Covid Vaccine Apartheid and the role of the International Regulatory Bodies: A Humanitarian Crisis

The Covid-19 Pandemic has affected every stance of life in all realms, especially the global economic loss and individual personal loss. However, through the advancement of technology, and research and development, the scientific community was able to develop vaccines that were highly effective in fighting the spread of viruses. Whilst the major developed countries had the means to vaccinate the majority of their population, developed countries and underdeveloped countries had the challenge to vaccinate their major populations. 

This paper aims to analyse the role of the international regulatory framework focusing on COVAX facility and analyse the factors influencing inequity to access the Covid-19 vaccines and how it has led to the humanitarian crisis. 

 An estimated 413 million Covid-19 vaccines were manufactured by March 2021. However, around 11 billion doses are required to be manufactured to reach 70 percent of the global population. Out of 8.6 billion doses that have been contracted, 6 billion have been secured by the comparatively rich and upper-middle-income countries. It is estimated that these countries only account for 20 percent of the global population provided how most of these rich countries contracted for more delivery of vaccines than required. 

International Framework 

The lack of access to vaccines in certain countries, especially the under-developed countries will affect the civil, social, and economic realms of the respective countries. There are numerous reasons why there has been inequitable access to vaccines. One of the major reasons why there have been vaccine shortages is the scarcity in the supply of vaccines. Amidst the scarcity, developed nations have bought a majority of vaccines directly from the manufacturers and already advanced the second doses. It is also to be noted that access to vaccines is comparatively easier in states which have the capacity to manufacture vaccines. Finally, the monopoly on the rights of vaccine manufacturers is a major issue that has enabled inequity in access to vaccines. 

The International Coalition of Medicines Regulatory Authority (ICMRA)[1] and World Health Organization (WHO)[2] have collaborated to create standards and ensure safe and equitable access to Covid-19 medicines and vaccines. The two organizations, in a joint statement, declared that a collaborative workforce with different stakeholders is the best way to ensure that Covid Vaccines are procured safely in an equitable manner and effective medical products become available as soon as possible.  

There have been various regional and global initiatives that are directed towards addressing the noticeable inequity in access to vaccines. One of the major global initiatives is the COVID-19 Vaccines Global Access (COVAX)[3] led by WHO, Gavi (The Global Vaccine Alliance), and CEPI (Coalition for Epidemic Preparedness) with UNICEF, which is a key delivery partner. The aim of the COVAX facility is to bring together various governments, global health organizations, manufacturers, scientists, the private sector, civil society, and philanthropy and provide innovative and equitable solutions to access to vaccines especially concerning the low developed countries which do not have means to procure vaccines, or bilateral trade supporting the access to vaccines. The initiative aims to procure 20 percent of the population coverage with over 200 participating countries. After the procurement of 20 percent of the vaccines, the vaccines are allocated according to the need determined by the Covid-19 threat and vulnerability. Gavi COVAX Advance Market Commitment (AMC)[4] is a mechanism within the COVAX facility that ensures the 92 middle and lower-income countries which cannot afford to pay for the Covid-19 vaccines get access. However, when India was going through its devastating 2nd wave of Covid-19 in April 2021, a large allocation of vaccines was shifted to combat the domestic wave.

COVAX’s funding model requires the wealthy countries to purchase some of the vaccines through the COVAX facility, even though they might have signed their own deals with the pharmaceutical companies on the other side. This enables COVAX to negotiate cost-effective deals with various vaccine producers. It is important to note that through this mechanism the participatory nations will have an insurance policy for the vaccines if their own deals are failed. The lack of transparency with the pharmaceutical companies is another major drawback of the COVAX facility. The COVAX model placed the bets to various pharmaceutical companies to be in pace with the global competition of production of vaccines like an investment in a mutual fund to compete with the procurement of vaccines with the richer nations.  

 

Human Rights Perspective on Vaccine Apartheid

The International Human rights call upon the duties of the state to respect, protect and fulfil the human rights of their respective populations by taking adequate steps to prevent, investigate and punish adverse interferences by third parties which directly or indirectly violate the human rights of the individuals. Article 12 (2)(c) of the International Covenant on Economic, Social and Cultural Rights (ICESCR)[5] states that 

the State Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health… The prevention, treatment, and control of epidemic, endemic, occupational and other diseases.

This implies that States must utilize their maximum available resources to gain access and to administer safe and effective vaccines. Right to Life under Article 6 of the International Covenant on Civil and Political Rights (ICCPR)[6] calls upon the duty of the state to practice due diligence and opt for mechanisms to stop the spread of Covid-19. Article 15(1) of the ICESCR calls upon the equitable distribution of benefits of the vaccines through the means of scientific research and technology. The same contradicts the lack of access to vaccines due to patents rights exclusive to certain companies and hence promoting the monopoly in the vaccine supply chain. 

To combat the monopoly of the vaccines a joint statement was made by several UN human Special Rapporteurs appointed to address certain human rights issues, on November 9th, 2020, and recommended the signatory bodies to join the COVAX-19 Global Vaccines Facility. Article 55 and 56 of the UN Charter[7] also calls upon the duty of the states to acknowledge their duties for the protection of the human rights of other states by ensuring the access of vaccines. International human rights also call upon the joint duty to share vaccines, however, the means of the sharing vaccines mechanisms falls upon a blurred line. 

The World Health Organization launched the Covid-19 Technology Access Pool (C-TAP)[8] in May 2020, whose main aim is to share the vaccine know-how through pooling and voluntary licensing agreements in a pandemic. However, no major company with a WHO-approved vaccine shared technology with C-TAP or WHO hub because of the reluctance of the various governments. This takes vaccines from the ambit of the public good and it remains a commodity owned by companies sold to the richer countries. This calls upon the duties of the richer countries to act upon the International Humans Rights Laws to not just help secure the lives of the people who are a member of the particular state but also to help the under-developed countries’ access to vaccines by donating and being a part of COVAX facility. However, it shall not be ignored that even through participatory help and donations, the access of vaccines to distinguished nations is not enough. The only sustainable way to move forward is through the relaxation of Intellectual Property Rights, Technology transfer, and support of regional manufacturing hubs.

 

The Mismanaged Vaccine-Supply

It is objectively clear from the bilateral interactions and the cross-border interactions including the economic and social collaborations, there is an urgent need to work on equitable access of vaccines to attain the Sustainable Development Goals which calls upon the access of vaccines to all individuals. It is also important to understand that major stakeholders were not a prominent part of the collaborative research and facilitation of the widespread public access to research and data relevant to Covid-19 during the outbreak of the disease in China. While major steps were taken by the WHO to coordinate research relevant to Covid-19, major stakeholders like the large pharmaceutical companies were not motivated enough to join in multilateral vaccine research collaborations. 

While countries like the USA, Australia, and Canada[9] administered more than the required number of vaccines, however, in Africa, Latin America, Asia, or the Caribbean, limited access to vaccines is not just the major issue hovering the access to vaccines. The present global system highlights the major concerning issues such as logistical difficulties with deliveries, lack of proper healthcare infrastructure, public hesitancy, regional inequality of access to vaccines, or public hesitancy towards the vaccines.  The following chart represents the inequity in the vaccine distribution.

It is outstanding that of the initial 1.3 billion doses of Covid-19 vaccines which were injected, only one percent of the same was administered by African countries. The injected vaccines are also administered to less than 2% of the population of the African continent. Latin America and the Caribbean, which account for 8 percent of the global population, registered 30% of the global deaths due to Covid-19. It is also important to understand that the local governance and regulatory bodies have also played an immense role in misconduct and access to vaccines. For example, Nepal’s slow, haphazard and opaque vaccine procurement[10] policy contributed to the crisis in the country. India’s Serum Institute struggled to meet the vaccine requirements of the country during the second wave.

The pandemic has not only resulted in failing international systems, but the precautionary measures such as the lockdowns disrupted the global supply chains. This has also led to the need to compress the different timelines of different nations to adopt technological know-how. 

 

Conclusion

COVID-19 Vaccines have tremendously helped shape the roadway to the management of the vulnerable fight to the life-threatening disease, however, the rays of the light are disproportionate. The inequity of vaccine distribution promising the richer nations a better chance at procurement raises an ethical and moral question aimed at the human rights perspective at the global race. However, it is false to accuse the countries of violating international Human Rights given that the steps are taken to secure the human rights of their own respective nations. However, over-supply of vaccines or overbooking of vaccines is completely under the jurisdiction of human rights violation which resulted in wastage of vaccines. Export blockages of vaccines or hiding or restricting information related to substances of vaccine production has added to the inequality of access to vaccines. Vaccine aid at the international level should be need-based and shall be provided through global networks like COVAX, although COVAX’s non-transparent issues and a complex model adds to the uncertainty of delivery of the vaccines to underdeveloped countries. However, the major reason which has led to the inequity in access to vaccines is simply the lack of vaccines. Nations should also negotiate a workable solution to waiver the Intellectual Property Rights of TRIPS over the Covid-19 Vaccines. 

References

· Eccleston-Turner, Mark, and Harry Upton. “International Collaboration to Ensure Equitable Access to Vaccines for COVID-19: The ACT-Accelerator and the COVAX Facility.” The Milbank Quarterly, vol. 99, no. 2, 2021, pp. 426–49. Wiley Online Library, https://doi.org/10.1111/1468-0009.12503 

·Irwin, Aisling. “What It Will Take to Vaccinate the World against COVID-19.” Nature, vol. 592, no. 7853, Mar. 2021, pp. 176–78. www.nature.com https://doi.org/10.1038/d41586-021-00727-3 

· OHCHR | International Covenant on Civil and Political Rights. https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx 

·OHCHR | International Covenant on Economic, Social and Cultural Rights. https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx 

·“The Emperor’s Institutions: Does COVID-19 Vaccine Distribution Demonstrate the Failure of Multilateralism?” Public Interest Media, https://www.thebigq.org/2021/03/16/the-emperors-institutions-does-covid-19-vaccine-distribution-demonstrate-the-failure-of-multilateralism 

· “Vaccine Inequality Exposed by Dire Situation in World’s Poorest Nations.” The Guardian, 30 May 2021, http://www.theguardian.com/world/2021/may/30/vaccine-inequality-exposed-by-dire-situation-in-worlds-poorest-nations 

·“Gavi COVAX Facility.” Drishti IAS, https://www.drishtiias.com/daily-updates/daily-news-analysis/gavi-covax-facility.

·March 2021, Jenny Lei Ravelo // 11. “Is COVAX Part of the Problem or the Solution?” Devex, 11 Mar. 2021, https://www.devex.com/news/sponsored/is-covax-part-of-the-problem-or-the-solution-99334. 

 http://www.icmra.info/drupal/en/home

https://www.who.int/

Gavi is co-leading COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator. This involves coordinating the COVAX Facility, a global risk-sharing mechanism for pooled procurement and equitable distribution of COVID-19 vaccines. https://www.gavi.org/covax-facility

https://www.gavi.org/gavi-covax-amc

https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx

https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx

Article 55 of the UN Charter states:

With a view to the creation of conditions of stability and well-being which are necessary for peaceful and friendly relations among nations based on respect for the principle of equal rights and self-determination of peoples, the United Nations shall promote:

a. higher standards of living, full employment, and conditions of economic and social progress and development;

b. solutions of international economic, social, health, and related problems; and international cultural and educational cooperation; and

c. universal respect for, and observance of, human rights and fundamental freedoms for all without distinction as to race, sex, language, or religionhttps://legal.un.org/repertory/art55.shtml

WHO and partners launched the COVID-19 Technology Access Pool (C-TAP) to facilitate timely, equitable and affordable access of COVID-19 health products by boosting their supply. C-TAP provides a global one-stop shop for developers of COVID-19 therapeutics, diagnostics, vaccines and other health products to share their intellectual property, knowledge, and data, with quality-assured manufacturers through public health-driven voluntary, non-exclusive and transparent licenses.

https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/about-rollout/vaccine-agreements

https://foreignpolicy.com/2021/06/14/nepal-vaccines-coronavirus-disaster/

About Bhawna Bhushan

Bhawna Bhushan is a final year Master’s student of Public Policy at National Law School of India University. Her interest lies in Health and Technology Policy. Currently, she is researching Digital Media Surveillance issues in India with respect to privacy.

Disclaimer

The views expressed in this article are the author's own.

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