Vaccine monopoly: Profiting from the pandemic

A recent report by Oxfam stated that the global pharma companies were making profits by the second due to the pandemic. The numbers are telling. The report notes that vaccine makers made over $1000 per second as they furiously held onto their monopoly without making any concessions for fair play in the manufacturing of vaccines.

In the last two years, the pandemic created over 40 billionaires in the pharma sector. The wealth of these billionaires soared to astronomical levels every day even as the daily pandemic related death toll increased globally. According to Oxfam, the pandemic alone creates a new billionaire every 30 hours. This is even more glaring when seen in the context of the United Nations warning the world of a looming global mass hunger crisis. According to Oxfam, for every new billionaire created during the pandemic - one every 30 hours - nearly a million people could be pushed into extreme poverty in 2022 at almost the same rate.

To accelerate the manufacturing of Covid-19 vaccines and to ensure that there is fair and equitable access to the vaccines across the world, an initiative called COVAX was started by the GAVI vaccine alliance, the Coalition of Epidemic Preparedness Innovations (CEPI) and the World Health Organisation (WHO) alongside UNICEF. But COVAX has not been able to meet its own targets regarding the delivery of Covid-19 vaccines because of rich countries securing millions of doses of vaccines for their own citizens at the cost of poor nations. Several developed countries resorted to hoarding vaccines and spent billions of dollars on deals with vaccine makes to acquire vaccines for their own citizens even before the effectiveness of some of these vaccines were proven.

“The fact that there is a monopoly has been the case for a long period of time. That is why the World Health Organisation came up with a good initiative called COVAX. But one needs to see why this global initiative did not work. The pharma companies have been looting governments during the pandemic. This is why the major manufacturers in India had actually begun to supply made in India vaccines to the developing world. However, the virulence of the delta wave and the omicron wave has more or less closed this process down. We shouldn’t be expecting great generosity from Pfizer, Moderna and other multinational corporations. The solution is India and China can supply more vaccines now as these countries have been able to vaccinate a larger share of their population,” said Santosh Mehrotra, a human development economist.

Pfizer logo on glass building | Photo courtesy: Special arrangement

The COVAX, in a statement released last September, had said: “The global picture of access to COVID-19 vaccines is unacceptable. Only 20% of people in low and lower middle-income countries have received a first dose of vaccine compared to 80% in high and upper middle-income countries. In the critical months during which COVAX was created, signed on participants, pooled demand, and raised enough money to make advance purchases of vaccines, much of the early global supply had already been bought by wealthy nations. Today, COVAX’s ability to protect the most vulnerable people in the world continues to be hampered by export bans, the prioritisation of bilateral deals by manufacturers and countries, ongoing challenges in scaling up production by some key producers, and delays in filing for regulatory approval.”

Vaccine nationalism and vaccine monopoly are some of the main reasons behind COVAX not being able to keep up its words and deliver 2 billion vaccine doses to the world’s neediest in 2021. On the contrary, the wealth of the billionaires has increased more in the first 24 months of the pandemic when compared to the last 23 years. According to Oxfam, the total wealth of these billionaires today is equivalent to 13.9 per cent of global GDP.

When it comes to vaccines, it is not only the issue of monopoly that has been hogging the headline. In India - as in other parts of the world - transparency related to data on the vaccines’ emergency approval and its clinical trials seems to be one of the significant concerns. Advocate Prashant Bhushan had recently argued in the Supreme Court over the lack of transparency. According to Bhushan, while clinical trials of the vaccines are scheduled to be completed in 2023, even the full dataset from the interim analysis conducted has not been made public.

“I had argued that the disclosure of segregated data of clinical trials was essential to determine the adverse effects of the vaccines, if any, across various age groups and diverse populations and accordingly, this would enable individuals to make more informed decisions on whether they want to be vaccinated and if yes, which vaccine would they like to go for. But each time there was a move from the side of the citizens to bring in more transparency, rather than addressing the main issue, members of the government went about saying that through such petitions, we were promoting vaccine hesitancy amongst the population, which is absurd. The fact is that the vaccine makers have been profiting enormously. The pharma companies have been looting the taxpayers. It is very likely that some of the decision-makers in the government may have gotten some commissions from these vaccine makers. Otherwise, what is the need to blindly support vaccine makers and not be transparent about data?” asked Prashant Bhushan.

Lab technician working with a sample of Coronavirus | Photo courtesy: Special arrangement

Following the petition to disclose data related to clinical trials, the vaccine makers had told the Supreme Court that the primary data related to clinical trials and the adverse events of Covid-19 vaccines cannot be put out in the public domain and that only the Indian drug regulators should have access to such data. The vaccine makers also maintained that there was no legal mandate to disclose such data. But the Supreme Court last month held that no individual could be forced to be vaccinated against Covid-19. The apex court also directed the central government to publish reports on the adverse effects of the Covid-19 vaccines on a publicly accessible platform without compromising the data of the individuals who reported the vaccine effects. The court asked the government also to make public all data related to past and future trials without any delay.

“Transparency is one issue, but if you remember, our own government policy allowed the private corporate hospitals to buy 25% of the vaccines for Covid-19. This was an inappropriate and reprehensible act by the government of India. This was against the national vaccine policy of 2011, which stated very clearly that vaccines are a public good and must be purchased by the government and delivered free to the citizens of the country. This was the practice which was going on for the last forty years in India’s immunisation program. The centre always procured the vaccines and provided them free to the citizens. But in the case of Covid-19, which is a once in a century pandemic, the government began with a flawed policy by violating their own guidelines where they said that we would acquire only 50 per cent of the vaccines and the remaining 25 per cent would be purchased by the state governments with their own funds, and the rest of the 25 per cent could be purchased by the private hospitals. Finally, after the Supreme Court rapped them on their knuckles, the central government changed their policy,” said Mehrotra.

According to Mehrotra, the government’s flawed policies enabled the vaccine manufacturers in India to make huge profits. “The policy of allowing the private hospitals to buy vaccines from the manufacturers was a wrong policy because the private hospitals were charging a lot of money and the government, in fact, wanted these private manufacturers to make higher profits. And they were making profits at a time when the government was facing a shortage of vaccines.”

Covid-19 vaccines | Photo courtesy: Special arrangement

Like in India, the pandemic has created and exacerbated inequality in several countries. According to the study by Oxfam, 2668 billionaires own $12.7 trillion, and the world’s ten richest men own more wealth than the bottom 40 per cent of humanity, which is 3.1 billion people. To put it plainly, the richest 20 billionaires are worth more than the entire GDP of Sub-Saharan Africa.

“Inequality is the biggest issue concerning vaccine distribution. There was no scientific way in which the vaccine was distributed globally, including in India. Whenever a vaccine distribution drive is carried out, the first question that needs to be asked is how are we going to reach the last citizen? The rich can always get access because they have money and influence, but the challenge is to ensure access to the neediest amongst us. The simplest example of this was India’s online vaccination drive. It is a general belief that everybody has a smartphone. This is not true. The majority of the poor don’t have smartphones. They did not even know how to register and get dates for vaccination. The rich could easily get access to vaccines. Still, the poor in our country did not get the privilege the rich got for a very long time,” said Bezwada Wilson, a human rights activist and the National Convenor of the Safai Karmachari Andolan.

Bezwada Wilson had received the Ramon Magsaysay Award for leading a grassroots movement in India to eradicate the degrading practice of manual scavenging. Wilson has been working to reclaim the rights of the marginalised sections in India and is critical of the Indian government’s Covid-19 vaccination drive. According to Wilson, the drive lacked empathy for the poor.

“They did not open the counters in the working place of the poor man. Leaving a day’s work hits his pocket hard for a poor man. The government was not concerned about the safai karamcharis either. The vaccination drive in India was not focused on the marginalised sections of our society. The rich can reach places. They can afford to take-offs. They can afford to fall sick after vaccination, but that’s not the case with poor people. The poor can neither travel nor take leave or afford to fall sick. The vaccines should reach their doorsteps. That was not the case in India. We must handle such drives very sensitively, taking into account the last man standing and the last citizen,” asserted Wilson.

According to Professor R Ramakumar from the Tata Institute of Social Sciences, technocratic interventions and solutions did not yield the desired results during India's vaccination drive. "Despite the technocratic interventions and solutions, India could not vaccinate a large number of its population initially because there were vaccine production-related issues. Apart from that, these digital solutions did not augur well with the poor. That meant that a large number of the population was left out of the initial vaccination drive. But the government understood its mistake, and then they introduced the offline modes as well, but then, the damage was already done, and many poor people by then had succumbed to Covid-19."

According to Prof Ramakumar, the Indian government had miscalculated the outcome of giving power to the pharma companies. "In fact, the government's idea was, if you allow the pharma companies to fix their own prices freely on vaccines, then they will have an incentive to produce more vaccines, and then the supply of vaccines would actually increase. But the evidence shows quite to the contrary. Also, a government vaccine called Covaxin was produced by only one company called Bharat Biotech. At the same time, many other private companies or public sector companies could have been given the opportunity to produce the vaccines. The Indian government did not do that. As a result, we could not produce as many vaccines as we could. This happened because the government allowed one or two companies to produce vaccines. It is a matter of great concern why even the three public sector companies which were given the permission to produce Covaxin, till today have not produced even a single dose of the vaccine."

It is no doubt that global pharma companies have been immensely successful at converting public funding into private wealth, but the buck stops with the governments and international bodies. International agencies must ensure that the private pharma players are not allowed to monopolise the global vaccine market.

The public health inequalities that we saw during the pandemic are shocking, to say the least. Studies have found that as a result of Covid-19, four times more people have lost their lives in poorer nations when compared to rich countries. Reports indicate that every minute, at least four children around the world lost a parent or a caregiver as a result of the pandemic. Almost half of them are in India, where data suggests that over two million children have suffered such a loss.

At the same time, many of the big pharma giants have shown an exponential growth only by manufacturing and releasing one product in the market - the Covid-19 vaccine. For instance, Moderna has only one product, which is its Covid vaccine, because of which it makes a 70% pre-tax profit margin. According to Oxfam, the company has created four new vaccine billionaires who are worth a combined $10 billion, while just one per cent of its total vaccine supply has gone to the poorest countries. On the other hand, Pfizer has sold the most number of vaccines in the world, yet the company has delivered the least number of vaccines to low-income countries. Both these companies have sold a majority of their vaccine doses to only rich countries.

Companies like Pfizer, Moderna and BioNTech have used their power and vaccine monopoly to bag profitable contracts with rich governments leaving low-income countries high and dry. For the longest time, these companies have refused to transfer vaccine technology and have continued to monopolise the global vaccine markets.

According to the World Health Organisation, as of May 22 this year, almost one billion people in lower-income countries remain unvaccinated. Only 57 countries in the world have so far been able to vaccinate around 70 per cent of their population. Almost all of these countries are high-income countries. The vaccine rollout drive that should have started with the most vulnerable communities in the world in fact, started with the rich and the mighty. While the focus should have been to get the neediest in the low and middle-income countries vaccinated, the rich and the powerful countries resorted to hoarding vaccines and keeping the technology to themselves.

So far, even the most powerful international bodies have not been able to rein in these pharma giants or make the developed nations accountable. The biggest example is the US. Even when the Biden administration had promised that it would support the waiving of the intellectual property protections for Covid-19 vaccines so that the world could get access to more vaccines, during a global Covid-19 summit held last month, it seemed that the White House had no concrete plans to break the monopoly of the big pharma giants on intellectual property for the vaccines.

The pandemic is here to stay. Newer variants of Covid-19 will continue to present a threat to global public health. To tide over the crisis, the vaccine monopoly must be broken, and more manufacturers must be allowed to develop the vaccines so that there is a fair and equitable distribution of the vaccines to the neediest. Unless this is done, big pharma giants will continue to profit from the pandemic while the world watches in helpless silence.