The situation in India has highlighted the global inequality that has existed throughout the pandemic. The virus may have started in China, but soon spread worldwide. Initially, because of global travel, richer countries and richer people within countries got the virus first. One of the sources of spreading in Europe was ski holidays in Italy. However, as the pandemic developed, the inequality between and within countries manifested itself with people in the less well-off countries, and the working class in all countries, being more likely to die from Covid.
The amount of cases and deaths, however, is not completely down to wealth. Some poorer countries such as Vietnam managed to get the virus under control early on whereas it raged in the USA and Europe. India managed to have a very low case rate until recently due to a very pro-active public health scheme. These differences had to do with policies of suppression or containment with countries like New Zealand, Australia, China, Taiwan and Vietnam following a suppression strategy. On the other hand, the USA and the UK let the virus get out of control and have yet to fully suppress it- worried about profits rather than the health of the population.
Nevertheless, the richer you are the more likely you are to be able to deal with the disease if you do get it. Richer countries have a better health care system and richer people in those countries will have the best access to that health care. Countries such as India and Brazil have a health care system that caters mainly to the well-off, with millions of people left to fend for themselves.
The vaccine and inequality
The vaccine has a crucial role to play in controlling the pandemic, though it needs to be stressed that it is only one measure among many. The vaccine does not offer 100% protection and it is still unclear how the vaccines will cope with new variants. The bigger the unvaccinated population, the greater the chance for mutations. And with world travel still going on at quite a significant level, the chance of new variants spreading is high. This is why the sooner everyone is vaccinated the better. Yet, that is not happening. As Johnson takes the credit, undeservedly, for the roll-out of the vaccination programme in Britain, many other countries struggle to vaccinate their population – and the poorer the country, and the poorer you are in that country, the less likely there is to be a vaccination programme. If it is so important to vaccine everyone why isn’t it being done? There are three main reasons:
- the cost of the vaccine itself which is prohibitively high for many countries,
- vaccine patents which prevent manufacturers getting the ‘recipe’ for the vaccine and greatly increasing the supply.
- vaccine nationalism which has obstructed efforts to have an international strategy both in research and development of the vaccine and in its distribution. All of these reasons stem from the fact that the development of the vaccine and its manufacture and distribution has been controlled by corporations whose main interest is making profits.
Cost of the vaccine
The cost of the vaccine to the government varies according to the company. AstraZeneca is the cheapest at £3.00 a go. This is meant to be based on the actual costs of production. Of course, with the UK government footing 99% of the cost of the research, the company could hardly do otherwise. However, this will only continue for the pandemic. It has reserved the right to declare the pandemic over. Boosters or new versions will be unlikely to be provided so cheaply.
Pfizer refused US government funding and has not made any efforts to provide at cost – it is honest about its desire to make money out of the vaccine. The Pfizer vaccine is costing the UK government £15 per dose. This explains why this vaccine was only used for the most vulnerable. People under 70 are being given the AstraZeneca vaccine, which according to studies so far is not as effective as the Pfizer, especially against the South African variant.
The prices charged, however, have been found to vary across countries. Companies have been using capitalist market relations to charge what they think they can get away with. Recent studies have shown great variations in what different countries have been charged.
“A string of revelations about vaccine prices has focused attention on a practice considered normal in the drug industry but often frowned on elsewhere: charging different prices to different customers for the same product.”
The excuse used for giving some of the richer countries a cheaper price is because they have contributed money to the development of vaccines. So if you are a richer country and can afford to do this, then you benefit whereas poorer countries have to pay more. And, prices are decided on the basis of the economic status of the country as a whole, even though there is great inequality within a country. So South Africa is considered a middle income country despite enormous poverty among large portions of the population.
Companies, even those like AstraZeneca who claim not to be currently profiting from the vaccine, are still operating as a capitalist company – ask as much as you can get away with, negotiate deals with big consumers etc, with no thought of simply getting the vaccine to those who need it.
The role of patents and the manufacturing of vaccines.
According to Stephen Buriyani:
“The world desperately needs coronavirus vaccines. About 430m doses have been produced so far this year, enough for about 215 million people. And of the doses already given, about half have gone to the richest 16% of the world’s population. Covax, the World Health Organization initiative to transfer vaccines to nations in need, has delivered just 38m doses. According to analysis by the Center for Global Development and the Economist, nations in the global south may not reach widespread vaccination until 2023.”
The key cause of this shortage is that the companies who have developed the vaccines do not want to waive the patents to allow manufacturing to go ahead.
Companies take out patents on products they develop. There is some justification in this within a capitalist system; if a company spends millions on developing something then it would be unfair for other companies to use the research and make money out of it. However, even within the logic of capitalism, the greed of the pharmaceutical companies during a global emergency, long known for their disregard for social welfare, is criminal.
If patents were shared then anyone could manufacture the vaccine. This would greatly increase much-needed supply and go a long way to getting the world vaccinated. Many factories are all geared up to start producing the vaccine if they can be given permission by the drug companies.
For example, according to Stephen Buranyi:
“Biolyse is a small pharmaceutical manufacturer in Canada with a simple proposition: provide a recipe for a coronavirus vaccine, and it will produce 20m doses for nations in the global south. It has approached AstraZeneca and Johnson & Johnson, and even asked the Canadian government to help it with compulsory licensing – which would give it the authorisation to produce another company’s patented product for emergency use – but so far no one has taken up its offer.
“When I reached him by phone this week, John Fulton, the vice-president of Biolyse, told me: “We’ve been passed over. We’ve got this production capacity and it’s not being put to use. If we had started this last year, we could have shipped millions of doses by now. This is supposed to be like a wartime effort, everyone in it together. But that doesn’t seem to be the case” (The Guardian, 24 April).
Of course, this would affect the profits of the companies that have done the work to develop the vaccine. However, there are already schemes to compensate companies who waive the patent. No company, including AstraZeneca, is willing to waive patents.
According to Jacobin Magazine, Bill Gates has played a major role in fighting calls for patent waiver.
He “used an appearance on Britain’s Sky News to explain why the various recipes for vaccines currently held by drug companies should not, in fact, be shared so that production and distribution can increase. Asked directly by Sky’s Sophy Ridge if he thought changing patent restrictions ‘would be helpful,’ Gates answered with a quick and curt ‘no’…
“Gates, who incidentally owes much of his own fortune to monopolistic intellectual property laws, has been more than a passive actor in the pandemic — having, among other things, convinced Oxford University to renege on its original promise of a no-patent vaccine and partner with the profit-driven AstraZeneca instead. Arguably more than any other single figure, the billionaire has mobilized his immense personal wealth and power to ensure that the interests of for-profit drug companies prevail over global public health.”
Nationalism has manifested itself in a variety of ways though-out the pandemic. Because of the fact that the nation state is the main political unit, it has dominated policy making. The necessity of stopping the spread of the pandemic necessarily led to border controls in many cases. It was people travelling from infected places that spread the virus in the first place. But as Independent Sage has repeatedly stressed, it is not that we are blaming foreigners for bringing the virus – it is movement in general which is the problem. We need to protect ourselves but need to protest others from us. Even within the UK the different “nations” have been responsible for managing the pandemic and have taken somewhat different approaches. On the one hand it is useful to be able to adapt to local circumstances but the division into “nations” has led to an upsurge in inter-nation competition and blame about who is responsible. Scottish nationalism has had a great boost with the Scottish government, supported by many, closing the borders to keep the “English” from spreading the virus, even though this was largely meaningless as there are no official border crossings.
Nevertheless, even with allowing to have distinct national policies on managing the pandemic, the lack of co-operation between nations has been a major factor in prolonging the crisis.
One of the main problems is that countries did not seem to learn from each other. The advent of the virus in Italy and Spain provided an ideal opportunity for the UK and other countries to learn from their experience. But instead, many governments were determined to manage the pandemic in their own way – keen to show their superiority. In the UK’s case, this backfired. The UK ended up having one of the worst death rates in the world, higher than countries like Germany, Spain, the USA, Brazil and India. The success of the suppression strategy adopted by New Zealand, Australia, Taiwan, China, Vietnam, and others, was completely dismissed, even though the success of that strategy soon became apparent.
International organisations such as the WHO struggled to unite everyone around a common set of policies but were often ignored. Many countries, including the UK and the US, ignored the WHO warning back in January 2020. It took months for governments to take action. In the case of the UK, the government has continued to ignore WHO advice, such as ensuring that an effective find, track, trace, isolate, and support system is in place.
If countries had worked more closely together, the spread of the virus could have been quickly contained.
The development of the vaccine has shown nationalism at its worst. We have already seen how pharmaceutical companies have looked after their own interests. Rather than international co-ordination, we saw individual companies racing to be the first to produce a vaccine – often with the support of a particular government. We now have at least 5 different vaccines. If there was more co-operation then maybe we could have developed one that was better than each one individually. Nevertheless, vaccines have been developed much quicker than many thought.
However, nationalism now comes in to the picture as countries, or blocks like the EU, compete to get hold of the limited amount of vaccines that are on offer. The UK has ordered enough vaccines to inoculate the population twice – that is two sets of the necessary two doses. Meanwhile, other parts of the world are being left without. If patents were waived, it would be a different story but given the scarcity, the rich countries have the money to grab up all the available doses.
An article by Fatima Bhutoo in The Guardian sums up the situation:
“Rich countries with 14% of the world’s population have secured 53% of the best vaccines. Almost all of the Pfizer/BioNTech vaccines will go to rich countries. The Moderna vaccine will go to rich countries exclusively; it is not even being offered to the poor. In fact, nine out of 10 people in poor countries may never be vaccinated at all. Washington is sitting on vaccines, making sure no one gets any while the US needs them. The European Union has exported 34m doses to, of all places, Singapore, Saudi Arabia and Hong Kong – countries that have no problem sourcing or paying for vaccines. In fact, the EU sent about 9m doses to the UK, a country which, no longer in the EU, also has what amounts in practice to an export ban of its own, official denials notwithstanding.
It’s unlikely that Moderna’s chief executives feel badly about the unvaccinated poor. The company forecasts sales of over $18bn for 2021, pushing Moderna into profit for the first time since its founding 11 years ago. Pfizer hasn’t done too badly either; they’re expecting a cool $15bn in sales.
“Canada has bought more doses per head than anyone else – enough doses to vaccinate every single Canadian five times over. But the entire continent of Africa – home to 1.3 billion people – has been allocated a total of 300m doses. As of the last week of January, in all of sub-Saharan Africa, only 25 vaccines had been administered. Twenty-five.
“Israel, administering over 150,000 doses of vaccine a day in the dawn of the new year, leading the world in vaccine rollout, is pointedly, purposefully, not vaccinating the Palestinian people it occupies. When asked about it, the Israeli health minister sniffed that Israel had no legal obligation to vaccinate Palestinians. What then were the obligations of the Palestinians, he asked, to look after dolphins in the Mediterranean?
“While western countries were barging ahead, stockpiling vaccine doses for themselves, China and Russia were practicing vaccine diplomacy. China offered free doses of their vaccines to 13 countries; between the two of them, China and Russia have supplied more than 800m doses to 41 countries. No one imagines they do this out of charity, but it’s a clear, resounding sign of the changing world order. Eight hundred million to the EU’s paltry 34m. The US and UK have given nothing at all. This petty vaccine nationalism is irreparably damaging the west, betraying their claims to magnanimity, inclusive global leadership and concern for global health” (The Guardian, 17 March).
The situation in India has arisen because the government allowed large political rallies and religious festivals to go ahead in the run-up to elections. They have a crisis in all areas, hospital beds and oxygen. However, lack of vaccines is also an issue. They had a good vaccine roll-out programme and are also one of the biggest producers of vaccines, though much of this is for export. All the issues discussed so far come into play. The overall global scarcity means that India does not have enough vaccines. They will have to divert the vaccines they are producing to their own people which will cause problems for other countries. Again we have a situation where countries are fighting to get hold of vaccines when there should be plenty to go round if patents were waived. It also shows the global nature of the pandemic – what happens in one country does affect what happens in another.
The People’s Vaccine, not a Profit Vaccine
Increasingly people are becoming aware of the need to have a global approach to the pandemic. Unfortunately, this is not widespread among corporations and governments. It is up to us to push for an international, anti-capitalist strategy. One campaign that has got underway is for a People’s Vaccine. Though Oxfam seems to be heavily involved, it is supported by a range of organisations and whatever criticisms we may have of Oxfam and other NGOs, the demands are clear and deserve to be campaigned around. They include:
- Ensure the vaccine is purchased at true cost prices and provided free of charge to people.
- Prevent monopolies on vaccine and treatment production by making public funding for research and development conditional on research institutions and pharmaceutical companies freely sharing all information, data, biological material, know-how and intellectual property.
- Ensure the vaccine is sold at affordable prices: Pricing must be transparent and based on the cost of research, development and manufacturing, as well as taking into account any public funding provided.
- Implement fair allocation of the vaccine which prioritizes health workers and other at-risk groups in all countries. Distribution among countries should be based on their population size. In-country vaccination programmes should include marginalized groups, including refugees, prisoners, and people living in slums and other crowded housing conditions. Allocation between and within countries should be based on need and not ability to pay.
There is also a related campaign to call for the suspension of all Covid patents.
The governments of India and South Africa along with 100 countries are calling on the World Trade Organisation to suspend patent rules during the pandemic to produce mass quantities of vaccines and treatments to tackle this virus. The UK government and other rich countries are opposing this proposal. The UK can defend big pharma profits or it can save lives. It can’t have both.
There is a call for the UK government to back this proposal to suspend patents during the pandemic (Global Justice Now).
The problem with these campaigns is that even though they have a lot of support, they rely on making demands on corporations and governments – the very institutions that have caused the problem in the first place. Making demands does have a role, but it needs to be backed up by a strong social movement. At the moment there are no grass roots campaigns mobilising for the suspension of patents. Setting up such a group could be a first step – under the slogan “No one is safe until we are all safe. For international solidarity.”
What really needs to happen is that scientists and workers in places which have vaccine manufacturing capacity take direct action. The recipes for the vaccines will be known by scientists and they can be distributed to appropriate factories, with workers taking control of production and then link up with distribution networks. In other words, we cannot afford to wait for corporations and governments to do the right thing – we can do our best to force them to act by building a movement, but the most effective would be for people themselves to take control of the production and distribution of vaccines.