Missed opportunities in the United States’ vaccine rollout

Kate Backshall | United States Fellow


Image credit: Daniel Schludi via Unsplash
Image credit: Daniel Schludi via Unsplash

Vaccines began rolling out in December starting in the UK and the US, offering a light at the end of the pandemic tunnel. But this rollout has proved to be painfully uneven, even characterised as a ‘vaccine apartheid’ as less developed nations have received only a fraction of the doses of developed nations. The rollout in the US is now so advanced, they have begun inoculating well beyond their vulnerable populations and are offering doses to teenagers. By rushing to vaccinate their healthy youth, rather than distribute doses to the vulnerable in other nations, the pandemic risks being prolonged for everybody. This is because variants mostly mutate within people with compromised immunity and so prioritising American children over at-risk adults abroad increases the chance of variants that could even be vaccine-resistant.


Only now is this inequity slowly being grappled with as President Biden has announced the export of 60 million AstraZeneca surplus vaccines (which are not approved for use in the US), plus 20 million of their approved doses. But by opting to behave self-servingly, rather than supporting an international pandemic response, they have undermined the credibility of the US-led ‘liberal world order’. In so doing, the US has shown that when push-comes-to-shove, the US hold little regard for their neighbours and missed an opportunity to repair some reputational damage on the world stage.

To address some of this inequality, a coalition of state and non-state actors have pushed for vaccine patents to be waived. The US has long been one of the most avid supporters of intellectual property (IP). But in a recent change of stance, the Biden administration announced they will be backing an IP waiver for COVID-19 vaccines. Although this is promising, the US is not the only developed nation standing in the way of IP distribution. Granting a waiver within the WTO requires all 164 members to reach a consensus agreement. A waiver alone will not be a complete solution to the transfer of technology. Trade secrets and quality control procedures need to be followed precisely too, and there are other more immediate concerns, such as shortages of medical supplies.


The problems with patents and the lessons that should have been learned


The AIDS epidemic, and particularly the case dubbed Big Pharma vs Nelson Mandela, highlighted how patent holders can manipulate IP laws and make essential drugs inaccessible to the general public. Despite the desperate situation, particularly in Africa, the US fought to protect their industry’s financial interests within the WTO at the expense of human life. Yet despite the reputational damage this caused, the world was equally unprepared to provide a coordinated response more than 20 years later. It is difficult to think of a situation more apt than a pandemic to enact the provisions supposed to be built into the global patent agreement such as TRIPS, which exists for the emergency sharing of IP.


The purpose of patents is to incentivise innovation, but with such notable pitfalls, support for alternative incentive systems, like economist Joseph Stiglitz’s recommendation of ‘prizes not patents’ has been discussed. But as yet, there have been few attempts to amend the system’s failures.


Although originally designed to share the cost of vaccine creation and ease the distribution of vaccines globally, COVAX was designed too late to be effective. Wealthy countries had already pushed ahead purchasing supplies unilaterally and had little incentive to join. Without them funding the project, which also supplies other needed elements like oxygen, this program was severely undermined and lacking capital.


Médecins Sans Frontiers described this as the international community failing the Global South twice, firstly by scarcely providing inoculation and secondly by underfunding COVAX and therefore limiting resources used to treat those infected in places like India and Yemen. As part of their unilateral endeavour, the US implemented a war-time law, the Defense Production Act, which was invoked to stockpile and restrict exports of supplies that are used in the making of vaccines. This is only now being relaxed. But its enactment stifled other nations production capacity by shutting off global supply chains, and these supply chain problems continue to be an issue.


There are considerable lessons that could and should be learned from the inefficiencies in the pandemic response particularly over ensuring the infrastructure for cooperation in future emergencies is prepared ahead to achieve fair and humane outcomes. There are also important discussions to be had about the role patents play in restricting access to drugs whose creation in this pandemic were largely government – not patent – funded. The Director-General of the World Health Organization had a clear message for rich countries who have hoarded supplies and vaccines: "The shocking global disparity in access to vaccines remains one of the biggest risks to ending the pandemic”. The US would do well to listen to the experts.


Kate Backshall is the United States Fellow for Young Australians in International Affairs.