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Millions of people continue to suffer and die from Covid-19. Yet, while rich countries have vaccinated more than 40% of their population and are rapidly advancing towards herd immunity against Covid-19, 39 developing countries have vaccinated only around 1%. This blog explores how international solidarity can help end this global injustice.

PATENT RULES There are various reasons for Covid-19 vaccine inequality but one key cause is the nature of global intellectual property rules. These rules grant pharmaceutical companies 20-year monopolies over new patent medicines or vaccines, preventing generic companies from making cheaper version. The rules also contain other protections such as trade secrets (know-how and data) and copyrights to block access to knowledge on the technology related to a product like vaccines. Last October, India and South Africa proposed a waiver to global intellectual property rules for Covid-19 tools including vaccines. It is now supported by 100 countries (with 62 officially cosponsoring it). While not a silver bullet, a broadly defined and workable waiver, would be a vital step in making vaccines available and affordable to people everywhere. However, a waiver is not yet guaranteed. Germany and the UK, for example, still oppose it. But in May the impossible happened: in an unprecedented move the US, historically the key driver and protector of global intellectual property rules, announced its support. This has now been followed by support from France, and Japan has said it would not block negotiations. It seems like history might repeat itself. 20 years ago, the global HIV/AIDS movement achieved a win in the battle over the rules that protect private intellectual property monopolies over public health with the 2001 WTO Doha Declaration on TRIPS and Public Health. So, what are the parallels and lessons to date?

THE ENDURING ROLE AND POWER OF INTERNATIONAL SOLIDARITY A key factor driving change in both cases is global solidarity. A month after the WHO announced that COVID-19 had become a pandemic, activist started to call for access to health products to deal with Covid-19 including potential new vaccines. A group of southern and northern civil society organisations, activists and UNAIDS then came together as a global coalition – the People’s Vaccine Alliance (PVA) – to advocate for access to a free vaccine to all irrespective of where they live or their income. The Alliance is fast becoming a mainstream movement having mobilised a huge list of supporters including present and past heads of governments, intergovernmental organisations, academics among others. More than 2 million people have signed a petition calling for a People’s Vaccine, including the temporary suspension of intellectual property rules. The PVA is a revival of the previous access to medicines global campaign which, 20 years ago, contributed to a massive decrease in the price of HIV/AIDs medicines and helped save the lives of millions of people in developing countries who were unable to afford them. That global movement similarly consisted of a loose unbranded coalition of southern and northern CSOs and activists, many of them are now part of the People’s Vaccine Alliance.

SUCCESS INGREDIENTS Both movements combine an overarching shared aim – universal access to vital lifesaving medicines or vaccines – with loose overall coordination or information sharing and flexible and agile action by members. A key success ingredient for both campaigns has been their ability to galvanise high profile media coverage and global public moral concern about global health crises and successfully frame global IP rules as a systemic injustice which denies people access to life saving medicines and vaccines, making it difficult for policy makers to oppose. Another shared characteristic is their ability to link together and amplify the voices of civil society groups struggling to increase access to medicines, particularly in the global south. Additionally, both campaigns have combined rigorous research and evidence, plus targeting of individual companies, to challenge the intellectual underpinnings of Big Pharma’s defence of current global IP rules and weaken its capture of government policy making.

ALLIANCES BETWEEN CIVIL SOCIETY AND DEVELOPING COUNTRY GOVERNMENTS Another critical shared feature of both campaigns is the alliance formed between civil society and key developing country governments on the issue. Currently South Africa and India are spearheading the current waiver. Similarly, back in 2001, the African group along with India and Brazil penned the WTO Doha Declaration and faced down US and EU resistance. In both periods, global public concern and civil society campaigning has helped embolden developing countries, and widen the policy space for them, to increase access to life saving medicines. For example, in 2001 South Africa’s Treatment Action Campaign , with support from the global movement, supported Mandela’s government to face down efforts by 39 giant pharmaceuticals to weaken a public health law which would improve access to medicines. India and Thailand issued compulsory licensing on HIV and cancer medicines.

LEARNING FROM THE PAST A key lesson from the previous HIV/AIDS global movement is the importance of persisting with advocacy and campaigning over the long term. After the gains in access to HIV medicines in the early 2000s, the intensity of the global campaign weakened enabling the pharmaceutical companies to recoup some lost ground including through stringent intellectual property provisions in bilateral and regional free trade agreements. A second and related lesson is to ensure that the TRIPS waiver is kept simple, broad and workable. The 2005 TRIPS amendment was supposed to enable compulsory license for export (obviously a problem in a pandemic) but ended up being almost unworkable due to its complexity.

LOOKING FORWARD As well as campaigning for the waiver, the PVA is seeking to convince Governments and pharmaceutical companies to share vaccine science and know-how via the World Health Organisation’s Covid19 Technology Access Pool.. The fundamental problem of inadequate vaccines supply requires the sharing of technology to enable companies in developing countries to produce the millions of doses needed to vaccinate the world rather than rely on the good will of pharmaceutical companies. Developing country governments also need to continue to invest in public health systems and prioritise domestic investment in know-how and manufacturing capacity so that they can secure supply of medical products in the future. It is time to intensify the campaign to change the global policies and practices that cause this injustice in access to knowledge and to medical technologies like vaccines.

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