In March 2022, Oxfam published a document called ‘Pandemic of Greed’. This document detailed the effects of vaccine inequality in the pandemic, as well as profit statistics for AstraZeneca, Pfizer, and Moderna, the three leading Covid vaccine manufacturers.

What is so shocking about the statistics in this document, as well as the current vaccine statistics, is that the huge inequalities evident could have easily been avoided. They are the result of big pharmaceutical companies prioritising profits over global health, and high-income countries hoarding vaccines rather than sharing them with countries who perhaps could not afford the massive fees charged by manufacturers. Because of this worldwide greed, only 32.8% of people in low-income countries have received at least one Covid vaccine. It should not have been allowed to happen.

Pharmaceutical companies’ greed

Up until March 2022, Moderna alone made around $12 billion in profit, creating four new billionaires. However, only 1% of their total vaccine supply has gone to low-income countries. Using the billions in profit to distribute vaccinations to those countries would have been a great use of the money. However, because there is no incentive, the money was kept instead. High-income countries pay big money for Covid vaccines, and vaccination equality programs pay significantly less. High-income countries can pay between $15-$37 per dose, while COVAX, the program that many lower-income countries relied on for vaccinations, and the African Union only pay up to $10. With no incentive to sell for a lower price, vaccine companies can give priority to those countries with significantly deeper pockets. This leads to massive inequality between those who are vaccinated in high- and low-income countries, and ultimately more deaths.

Government self-interest

In addition to pharmaceutical companies putting profits before people, governments hoarded vaccines, citing national interest and political ethics as their justification.

As a result of hoarding, 11% of vaccines purchased in the US, around 82 million doses, were thrown away. While this is in line with the upper end of WHO estimates, these doses could have gone to low-income countries. Additionally, Covid vaccines expire, and hoarding allows them to expire rather than be used by those who need them.

CTAP and waiving monopolies

In October 2020, a proposal was tabled by India and South Africa at the World Trade Organisation, which would waive patent and intellectual property right associated with Covid vaccines, as well as other Covid-related technologies like testing and treatments. This would mean that countries could manufacture vaccines and tests for much cheaper than those sols by the manufacturing companies. Médecins Sans Frontières reported countries’ positions on this proposal (see article image).

Companies producing vaccines vehemently opposed this proposal, as well as opposing the Coronavirus Treatment Acceleration Program, or CTAP. This would have allowed drug companies to share technologies with competent manufacturers. In addition, the map highlights that countries opposed to the intellectual property waiver were in the minority, yet their efforts resulted in a weak agreement that hindered programmes in the global south.

Vaccine nationalism

One of the driving forces behind vaccine inequality, blocking the waiver, and vaccine hoarding is vaccine nationalism. In the minds of some, this is not unethical. Some defend national partiality, the right and duty to defend one’s own citizens, as a politically ethical manoeuvre.

Whether or not we accept this as politically ethical, it is not medically ethical. Herein lies the dilemma. Should countries prioritise their own citizens, even if it wastes vaccines and blocks cheaper access for lower-income countries?

The clear answer is ‘no’. While something may be politically excusable, this does not mean it is right in all circumstances. A global pandemic is an unprecedented event. In addition to this, politics has no right to take priority from what is a medically better option in a health crisis. The priority in such cases ought to be to use global wealth to alleviate stress on lower-income countries and encourage global cooperation to end the pandemic. Global vaccination, avoiding hoarding and inequality, reduces the number of mutations and the number of boosters necessary to contain infection, driven by pharmaceutical greed and priority of politics over people, leads to economic inequality and continued deaths.

The common good ought to have been the driving force behind vaccination programs, but even now this is not the case, as is evidenced by vaccination numbers. The fact that pharmaceutical companies were allowed to form such monopolies, and that high-income countries were allowed to claim their actions were ethical, was heinous. Should we ever enter a similar situation, we can only hope that we learn from these mistakes and collaborate globally.

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