In Soweto, South Africa, 20 years ago there were billboards along the roadsides for funeral companies: “Motaung Funeral Directors – We Salute the Spirit of Ubuntu!” You can choose a 21st century funeral home or give your loved one a “Rasta” funeral. Medicines to save people with HIV already existed at that time; Unfortunately, poorer countries could not afford them, and millions continued to die.
It wasn’t until years later that cheap generics manufactured by Indian companies reached most African people with HIV. President George W. Bush, who helped make the treatments available, ended up saving many lives in Africa – something that should be as much on his record as the lives he destroyed in Iraq and Afghanistan. The messy, late compromise on HIV is the model for what needs to happen much faster for Covid-19. We must help poorer countries to produce vaccines.
The world is now in the same situation as it was 20 years ago: the drugs work, but poorer countries cannot get them, even though the main obstacle today is supply rather than price. The problem is that every adult human needs the shot at the same time. High- and higher-income countries have so far purchased more than six billion of the 8.6 billion vaccines ordered. Less than 600 million have been managed.
Since there are about 5.8 billion people on the planet aged 15 and over, most of whom need two doses, we quickly need more than 11 billion vaccines. The mantra “No one is safe until everyone is safe” sounds corny but it is true. But even if we were to administer 11 billion doses, the virus would almost certainly continue to circulate, so we need billions of booster shots every year to remove mutations.
According to the International Chamber of Commerce, the global economic cost of vaccine nationalism would be between $ 1.8 and $ 3.8 trillion. In contrast, vaccinating the world’s poorest people should only cost tens of billions. So how are we going to do that?
Rich countries will not share their scarce supplies. When governments have to choose between pricking their own voters first or doing the right thing for the world, we know what choice they will make. That’s why we shouldn’t force them to make it. Instead, they can help lower-income countries produce Covid-19 vaccines.
This is already happening on an insufficient scale in India, Brazil, South Africa and elsewhere, but we need much more global vaccine-making capacity, permanently: first to tackle the endemic Covid-19 and then the next pandemic. We will have to build factories around the world so that poorer regions can provide for themselves, now that they know they cannot count on rich countries.
There is a struggle to get vaccine-producing companies to relinquish their patents for lower-income countries. The companies – supported by most of the rich countries – are resisting. Pfizer CEO Albert Bourla derided the proposals as “nonsense” and “dangerous”.
But the White House is discussing suspension of patent protection, and rightly so. Many pharmaceutical companies have taken billions from governments to develop their vaccines. In addition, US government scientists at the National Institutes of Health helped make the crucial discovery of how to stabilize spike proteins.
Still, patents are a bit of an afterthought. Countries are allowed to issue compulsory licenses to cancel them as long as production is primarily for domestic use. The least developed countries are given wider exceptions. And Moderna has said it won’t enforce patents during the pandemic.
The bigger problem, explains Mark Dybul, former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, is that pharmaceutical companies need to transfer their vaccine-making technology. That means scientists and technicians fly to low-wage countries to educate the local population.
Pharmaceutical companies should also allow vaccines made in poorer countries to be labeled with their names, as that will speed up regulatory approval. But technology transfers are not yet underway, in part because the drug companies are overwhelmed just trying to deliver to wealthy countries.
Building a factory in Africa that could make a billion doses of vaccine could be done for as little as $ 200 million, Dybul says. He thinks that as technology improves, the price of a shot could eventually drop from $ 20 or $ 30 to $ 5. Whenever the virus mutated locally, the factory was able to quickly produce booster shots.
Taming pandemics would be transformative. But the potential of global vaccine factories goes beyond that. The Pfizer and Moderna vaccines are the first human applications of an exciting technology: messenger RNA. Vaccines made with mRNA teach our cells how to make a protein, or piece of protein, that triggers an immune response.
One day we could have mRNA-based vaccines against HIV, tuberculosis and cancer, says Ugur Sahin, co-founder of BioNTech and developer of Pfizer’s vaccine. RNA solutions could be used in agriculture in place of chemical pesticides, says GreenLight Biosciences. In fact, the potential of RNA is one of the reasons pharmaceutical companies hold on to patents. They are not interested in making money by vaccinating Africa against Covid-19. They play a longer, bigger game.
We wasted a deadly decade on HIV drugs. By doing the right thing this time, global medicine could enter a new era. It wouldn’t even be particularly expensive.
Follow Simon on Twitter @KuperSimon and email him firstname.lastname@example.org
To follow @FTMag on Twitter to be the first to discover our latest stories.