Australia pre-purchased 25 million doses of the Moderna vaccine this week, bringing the total number of vaccine doses we've ordered from suppliers to 169.8 million. Meanwhile, COVAX, the global program for distributing COVID-19 vaccines equitably, has been crippled by supply shortfalls, and low-income countries are lagging badly behind in starting their vaccine rollouts.
These stark inequities in vaccine access are not just a problem for low-income countries, which will undoubtedly see many avoidable deaths as a result. Unless rich countries including Australia immediately share more vaccines and support efforts to expand the global supply, many countries won't achieve widespread vaccination coverage until at least 2023. And variants emerging in countries where transmission is uncontrolled could threaten the progress of the whole world in bringing the pandemic to an end.
How bad is vaccine hoarding?
Hoarding of COVID-19 vaccines by rich countries has been a worsening problem throughout the pandemic.
By November last year, rich countries making up only 14 per cent of the world's population had snapped up more than 50 per cent of the almost 7.5 billion doses reserved by that stage.
In April, the director-general of the World Health Organization indicated that while one in four people in rich countries had received a vaccine dose, only one in 500 people in low-income countries had yet received a shot.
The yawning gap in vaccination rates between rich and poor countries is getting worse by the day.
COVAX had planned to distribute more than 2 billion doses by the end of 2021, but has so far managed to ship less than 61 million, putting it way behind target. And 92 low-income countries are relying on COVAX to vaccinate their health workers and vulnerable groups - many can't afford to purchase doses directly from pharmaceutical companies, even if there was sufficient supply.
Countries like India and Brazil that have experienced large outbreaks while the bulk of their population remains unvaccinated have seen variants emerge that seem to be less responsive to at least some of the available vaccines. The B.1.617 variant which emerged in India last year - now classified by the WHO as a "variant of global concern" - is spreading rapidly in the UK, calling into question its plans to lift restrictions.
If we don't put the brakes on the emergence of variants by distributing vaccines more equitably, even rich countries with large-scale vaccine manufacturing like the UK could end up on a protracted merry-go-round of new vaccines and booster shots while being unable to achieve herd immunity and resume normal life.
What Australia and other rich countries will need to do
Australia has now secured enough vaccine doses to vaccinate our population roughly three times over, even without counting the 15 million booster shots of Moderna that make up part of its order of 25 million. No doubt the government plans to share the extra doses we don't need with our neighbours in the Asia-Pacific region. But donating excess doses after we've vaccinated our own population will come too late for countries that are battling surges, as vaccination is a preventive strategy rather than an emergency measure to contain an outbreak.
On Wednesday, the Independent Panel for Pandemic Preparedness and Response, commissioned by the WHO in May last year to review the international health response to the pandemic, said "the significant inequity in vaccine access must be addressed immediately".
The panel's report called for rich countries that already have enough vaccines in the pipeline to urgently donate at least 1 billion doses by September 1, 2021, and more than 2 billion by mid-2022. These donations should be funnelled through co-ordinated mechanisms such as COVAX, to ensure they go where they are most needed.
But donating doses from the existing supply is an urgent stopgap measure, rather than a sustainable strategy for ending the pandemic. The panel also stressed that vaccine-producing countries must work with vaccine manufacturers to ensure they enter into licences and share their technology with more manufacturers, to increase the amount of vaccine being produced globally.
So far, very few vaccine producers have voluntarily entered into these types of arrangements, preferring to hold on tightly to their intellectual property, know-how and technology, while manufacturing capacity in Asia, Africa and Latin America goes unused. Not a single vaccine producer has contributed to the COVID-19 Technology Access Pool, a mechanism set up by the WHO a year ago for sharing information, data and knowledge in order to increase production of COVID-19 medical products. This situation can't be allowed to continue while millions of people are dying.
The panel indicated that if initiatives to increase voluntary licensing and technology transfer haven't made progress within three months, a waiver of intellectual property rights under discussion at the World Trade Organization should immediately come into force.
India and South Africa first put a proposal to the WTO in October 2020 to waive certain intellectual property rights for COVID-19 medical products during the pandemic. The rights in question are governed by the Agreement on Trade-Related Aspects of Intellectual Property Rights, known as TRIPS - so the waiver proposal is referred to as the "TRIPS waiver".
The TRIPS waiver has gained the support of more than 100 of the WTO's 164 members, but so far negotiations have been prevented from moving forward by several wealthy countries. Until last week, these included the US. But in an historic move, the Biden administration has now declared it will support a waiver of intellectual property rights for COVID-19 vaccines.
The US support for a waiver is limited to vaccines and excludes treatments and diagnostics - a short-sighted approach given the importance of these products for managing the pandemic. But the US support for this initiative has made the success of negotiations for the waiver much more likely.
Unfortunately, several wealthy countries are still refusing to support even a limited waiver for vaccines. Australia's Trade Minister, Dan Tehan, said last week that the waiver "will be an important part of trying to get a resolution in the World Trade Organization", but Australia has so far held back from throwing its support behind the proposal.
To do its fair share in correcting the gross inequities in global access to COVID-19 vaccines, Australia should immediately donate a fair share of our vaccine supply to COVAX to meet the goals set by the panel. Australia must also support initiatives to increase the global supply of vaccines and other medical products to fight the pandemic, through licensing and technology transfer mechanisms, and waiving intellectual property rights.
- Deborah Gleeson is an associate professor in public health at La Trobe University.