We must tackle the root causes of vaccine inequity

Twenty years ago, MSF launched its pioneering Access Campaign with the aim of securing equitable access to affordable medicines, diagnostics and vaccines. Today, as Roz Scourse writes, the vaccine rollout is a painful reminder of our failure to tackle the root causes of unequal access.

For decades, MSF has seen the impact of inequity in access to health products, including treatments and vaccines, on vulnerable people. The inequities the world is now seeing in access to COVID-19 vaccines is unfortunately another striking example of the broader failures within the current system of medical innovation, which continues to prioritise profit over people with devastating impacts.

There was an estimated 10-year delay between when people living with HIV in the US started to receive lifesaving treatments in the mid-1990s, compared with those living in Africa in the mid-2000s. This lag led to 12 million unnecessary deaths because of lack of access to new antiretroviral drugs. The experiences of frontline MSF healthcare workers responding to the HIV crisis in part led to the launch of the MSF Access Campaign.

We hoped at the beginning of the pandemic that we would not see the same happen with diagnostics, treatments and vaccines for COVID-19 but we are tragically seeing this inequity in access play out again in real time.

We are failing to ensure fair and equitable access to vaccines for every country in the world.

There were early international efforts to try and prevent this from happening. The WHO and a number of partners, including Gavi, the Global Vaccine Alliance, launched the COVAX Facility, in an attempt to ensure equitable distribution of COVID-19 vaccines. However, it is clear that the COVAX Facility is so far failing in it aims. Furthermore, COVAX has estimated that it will only be able to provide three per cent of the supply promised to low and middle-income countries during the first half of 2021.

The media has to some extent highlighted the dangers of vaccine nationalism being seen in many high-income countries, and the progress and challenges being faced by COVAX in trying to ensure equitable access. However, too few have asked the more fundamental question of why we keep seeing these issues in the first place, and why the same reasons are also leading to the failure of COVAX.

Why do the same issues of inequity play out over and over again when it comes to accessing lifesaving medical products?

What is going wrong in the pharmaceutical system that means this vast inequity of access is happening? Why are there not enough supplies for everyone? Why can pharmaceutical companies charge eye-watering prices for their products even during a pandemic?

The answer is that the medical innovation system is currently structured to maximise profits for pharmaceutical companies. The monopolies that pharmaceutical companies hold on medical products, including intellectual property rights such as patents, guarantee them an exclusive market and enables them to charge high prices. One thing that this global pandemic has shown us is that monopolising and limiting available supplies of medical products is very dangerous, particularly when the whole world needs access to them at the same time.

COVAX has failed to address the root causes of equitable access.

Unfortunately, there were many lost opportunities to achieve equitable access in the design of COVAX itself. COVAX was created and crafted under the influence of high-income countries, who are heavily influenced by the Big Pharma lobby, as well as Bill Gates, a staunch advocate for business-as-usual and intellectual property rights.

This is an approach that is unsustainable amid a global pandemic. Instead of the artificial supply limitations and high prices that we are seeing now, COVAX and its donor governments could have required pharmaceutical companies to openly license their COVID-19 vaccines, breaking monopolies, maximising available supplies and ensuring access for all. But they didn’t. And the reason why is a question that not enough people are asking.