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India’s stand TRIPS vaccine inequity

The distribution of essential medical supplies should be governed by the humanity model—early supply goes wherever it will contribute most to containing and suppressing the disease

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Whatever little has been achieved to kickstart the debate on global vaccine equity and to change things on the ground has happened due to India’s exemplary global leadership.

By Sachin Chaturvedi and Thomas Pogge

Right from the outbreak of the pandemic, India’s role in supporting global and regional efforts stood out, being examples of stellar leadership transcending the realities faced as a developing country. India’s own challenges in dealing with the pandemic have been gigantic as it is home to the world’s second largest population. India’s capabilities as the ‘pharmacy of the world’ enabled it to take the lead on global supplies of essential medicines to fight the pandemic in the initial months. Being a world leader in vaccine supply and not a recipient in waiting, India could easily overcome the challenges of vaccine inequity. India’s cumulative Covid-19 vaccination coverage exceeds 193 crore doses as on May 28, 2022 including ongoing precautionary doses and vaccination among children above the age of 12 years.

India has been at the forefront of vaccine equity and has pushed for the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver at the WTO (along with South Africa that has previously faced the brunt of the HIV epidemic) since as early as October 2020. The initial proposal signaled a fundamental shift to broad-based temporary IP concessions during global health emergencies like that of the Covid-19 pandemic, across IPR provisions to allow “prevention, containment or treatment” of the disease. This proposal (revised in May 2021) has now been co-sponsored by a large number of developing countries. Notably, India’s Vaccine Maitri programme worked on the premise that ‘no one is safe until everyone is safe’.

Whatever little has been achieved to kickstart the debate on global vaccine equity and to change things on the ground has happened due to India’s exemplary global leadership. India took the lead in proposing the TRIPS waiver for vaccines (and other health goods) despite having no direct interest. The efforts of India and South Africa in this regard has galvanised the developing world.

India has remained steadfastly committed to this idea despite pressure from the EU, UK, and Switzerland, which are preventing access to vaccines to poor countries, making them suffer and leading to loss of lives. Thanks to India’s pressure, global supply lines have remained open throughout for key components of vaccines being made in India and elsewhere.

In making these extraordinary efforts, India is upholding the idea that life-saving medical supplies are not ordinary consumer goods to be distributed pursuant to the fashion model— so long as supply falls short of demand, sellers ration access by raising the price, giving early access to the highest bidders. Instead, the distribution of such essential goods should be governed by the humanity model—early supply goes wherever it will contribute most to containing and suppressing the disease. The fashion model favors suppliers. It allows them to collect handsome premiums during the early period of demand-supply imbalance, which they can prolong by slowing production and delivery. Obviously, the humanity model would be much better for most people, as it would help in ramping up production and delivery at top speed and ensure supply to suppress the pandemic as effectively as possible, thereby averting infections and new disease strains. This model is better even for the world’s affluent and well-insured—they may get access to relevant remedies somewhat later, in comparison to the fashion model, but the overall extent and duration of the pandemic are reduced. By valuing the health of all human beings equally, the humanity model is also morally superior, recognising that essential medical supplies are fundamentally different from fashion goods such as handbags and exercise machines.

How can we build on the TRIPS waiver and its underlying principle toward increasing the justice and effectiveness of global provisioning of medical supplies? One key idea is to broadly remove the monopoly markups that deprive so many people of access to patented medical products. Pfizer has just taken a laudable such step by committing to sell all its patented products at non-profit prices in low-income countries. To ensure R&D towards developing new products, pharmaceutical innovators must earn enough to cover their fixed costs and make a decent profit. But these earnings need not be from monopoly rents. A coalition of states could finance a health impact fund (HIF) to encourage and incentivise innovators to exchange their monopoly privileges on specific new technologies for annual payments based on the health gains achieved with them. This HIF would motivate innovators to organize their development, manufacturing, and delivery efforts toward reducing the global burden of disease most cost-effectively, while fully including the poor in their population-level strategy.

Respectively, DG, RIS, and professor, Yale University

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