Today on The Argument, what’s the best way to vaccinate the world?
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The international charity Doctors Without Borders is urging rich countries to take steps to allow more coronavirus vaccines to be produced right around the world. Now intellectual property rights prevent other countries from making domestic versions of vaccines. But waiving these rights would allow developing nations to produce vaccines without fear of reprisal.
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The White House now says that it supports waiving the intellectual property protections for the Covid-19 vaccine.
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We need to help fight the disease around the world to keep us safe here at home and to do the right thing of helping other people. It’s the right thing to do.
Only about 10 percent of the world is vaccinated right now from Covid-19. And COVID cases are on the rise in places like Argentina, Brazil, and South Africa. As of this recording, 85 percent of shots given out have been in high and upper middle income countries, which brings me to one potential solution making headlines — waiving patent protections for Covid vaccines. Patents are a huge part of how pharmaceutical companies work. They spend big to develop a new medicine or a vaccine, own the patent, and can charge a lot. See the high cost of drugs for cancer or rheumatoid arthritis. But in a global health crisis, why not make a lifesaving vaccine as accessible as possible, even if it cuts into profits? A waiver today could set a precedent for future drugs and vaccines to be rolled out faster worldwide, like for H.I.V./AIDS, or the next pandemic. [MUSIC PLAYING]
I’m Jane Coaston. And I know waiving vaccine patents isn’t a silver bullet. And I know it comes with potentially big trade-offs. But I still think we need to understand what the stakes are here. My guests today disagree about whether lifting patent protections is the best way to get more shots in more arms and to get to the other side of this pandemic once and for all, for everyone. Rachel Silverman is a policy fellow at the Center for Global Development. Tahir Amin is co-founder and co-executive director of I-MAK, the Initiative for Medicines, Access, and Knowledge. [MUSIC PLAYING]
So let’s just get right into it. Tahir, tell me why you think that waiving vaccine patents is crucial to ending the Covid-19 pandemic worldwide.
I think it’s a significant step in helping to end the pandemic much sooner. I think it’s important because there are other manufacturers out there that can potentially make these vaccines and other necessary technologies that can counter or help curtail Covid-19 issues. And it’s not just about patents on the vaccines. It’s about all sorts of intellectual property that go into supply chain materials and also things that go into the vaccines. So it’s important to recognize this waiver is not just about vaccines, it’s broader than that.
And Rachel, why do you think that’s the wrong approach to getting the world vaccinated?
I think it’s vaccines specifically where I am skeptical that the waiver as proposed or a patent waiver, I.P. waiver more broadly, would make much of a difference in getting us out of this pandemic quickly. The key issue is just that it’s not that it can’t be done. I think it can be done in low and middle income countries with time and money. But I think that going through the process of getting regulatory approval for a new vaccine, trying to reverse engineer vaccines without the patent holder’s cooperation would be a delay in what I think is a very urgent problem of scaling up vaccine access. So my preferred approach would be to create the right incentives for the originator companies to play ball on this. This can include threats. I’m not necessarily saying just be nice to them. But I think we need them to play ball if we want this to happen quickly and for everyone.
I think it’s worth taking a step back because I know when I started researching this, I didn’t really know — and I would guess most people don’t know — how much pharmaceutical patents play into how vaccines are developed and how medications are developed. And I want to separate those two things. There has been a lot of debate over lifting the I.P. protections and lifting patents for drugs to treat H.I.V. or drugs to treat malaria. But developing a vaccine is different. And Rachel, you’ve written about this, but can you explain what is the difference here between lifting the patent on a H.I.V. drug? What’s the difference between that and lifting the I.P. on a vaccine?
So I’d say there’s two different issues. I think if you think about a drug, it’s a bit of a simpler picture. Because if you think about it, what is it? It’s a chemical compound. If you’re a competent chemist, you can take a look at it. You can see what it is. You can probably figure out how to reverse engineer it. So nobody necessarily needs to teach you how to make it. You can see what it is. And you can figure it out with some trial and error for yourself and make the exact same thing. And once you make the exact same thing, you can show to a regulator, hey, this drug is the exact same thing as this other drug. So I should be able to sell this under the same regulatory framework as the other drug. So now I can sell this drug. And the only thing stopping me from doing that, really, is patent protection. It’s basically this patent that says only the originator is allowed to sell this drug in a certain market for a given period of time. If not for that, I could enter and I could sell at a cheaper cost, and so could everybody else. So for drugs, the monopoly power is very, very strong, granted by the patent. It is pretty much the only thing stopping others from entering. And so we see after the patent exclusivity period, usually about 20 years, a pretty steep and quick drop-off in the price of drugs as generics enter the market. And this is what has been the case for H.I.V. drugs, for example. For vaccines, in contrast, the key issue is you can’t really reverse engineer them. They are complex. They have different components that go into them. You can’t look at them under a microscope, tell what they are, and then figure out how to make them. You can figure out certain parts of them. So there have been scientists at Stanford that reverse engineered the mRNA sequence. But you can’t reverse engineer the entirety of how to make the vaccine. So what you need is know-how and, ideally, technology transfer. Know-how would be sort of the process steps, everything described in the patent application, the how to make this kind of video, recipe, whatever you want to call it. The tech transfer would be ideally somebody actually coming from the originator company or someone who has knowledge of how to make this and has done it before, coming into your factory, helping you set up your factory, showing you every step of the process, and supervising you as you make the vaccine.
So, Tahir, waiving patents doesn’t require companies to do any of that. And we’ve seen with Moderna, for example, they haven’t enforced the I.P. rights, but they also haven’t shared information about vaccine design or manufacture. So what does lifting the patent do if you don’t know how to make it, and you don’t have the manufacturing capacity to make the vaccine?
So, again — and this is why the waiver on I.P. is important — is actually removing all the bottlenecks. And I’ve studied vaccine production in the developing country vaccine manufacturers for Gavi, in fact. And what we found when we spoke to a lot of developing country vaccine manufacturers is they can actually get further down the road in coming up with their own versions. But what happens is many of the components that go into a vaccine are the intellectual property, whether it be patents, whether it be the know-how, the trade secrets, all those are held by different people. If I’m the originator vaccine manufacturer like a Moderna, I will license those in. And I might have an exclusive license. And if I’m a developing country vaccine manufacturer and I try to get an exclusive license to that kind of piece of technology to help me make that vaccine, I might not be able to get it. Because somebody has already tied that up with Moderna or somebody else. And so these are all the factors that play out. And why the waiver is important, it actually creates a level playing field. And so you don’t have to jump through all these hoops, all these barriers. And granted, I think Rachel’s correct that we might not get there very quickly. But what we might achieve is a sustainable solution. Within six to nine months, we might have other producers. And if we look at the projections out there of where some low income countries might not even see a vaccine until 2023, let’s move out of the status quo because this is a pandemic. Let’s put all our cards on the table.
There was a piece I read on this that made the point that a pandemic is not a time for competition between companies, and also, patents weren’t intended for wars or pandemics. And so we have seen this discussion during the Second World War, but also during the anthrax panic in 2001, where the United States government essentially threatened to break the patent unless Bayer agreed to a fire sale. Tahir, you spoke with friend of the podcast Anand Giridharadas, where you talked about how the current World Trade organization rules empower the global north and the developed world and prevent upper middle to middle to lower income countries from competing in this space at all. Rachel, I’m guessing you don’t agree. Why?
To be very clear, I’m not an intellectual property or patent absolutist. I would just say I’m ruthlessly practical. I want to get vaccines to low and middle income countries as quickly as humanly possible to end this pandemic. And I don’t think the waiver will get us there. Because I’m worried that it will make originators hold on tighter to their trade secrets, hold on tighter to their patents and licensing deals, et cetera. So that’s my concern. But I actually share a lot of Tahir’s broader perspective about some of the inequities built into the system. And I think some of the issues that have been raised with the TRIPs agreement, how it works, the context in which it was developed, are valid and important.
So TRIPs is short for the Trade Related Aspects of Intellectual Property Rights agreement — very fun sentence. And when we talk about waiving I.P., what we’re talking about is waiving the TRIPs agreement, which was signed by member nations of the World Trade Organization. So what has that agreement meant for global access to medicines on the ground, Tahir?
Well, there’s been significant battles since the World Trade Organization was created. The first battle was the H.I.V. epidemic, which was emerging around ‘95, ‘96. South Africa was in dire need of getting affordable antiretroviral treatments. And these were priced at some $10,000 at the time. The government in South Africa actually wanted to issue what is called a compulsory license, whereby the government can override any patents. That’s the only thing that a compulsory license can be useful so that other manufacturers could make and bring cheaper generic versions in. And at that time, 40 pharmaceutical companies sued the South African government. And eventually, it was settled. And it was probably the biggest PR disaster for the pharmaceutical companies, which kind of taught them a few lessons. But unfortunately, that’s played out in numerous other occasions, like hepatitis C recently in 2013, ‘14. Companies now voluntarily give licenses to other manufacturers. But I think it’s important that relying on voluntary measures by pharmaceutical companies has never succeeded in getting global access. And we’ve seen that with H.I.V., with hepatitis C. We cannot rely on the voluntary behavioral forms of companies. They have to be compelled to share this information. I think that’s the difference when perhaps Rachel and I may have, is that she might say the voluntary measures by companies may be enough. Having worked in this space for 20 years and seen the voluntary mechanisms, they’re usually so restricted. They’re geographically restricted. It allows companies to play games, which are non-transparent and charge prices which really is going to affect the overall ability to get out of this pandemic quicker.
Rachel, I’d put that to you. Do you think that pharmaceutical companies are being good faith players here? The companies, in many cases, are the ones saying that waiving patents could be dangerous or raise the risk of counterfeit doses. You have Scott Gottlieb writing in the Wall Street Journal — Scott Gottlieb who’s at the American Enterprise Institute, but also on the board of Pfizer — saying that there are all these other better options other than waiving the patents, including exporting doses and investing in expansion of manufacturing facilities. But they’re pharmaceutical companies, so clearly, there’s a financial incentive here. What do you think?
So I think it’s a mix. I think there are some arguments in there that are good faith real concerns. And there are some arguments in there that are clearly just in service of their bottom line. So the good faith arguments, one is I do think there are genuine concerns about safety and product quality. And again, I want to be very clear that I am not arguing that low and middle income countries cannot produce safe and high quality drugs. They absolutely can. And I am not arguing that. What I am saying, though, is that even in the U.S., internally in the U.S., we have had major difficulties in scaling up vaccine production: The Emergent biotech facility which has spoiled tens of millions of J&J vaccines through shoddy manufacturing process. If we do not have a system of really stringent kind of oversight and quality control, there is the risk that substandard vaccines would get out there. And by the way, then calling itself a version of, say, the Pfizer vaccine or the AstraZeneca vaccine, there’s a reputational risk that then would redound to them. A maybe prosocial argument around that would be that would be bad for vaccine hesitancy. A more self-interested argument would just be it’s bad for their brand name and their bottom line.
Do you think that such voluntary measures, though, could really work? A lot of times, the carrot doesn’t seem to work, and sometimes the stick does. So what would be different in this situation, as Tahir as discussed, that didn’t happen before?
So I agree the stick is important. I am not against sticks being used in this whole process. What I would say is that I think it needs to be done on a case by case basis. The whole problem I see with the waiver is that it is a blanket waiver. The problem with that is that instead of a threat to be used against companies, it becomes a done deal. So actually right now, in this moment, before there is any such a waiver in place, this is good! This is good because they see this threat on the horizon. And it’s motivating them, hopefully, to be more proactive in how they’re serving low and middle income countries. So when I say voluntary, I don’t mean just what they want to do out of the goodness of their hearts. I’m in favor of creating an incentive environment through both carrots and sticks that makes it easy to say yes and hard to say no. A blanket waiver sort of takes away some of that threat. By executing the threat, you sort of take down the potency of the threat. And therefore, what’s the incentive? What’s the additional stick that can be brought to bear against them?
Last month, a ton of people were surprised when President Biden reversed U.S. policy and declared support for waiving vaccine patents. People who supported this idea were surprised. People who did not support this were surprised. There have been a ton of non-governmental organizations that have been in support of lifting waivers. But clearly, a lot of countries weren’t, including a lot of other high income countries. What do you think that says about the opposition that you’ve seen from Germany, for example?
No, that’s really interesting. I personally, having looked at the trade issues for the last 20, 25 years and being around people who’ve negotiated some of these agreements, there’s nothing that was done by the United States that the Europeans didn’t know. I think this is good cop, bad cop. And they’re all playing out of position, basically, to restrict the waiver as much as possible, and so that the countries like India and South Africa and the countries that supported the proposal will basically have to keep going back to the drawing board. And this is going to get dragged out. So this is all a game. Actually, to the point of why I think we need this to happen much quicker, the G20 just came out with a statement where they said that they’re going to support voluntary measures. And there’s so much gaslighting that’s gone on over the last six months, it’s incredulous. Interestingly, the companies were pooh-poohing the idea of voluntary measures just last year when the W.H.O. in May created the “C-TAP,” which was a pooling mechanism.
Can you back up just very quickly? When you say pooling mechanism, what do you mean?
So pooling mechanism with all the intellectual property that would allow all the manufacturers to make a vaccine, that you would just put that technology into a pool, and companies would get paid a royalty or what have you. It was based on a similar mechanism that’s worked for H.I.V. medicines, where, basically, generic medicine manufacturers can take a license from a pool. And the royalties on the sales or whatever go to the originator. And so this was proposed back in May, but the companies, to this day, have not actually put anything into that pool — no technology whatsoever. And this is where the stick has really played a role. It’s actually brought some pressure to bear. And I actually think that if we are going to move out of this pandemic, we cannot rely on the pharmaceutical companies. They are already talking about endemic situations. I mean, there was an investor call where Pfizer were looking at pricing the vaccine at $150 to $175. And they’re saying there’s a significant opportunity here. And so we have to ask the question, is it even in their interest to end this pandemic?
Can I jump in here on two of the points raised?
Oh, please, please.
So I very much agree with Tahir that a lot of this is theater. And I guess that gets to part of my concern about the waiver, which is, I’m not, again, that opposed to the waiver per se. I’m a little bit wishy-washy on it. I think there are people who yell doom about it. I don’t think it will spell doom. But what I really am concerned about is that while I do think the waiver campaign has been helpful in terms of putting pressure on the pharmaceutical industry, you know, that threat of a stick that we’re talking about, what I do worry about is that it’s sucking up a lot of political oxygen. And it’s the kind of thing where the U.S. can come out with a statement and say, oh, yes, we support the waiver. And what that will really mean is we spend the next 12 months negotiating it down in the W.T.O., and we coordinate with the Europeans to weaken it further. And everyone applauds, and everyone says, oh, great, what a great move towards vaccine equity. And nothing really comes of it. And it takes pressure off them to address the more immediate challenges. And I’d say we had a letter out from my institution, the Center for Global Development, and some other think tanks, calling on the Biden administration to do a lot more, generally, more money, more support, more engagement, better dose sharing, more leadership in this space. And we haven’t seen it. The reality of the world we live in is there’s a limited amount of political capital. And I’m worried we’re sucking it up on this, which will maybe, maybe best case scenario, have an impact six to nine months down the road if everything goes right, and not the immediate measures that we could be taking worldwide.
Tahir, the Federation of Pharmaceutical Manufacturers and Associations, they’ve also argued that waivers would be a distraction and a feel good measure and that the real challenge is scaling up production and distribution and fixing bottlenecks in the supply chain. Now, I am long opposed to people who say that this isn’t a problem. This is the real problem. Because I think we’ve got a lot of problems. And they’re all problems. But is lifting a waiver activist theater?
Well, again, this has been an ongoing problem for a long time. And I think if we can’t do it in a pandemic, then when can we do it? And I think for the likes of the pharma lobby groups and these institutions that say that the problems lie elsewhere, they’re effectively saying, in my opinion — and this has always been the case if you look at the other situations — is what they’re saying is, put more money into the system, pay us, and we’ll get richer off it. That’s basically what they’re saying. We’ll handle it. That’s effectively what they mean by saying, we want more money in the system, and we will take care of supply. But we want a monopoly. And we are in a situation where we should not be living in monopolies, especially with some of the public health emergencies and pathogens that are appearing on a regular basis now.
Do you think pharmaceutical companies are worried about the precedent crack in the ceiling that you’re essentially arguing for, that if we use the waiver here, that we could start using the waiver in non-emergency situations to break pharmaceutical monopolies?
Yes, I think that’s a large part of what they’re worried about. I mean, I think there are specifics about what they’re worried in this narrow situation, too, although I think it’s less about competition related to Covid vaccines per se. And it’s more about losing control of the broader platforms, the mRNA platforms that they think have many other applications, that it would be very lucrative, including oncology drugs. So I think that’s part of it.
So I’d just add to that. I think we have a drug pricing crisis in the United States. And a lot of people feel that these are two very separate systems that doesn’t affect us over here. But the W.T.O. agreement actually gave so much more monopoly power to the pharmaceutical companies. And that’s why we are having a drug pricing crisis. And so this idea that, oh, the company is going to lose some of the power in monopoly, I’m not saying that the waiver should be used for that purpose. That’s not the purpose here. The purpose is here to actually get as many vaccines and producers out there as possible. Because with all the variants and with children now getting vaccines, we’re already going to need more supplies. But the fact of the matter is, going forward, we do need to look at the rules of the W.T.O. and how they were framed, how they were created, and how they also impact the United States in terms of the power that the pharmaceutical companies have actually created through this process. [MUSIC PLAYING]
My name is Chevy. I live in South Hadley, Massachusetts. Last night on the phone, I had a knockdown drag-out fight with a good friend from Chicago. We were talking about the children who are crossing an international border in the south of our country. As far as she is concerned, they’re children, and she gets very passionate and hot and says we absolutely have to let them in, help them, find sponsors for them. I’m not so sure. There seems to be 50 shades of gray here about the adults behind this and maybe reverse chain migration. What are we going to do? I just don’t know.
Are you having debates about immigration, too? Tell me what your argument is, and we might play an excerpt of it on an upcoming episode. Share it with me on a voicemail at 347-915-4324. From the perspective of pharmaceutical companies, do either of you see value in their argument that waiving the patents here would disincentivize further innovation? I’ve definitely seen a lot of people saying, this is a great moment for pharmaceuticals, because you had the arrival of a vaccine for Covid-19 in a much shorter time frame than a lot of people within the scientific community expected. Do either of you buy that argument at all that this kind of innovation requires the protection of intellectual property that the W.T.O. has set out?
So I would say I buy it to a limited extent. I think the pharmaceutical industry has lost its credibility on this issue by claiming everything under the sun will hurt innovation. At some point, it stops being credible. And a lot of the things they call innovation are basically marginal differences over old things that they say, oh, it’s an innovation. And now we’re going to charge you a million dollars for it. The money is often in these things that have very little societal value, the next Botox, the next Viagra, that they then exert this monopoly power to have a say in prices over. However, we, at the same time, do have a problem that pharmaceutical companies do not, generally speaking, want to spend their money on the things that are most important in the world. We have a deficit of financing for research into some of the top global killers: Into malaria, into tuberculosis, into neglected tropical diseases, into vaccines generally, vaccines. A lot of manufacturers or originator companies have discontinued their vaccine programs historically because they’re not lucrative. They don’t make much money, compared to the other places they can go. I certainly feel that the current system does not create optimal incentives. And there’s a lot of reform needed in terms of pricing, in terms of the levers that would influence what gets investment or not. But what I don’t want to do is further entrench the existing inequity, let’s say, between investment in things that actually matter and will save a lot of lives around the world and things that are marginal, but will make a lot of money. This would push them a little bit to say, well, I don’t know. Pandemic preparedness, we thought it was going to be a big money maker, but it turns out it’s dicey. The activists get on our case. Forget it. I’ll work on the Botox market again. So —
That’s the most depressing hypothetical sentence I’ve heard on this.
Yeah, it’s really depressing. And it’s very possible. I mean, again, I don’t want to overstate it. I think it’s at the margins that any such thing would happen. But I think we already have a problem in this direction. I am worried about doing anything to further disincentivize investment in the things that actually matter.
Tahir, because this a very visual medium, you had a face that said that you felt a little bit dubious about Rachel’s argument. Could you tell me why?
No, I think Rachel’s intention, if I can — I don’t want to read anyone’s intentions, but I think she’s absolutely right. We do want the money to go into the places to solve the biggest problems. However, I feel the industry is using this as an opportunity to launder their reputation. Basically, if you look prior to this — and again, I bring it back to the U.S. drug pricing issue. Their feet were held to the fire before this all happened. And they were under such scrutiny for the practices they’ve carried outright where people are crossing borders to buy their insulin and what have you. And now these pandemics happened. And we have to be grateful. They’ve shown up. It’s not as though they provided all the ingredients for the recipe for these vaccines. These were ingredients that were already there. They may have given us their kitchen to make these recipes, but they didn’t provide all the goods. The idea of them going to make the next Botox thing instead of actually investing in some neglected disease, the R&D blueprint by the W.H.O. says the current market-driven model does not work for dealing with unexpected diseases and pathogens. And that’s the W.H.O. saying that. And I wrote a piece, actually, last year in “Stat” about why the pharmaceutical market model doesn’t solve the problems in pandemics. And one of the things that I found which was notable is, like, in 2018, global funding for neglected diseases, 64 percent came from public taxpayers’ dollars. Nineteen percent came from philanthropic organizations. Only 17 percent came from pharmaceutical companies, which is about $650 million. And if you take the revenue of the top 20 pharmaceutical companies in 2019, which was some $661 billion, that’s not even 1 percent. They don’t care about these markets. And they only arrived at the party because everything had been derisked. They had the biggest global market, and that’s where they showed up.
So I, again, agree with Tahir on a lot of the problems with the current system. But my concern is, we’re in a mass casualty event currently right now. And to me, we need to get ourselves out of that as quickly as possible. And then I’m very happy to do a postmortem on everything that went wrong and potentially be more radical in thinking. But right now, I just think there’s a little bit of a conflation around the long-term agenda, which I don’t necessarily think is unimportant, although I probably would disagree with Tahir on some of the specifics of what that would look like. But I’m just focused on the here and now of what is the crisis we are currently in and how can we get people vaccinated as quickly as humanly possible, trying to abstract that away from these broader systemic critiques.
But I would just want to say, I think it is about actually getting people vaccinated as quickly as possible and also making a sustainable system in this pandemic, which is not going to go away next year. There’s going to be these booster shots.
But the waiver is temporary.
Well, at the moment, it’s three years. Now I think that’s a reasonable period to have an ability to scale up. It’s not just about six months from now because I don’t think the pharmaceutical companies are going to deliver that.
But who’s going to build a factory and invest all of the money to build the factory? Let’s say the patents were waived tomorrow, and everyone had the know-how, right? And it was basically you have three years to do whatever you want, and then it stops. Who is going to build that factory, knowing that at the end of it, they lose their access to all of this? I’m sympathetic to the idea that, for example, we would need in the future, every continent would need to have its own mRNA manufacturing hub to not be reliant on the United States and Europe or even India, which has had export restrictions currently on its vaccines, that we would need some sort of decentralized manufacturing hub, that this would be a long-term sustainability project to also protect against the next pandemic. And I am sympathetic to the idea that will run into I.P. issues down the road or now — at any point. But I don’t see how a three-year waiver gets you there. That’s part of why it feels more symbolic to me. If I’m thinking about the long-term and thinking about what it would take to create this reality, this doesn’t feel like it would do it. And then I hear, OK, well, that’s a good first step. But then let’s talk about what we actually think needs to happen and debate that.
Is scaling up manufacturing a — would that be better and faster than just forcing better distribution to low income countries, though?
I think yes. I think there is plenty of room to scale manufacturing. And I think that needs to happen, in addition to better distribution to low and middle income countries and more equitable sharing. I just think that you need and want the originators’ cooperation to make that happen as quickly and effectively as possible. I don’t think it’s an optimal solution for different companies around the world to be sort of cooking up their own vaccines with the time that would take to do with the need to rerun clinical trials because such vaccines would not necessarily get automatic regulatory approval. If time is of the essence, I think the best way forward is working with the originators, even if that’s unpalatable and even if that means they capture more money. I am actually OK with that. I know not everyone is. I am OK with pharma getting more money if it means we get vaccines out around the world faster.
Tahir, would you be happy giving them more money if they were able to deliver?
Well, I think if they could deliver, then certainly, they’re making a handsome profit. I mean, Pfizer has already made $26 billion —
Well, not in profit — in revenue.
In revenue. But the thing is at the end of the day, I don’t think we should be beholden to just a few companies to save the lives of everyone. This is not a Hollywood Marvel comics where only the superheroes exist in the United States. There are potential heroes elsewhere. And we should be giving them the opportunity to be able to save the people in their own countries. But we’re not doing that. Everybody should have the ability to try and save lives. And that’s the point I’m making.
Let’s say that Biden’s waiver announcement is where the idea stops globally. How long would it take to vaccinate the world without waivers, do you think, Tahir?
Well, again, this is all by different projections. I think universities put projections out, affinities put projections out. Some people are saying the low income countries might not see their entire populations vaccinated until 2024.
And with the waivers, are there any estimations on how that timeline would change?
Well, it’s difficult to say. I think by some companies standards, they think that they could get to a point where they could actually try and seek regulatory approval within six to eight months, nine months even. There’s over 200 biologic companies in India, for example. And there are many others in other countries that could potentially get to a stage where, OK, if they had all the I.P. waived — and there was some sharing of technology or data — then maybe six to nine months, we might see some movement in terms — and that’s still these current projections, at least based on what I’ve read.
Rachel, does that sound right to you?
So I think it’s really hard to say what the status quo is. Again, the projections are all over the place. We had some semi-pharma backed estimates saying we would have something like 10 to 12 billion doses by the end of this year. They do not seem on track to do that. So count me very skeptical of that. I do think some of the later estimates are also probably off base. I mean, it does seem like things are accelerating, just not at the pace that was promised. So, to me, I would expect maybe end of next year that there would be wide access, basically, across all countries. But it is dependent on a lot of contingencies, as Tahir says. And I guess my position is the waiver itself would not do anything to speed things up. But I do think there’s things we could do to speed things up.
My last question for both of you — and it’s kind of a magic wand question — I think that a concern for all three of us is that as Americans return to some sort of normalcy, though I don’t really want to go back to 2019 — that sounds annoying in a lot of ways. But Covid-19 is quickly becoming a multi-tier disease. And we’ve seen that happen time and time again. With H.I.V./AIDS, in the United States, people can have access to prophylaxis, and H.I.V. can still be killing thousands of people. Because, again, it becomes a multi-tiered disease. So if you had access to a magic wand and could recreate the way the world develops, manufactures, and distributes medicine and vaccines, what would it look like? What would be your top priority change if you could make it, if you were in charge of everything? Rachel, why don’t you go first?
Yes, well, if I was in charge of everything, I would love to see pull mechanisms and prizes. Basically, if we have big problems, get the world together, say, hey, if we had a cure for H.I.V., that would be amazing. Not just a treatment, we have very effective treatment, but a cure. And it’s gone forever — or a vaccine— and we’ll never get it. And if you come up with this, we will pay you, off the top, $10 billion or $25 billion or $100 billion. For some cases, it might be worth paying an enormous amount of money. And we say open competition, work on it, get it to us, and then we’ll buy out the I.P. around it. And we’ll make sure it’s available to everyone at cost or cost plus a small margin to compensate the generic producers. So I think I still believe that there’s an important role for private sector incentives and private sector greed, frankly. I mean, greed is a powerful motivator. And it can get you pretty far. But it’s our job as a global policy community to channel greed for good, and not for just padding people’s pockets without creating social benefit. So I’d like to see that done more explicitly.
I want to ask you about that before Tahir gives us how he is going to save us all by taking charge of everything. Because I was thinking about that. My concern with the argument that greed foments good things in the pharmaceutical space is that it absolutely can. But that greed can benefit a specific community. And we’ve seen that with H.I.V. medications, which can make, for certain people, H.I.V. essentially a chronic condition. And for other people who don’t have health insurance or other people who don’t have access to that kind of thing, we still have a concern in sub-Saharan Africa, for example, of prevention of mother to child transmission of H.I.V., where those drugs aren’t as available. I think that that’s my concern here. Because drug companies, they’ll make whatever they want to make if it makes money. But for me, the concern is, for whom?
The H.I.V. example is an interesting one because at this point in H.I.V. — and this was not true earlier in the H.I.V. pandemic — the drugs are widely produced by generic producers. I do think, though, that your core point of, OK, greed is good, but does that work for everyone, is fair. And again, I think it’s our job as kind of policy makers at the national level — I mean, I’m not a policymaker. I work for a think tank. But I talk about policy. It’s almost as good. Our job, as the global policy community, is to create the right kinds of incentives that address that, right? That say, it’s not an open free market in the sense that it’s just chaos, it’s anarchy. Solve whatever you want, and if someone can’t afford it, they die. I think we need to organize ourselves as large payers for drugs and services that are able to negotiate prices based on affordability and cost effectiveness. I think we need to have an enabling regulatory framework for that. So that’s on us as a policy community. I agree, don’t leave that to the drug companies and expect them to do it of their own volition and free will. But if we create the right incentives for them to do that, then they will respond.
I love an answer that tells me that I am both right and also wrong. Tahir, what is your top priority change?
So I think whether it is the amount of public funding that’s gone into making these vaccines, if they were more openly accessible, because the government had derisked a lot of the investment, basically, governments should be setting up manufacturing plants to be able to kind of carry that through so that you scale up immediately. I think also the World Trade Organization is in desperate need of revision. It’s interesting that the trade agreement signed in ‘94 talks about technology transfer, and yet, that bargain has not lived up. Ultimately, I think we do need to get local country governments in the global South to start investing in their infrastructure so it’s not entirely on the global North to do it for them. They need to start putting some money into the systems. But as I said before, I think just the way the Modernas were able to just create manufacturing capability, they got government subsidies. We need to be saying that these other countries can do that, too. But they need to be incentivized to be able to do that. And there has to be a bit of a level playing field in order to be able to do that.
Well, thank you for joining me for The Argument, which is sometimes just the agreement with some light arguing. Rachel Silverman is a policy fellow at the Center for Global Development. And Tahir Amin is the co-founder and co-executive director at the Initiative for Medicines, Access, and Knowledge. Thank you both so much for joining me to help me understand vaccine patents, waivers, the World Trade Organization. Thank you both so much.
Thank you so much. [MUSIC PLAYING]
It’s easy to go down a patent rabbit hole online. Trust me, I cannot stop talking about intellectual property rights. So let me recommend a few pieces to get started with if you want to learn more. First, an issue of the newsletter, The.Ink, called “Of Patents and Power,” that has interviews with people who support waiving the patents. On the other side, you can read a piece on the Harvard Law blog called “The Covid-19 Vaccine Patent Waiver, The Wrong Tool for the Right Goal.” You can also read a piece in The Economist by the head of BIO, a trade group that includes pharmaceutical companies, arguing that patents are the reasons Covid-19 vaccines exist and waiving them would undermine our future response. And I recommend the opinion guest essay, “The West Has Been Hoarding More Than Vaccines,” by Walden Bello, co-founder of Focus on the Global South, an activist think tank. You can find links to all of these in our episode notes. The Argument is a production of New York Times Opinion. It’s produced by Phoebe Lett, Elisa Gutierrez, and Vishakha Darbha; edited by Allison Bruzek and Paula Szuchman; with original music and sound design by Isaac Jones; fact-checking by Kate Sinclair; and audience strategy by Shannon Busta.
Waivers, the World Trade Organization, supply chains, lubricating supply chains, which is apparently the term for it that I learned about over the weekend. [LAUGHTER]
It sure is.