We have consensus that the Covid-19 pandemic is an unprecedented health crisis with a devastating impact on lives and economies.

Equitable vaccine roll-out across the world is urgent, necessary and in all our interests. Reportedly, 73% of the vaccines administered were in just 10 countries.

We face a dramatic supply constraint. At current levels of vaccine production, it may take the world another two to three years to bring the virus under control. The gap in availability of supplies will give time for the virus to spread and to mutate into more deadly or contagious strains. Vaccine nationalism, the race to purchase vaccines by those who can afford them and vaccine hoarding are not a solution to the global supply constraint. They are pernicious examples of beggar-thy-neighbour policies. 

We need to step up production on scale. This means using all available capacity and repurposing capacity where this can be done safely and by adhering to necessary standards.

The constraints to scaling up production include technical challenges, inadequate investment to repurpose existing production facilities and the current intellectual property rights regime.

In this context, we need a “Covid New Deal” to significantly and rapidly increase supply of vaccines and related medical goods and promote more equitable access to such essential goods. In support of this, on 2 October 2020, South Africa and India proposed a time-bound and limited waiver of certain provisions of the TRIPS Agreement (Agreement on Trade-Related Aspects of Intellectual Property Rights). At the time, the global death toll was just above one million people. Today, many meetings later, almost three million people have died.

Fifty-eight WTO members have co-sponsored the Waiver Proposal and another 60 have indicated their support. There is support across the developing world, and from members of the US Congress, among EU Parliamentarians and from civil society globally. Until the pandemic is brought under control, it seems to us that support for the Waiver will continue to grow.

The current approaches are a start but not adequate on their own. The helpful Covax facility is constrained by supply challenges, national purchasing agreements and finance. Voluntary arrangements in many cases are simply contract production on a “fill and finish” basis that do not address backward integration and distribution rights; while compulsory licensing procedures are onerous and cumbersome.

Negotiations with suppliers are hampered by information and bargaining asymmetries that can result in inequitable outcomes and untenable conditions attached to their procurement.

TRIPS flexibilities were simply not designed to meet the scale of the challenge we now confront. That is why I wish to welcome the initiative by the director-general of the World Trade Organization to find a way forward on vaccine equity.

We need a Covid package or New Deal, pursued on parallel and mutually reinforcing tracks, done pragmatically and covering five areas.

First, we must scale up production, in partnership with pharmaceutical companies, that can cover investment and funding to enhance supply capacity in different and additional parts of the world, including the African continent. This necessitates effective transfer of technology, sharing of know-how, backward integration of the raw materials and distribution rights. It must unlock productive capacity and not be confined simply to “fill and finish” arrangements.

Second, a time-bound and targeted TRIPS waiver is needed, covering only essential diagnostics, vaccines, therapeutics and supplies to enable production of these essential goods wherever possible.

Third, protocols covering transparency of contracts and price stability undertakings by pharmaceutical producers should be put in place.

Fourth, a commitment to avoid a resort to vaccine nationalism is required by all countries, undertaken simultaneously.

Finally, a TRIPS provision dealing specifically with future pandemics needs to be developed now, that provides automatic rights of use of intellectual property in circumstances such as that faced currently and obviates the need for special arrangements and waivers during emergencies.

These tracks are not mutually exclusive.

We have a responsibility imposed by circumstances. We need to find the will to act with both boldness and pragmatism to save lives. DM

This is an edited version of Ebrahim Patel’s address on Wednesday, 14 April 2021 to a World Trade Organisation (WTO) webinar on the importance of vaccine equity in the face of the most severe health and economic crisis of our generation. The opening session included the trade ministers of South Africa, the United States, India and the European Union, as well the heads of the WTO, the World Health Organization (WHO), the International Monetary Fund (IMF), the World Bank’s International Finance Corporation (IFC), World Intellectual Property Organisation (WIPO) and the European Medicines Agency. It provided a platform for South Africa to lay out its argument for a temporary waiver of key areas of the WTO agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

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