Unfair World: Why Are 92 Countries Dependent on Serum's Vaccine?

"Serum, that is contracted to provide vaccines to 92 countries, can only manage to provide to one - that is India."

Unfair and inequitable COVID-19 vaccine access explained

(Photo: iStock/Altered by The Quint)

The story of vaccines to protect the world from the novel coronavirus is an extraordinary one. A month into the pandemic, work had already begun to develop vaccines to fight the virus. Various countries and pharmaceutical companies were pumping in money in R&D, and never-before-seen global cooperation meant we would have several vaccines to fight the pandemic in a very short span of time. While the first generation of vaccines, the mRNA vaccines made the biggest splash, seeds of vaccine nationalism were already beginning to be sown. Even as the big press releases on promising clinical trials were coming in, the developed countries of the world were already blocking all possible available stock.

That's when Oxford's Jenner Institute's vaccine emerged as the 'saviour of the world.' Cheap, easily stored and distributed, and more importantly, Oxford said it would be 'not-for-profit' and they would licence it to manufacturers who had the capacity to make the vaccine.

What Went Wrong?

In an interview with The Quint, Leena Menghaney, a lawyer who has worked extensively on public health and works with Access Campaign at Médecins Sans Frontières (MSF), and Achal Prabhala, coordinator of the AccessIBSA project, the two talk about about COVID vaccines, inequitable access, India role as the 'pharmacy of the world' and our own sluggish vaccination programme.

According to a WHO release, so far, more than 38 million doses of vaccine have been delivered to 98 countries. The Oxford-AstraZeneca vaccine accounts for more than 90% of the vaccines being distributed through COVAX facility, set up to ensure equitable access to the poorest countries.

"Very early on, a handful of countries put in preorders for these vaccines, and made sure they got first in line. At this time, WHO, CEPI and GAVI stepped in and said to the poorest countries 'we've got you,'" says Achal.

He points to two anomalies that stood out - First was India, because India is a poor country but with great manufacturing capacity, and the other was Oxford vaccine that insisted before they exclusively signed a deal with AstraZeneca, that the vaccine should be produced elsewhere, and it entered into a large access agreement with Serum Institute in India, the largest vaccine maker in the world.

Where did WHO, CEPI, COVAX, GAVI go wrong?

Leena alleges that their failure to challenge the big pharma on intellectual property played an important role in the mess. "They were unwilling to challenge AstraZeneca and say that your licensing model needs scrutiny, and we would like to add more manufacturers in India and elsewhere."

Why was an exclusive deal signed with AstraZeneca?

Achal challenges the 'gold standard' label for the AstraZeneca-Oxford deal. 12.5 per cent of vaccines for 4 billion people would have never worked. He says, "Gates Foundation and other organisations advised Oxford to sign a deal with AstraZeneca. COVAX did not challenge the deal and ask for wider licensing. They presumed these vaccines will be enough to take care of the poorest countries in the world." He also calls out COVAX for exclusively trusting western pharmaceutical manufacturers and not signing deals with Chinese and Russian companies that were going to produce 300-400 million vaccines.

How did India add to the mess?

Achal says India's wake-up call that it needed vaccines to inoculate its very large population came in too little, too late.

"Indian government suddenly woke up to its population in January and followed up with ordering only 10 million doses with Serum Institute. They followed that up with another 25 million, 25 million, and now suddenly 100 million."

This has halted all exports from Serum Institute. So Serum, that is contracted to provide vaccines to 92 countries, can only manage to provide to one in the foreseeable future - that is India.

Does Canada and the UK deserve to take the vaccines meant for the poorest countries?

Leena says this is a big scandal made possible due to one contract obligation that if AstraZeneca could not meet its requirements, Serum would step in. Serum was contracted to provide its vaccine to 92 of the poorest countries.

"You are diverting vaccines meant for the poorest world to countries that have already vaccinated 50 percent of its population," says Leena.

Why aren't regulatory authorities like Competition Commission in India opening up these contracts to scrutiny and questioning what is happening?

Open Inoculation for All: But these are not India's vaccines

"These are not India's vaccines," says Achal. 35 percent of Serum's vaccines were meant to be India's vaccines, but there was an understanding that 50 percent would go to India. So already, India was pulling in more than its fair share.

"What's absurd is that these countries that want Serum's vaccines, like the UK, Canada, Brazil are the same countries that are blocking India and South Africa's proposal to waive pharmaceutical monopolies at the World Trade Organisation to create greater vaccine supply."

What could India have done to improve its own vaccine access?

To begin with, both Achal and Leena point out that India needed to have provided better infrastructural, R&D support, capital infusion and cut through red tape for its own pharma companies. It should have created wider licenses, got speedier access to companies wanting to come in.

Leena also says that the regulatory authorities need to look at the kind of licensing agreements that Sputnik V has with five pharmaceutical companies in India, and to look at the contract that Biological E has with Johnson & Johnson's single dose vaccine.

We need to do all of this to open up better access to vaccines, else we'll be scrambling for vaccines six months, one year down the line.