrial scale-up. The effort to vaccinate as many people as we can as the virus tries to outpace us is the most urgent global priority of our time. India has exploded in a firestorm of death and suffering due to Covid-19, but that may be just a prologue for the infernos to come across an unvaccinated planet. Business as usual—for Pfizer, Moderna, and Johnson & Johnson—may suit their private interests, but at a time of unprecedented crisis, it is wholly inadequate to the challenge that faces us. Yes, we’ve had a small victory in getting the United States to support the TRIPS waiver. But we cannot let down our guard—or rest for a second.
