Vaccine apartheid shows that, once again, the free market has failed

Last year, the world marvelled at the speed with which scientists developed effective vaccines against Covid-19. Many of the factors explaining such extraordinary success came down to global cooperation: world leaders joined forces to throw funds at this vital mission, scientists pooled research across borders and thousands of people around the world volunteered for vaccine trials.

It’s a heartening story that stands in shocking contrast to the world’s vaccine rollout: a tale of selfish nationalism, blatant inequities and a failure of humanity on a global scale.

Just this week an exasperated World Health Organisation called for a halt on vaccine boosters in richer countries, pointing out that wealthy nations which have already used up most of the world’s vaccine supply could not think of delivering a third round of shots while so many poor countries have yet to administer a first.

There now exists an unconscionable global gap, which WHO head Tedros Adhanom Ghebreyesus has unequivocally labelled “vaccine apartheid”. Some 80 per cent of the 4 billion vaccine doses delivered globally have gone into the arms of those in higher-income countries, which represents less than half of the world’s population. Meanwhile, only 1 per cent of those in low-income countries have been given one dose. In Africa, just 2 per cent of nearly 1.3 billion people have received a first dose. And as wealthy countries pledge to send more doses to the developing world, most people in poor countries will be waiting years to be vaccinated.

There is no possible justification for this damning inequality. But even on the basis of naked national self-interest, it is self-defeating: infections soaring in unvaccinated countries create the conditions for increasingly robust virus variants to percolate and weaken the defences of safely jabbed nations. This is why scientists keep repeating that “no one is safe until everyone is safe”. Politicians in vaccine-hoarding countries seem to have blocked their ears.

What makes this especially painful is that developing world leaders and health inequality campaigners warned that this would happen. They knew that it would be foolish to trust the market to deliver, because that is not how the market works – not even in a global pandemic. Despite receiving unprecedented billions in public funding and being driven by health innovation in the public sphere, drug companies have monopolised vaccine formulas, creating zero-sum scarcity for the world and huge profits for their shareholders. Instead of being accessible to all, vaccines have become a commodity in a competitive market.

And despite a growing, global People’s Vaccine campaign, spearheaded by 100 developing world countries, calls to waive intellectual property rights and share tech knowledge to allow for wider vaccine production are routinely blocked by wealthy countries. The global south is forced to rely on the goodwill of Covax, a public-private partnership to deliver vaccine doses to poorer countries, which has failed to meet even its own target of 20 per cent vaccine coverage for low- and middle-income countries.

Epidemiologist Catherine Kyobutungi, who heads the African Population and Health Research Centre in Nairobi, has blasted Covax as a “paternalistic, donor-driven approach”. Nations across Africa and beyond did not ask for vaccine charity. They have asked for patent waivers and want to produce their own vaccines.

Many of the organisations backing the People’s Vaccine movement, including UNAids, Global Justice Now, Oxfam and Free the Vaccine, also campaigned during the late 1990s to redress the horrifying health inequalities of the global Aids epidemic. Activists fought the pharma industry to lower price tags on unaffordable, life-saving drugs for the hardest-hit countries such as South Africa, where the epidemic was, at its peak, killing 1,000 people a day. Drugs companies sued president Nelson Mandela when he changed South Africa’s patent laws to allow imports of cheap, generic HIV drugs – but later dropped the case amid a PR disaster.

For campaigners, cruel disparities in vaccine access today are a nightmarish déjà vu. Fatima Hassan, a South African human rights lawyer and founder of Health Justice Initiative, which advocates for medicines access, told me: “It is such a trigger, we thought, ‘Oh my God we have been here before, we have been burned by this before, we know what health inequality looks like.’”

Time and again, campaigners describe coming up against a western political class that has drunk the Kool-Aid of free-market solutions and cannot countenance patent waivers. It is at odds with public sentiment: polling from the People’s Vaccine Alliance in May showed 70 per cent public support across G7 countries for the sharing of vaccine recipes and knowhow.

Hassan says vaccine inequity is so obviously unjust, it has galvanised a new generation of global activists pushing for change. Spurred by progressive shifts in his own Democratic Party, US president Joe Biden in May announced support for patent waivers, a dramatic turn from a country that has staunchly defended intellectual property rights.

It put pressure on other countries currently blocking waivers, including the UK and Germany. And it caused vaccine share prices to tumble – the market response to the mere suggestion that developing countries should have access to the patents to produce their own vaccines. That shows us what should already be manifestly clear: in the race to vaccinate the world, misguided faith in market-led solutions is killing people.