Nurse applying vaccine on patient's arm using face mask
Credit: Getty Images/iStock

When Rodney and Ekaterina Baker, a wealthy couple from Vancouver, Canada, flew to a remote Yukon community on January 21, they never expected the world of trouble their little trip would bring. The couple posed as local motel workers in order to get COVID-19 vaccinations—shots that were meant for members of the indigenous White River First Nation. When they were caught, the couple was excoriated in the press and social media and fined by the Canadian government.

No such outrage has met wealthy countries that are effectively doing the same thing. By buying up the vast majority of available vaccines and not using government powers to ramp up production, wealthy countries, including the United States, are making it all but impossible for poorer countries the get their citizens vaccinated.

That’s shortsighted. As long as large swaths of the globe remains unvaccinated, we all remain at risk from a virus that is free to mutate rapidly and is already proving capable of evading at least one vaccine. The Biden administration is going to have to decide what role the U.S. government will play to ensure that poorer nations get the vaccine quickly and affordably. If the United States and other wealthy countries do not find a way to increase production and lower prices, people around the world will die unnecessarily and U.S. economic and geopolitical interests will suffer.

By mid-January, only 25 individuals in low-income countries had received a vaccine. The World Health Organization (WHO) says 95 percent of COVID-19 vaccine doses administered thus far are limited to just 10 countries. Some experts are estimating that global coverage won’t be achieved until 2024—if it’s achieved at all, since poor countries simply can’t afford the costs of vaccination. The United States and other wealthy countries aren’t helping enough. They have bought up more vaccines than they need to inoculate their citizens. This kind of hoarding drives up prices and reduces access for rest of the world.

The consequences of a slow vaccine roll out in the developing world are huge. First, of course, there’s the loss of life. But failing to end the pandemic around the globe isn’t good for us, either. The longer the virus circulates freely, the more opportunities it has to develop variants that pose new challenges. Even if the United States were to ramp up its own (currently deficient) vaccination program and get it done by summer, there’s no guarantee it would protect us against variants that are sure to evolve in other countries and end up here.

Then there’s the economy. The longer it takes for all countries to get immunized, the more slowly the global economy will recover. Faced with the worst economic disaster since the Great Depression, deficit hawks may balk at massive expenditures for global vaccine deployment. But such investments pale in comparison to what it will cost if we fail to bring the pandemic to a relatively quick end. Economic losses in the United States alone are estimated to reach $7.6 trillion over the next decade even with a global solution. That doesn’t include another $8 trillion that will go down the drain due to deaths and disability by the time the United States is fully vaccinated, according to an article published last fall in the Journal of the American Medical Association. (And that’s assuming the vaccine works as well as claimed.) A long-lasting global recession would make matters worse.

Finally, there is a global leadership vacuum to consider. If the United States fails to work with other wealthy countries to ensure everyone has access to affordable or free vaccines, we will hand over whatever remaining international good will we have to Russia and China, which are racing to cut vaccine deals with poor countries. Even a number of our European allies are looking to purchase Russia’s Sputnik V and China’s Sinopharm vaccines. This isn’t only an arms race to jab medicine into arms. It’s a battle for hearts and minds.

Fortunately, there are some remedies. The federal government has the right to “march in” and assume control over the patents of a product that was developed using federal funds. This power was written into the Bayh-Dole Act passed in 1980 to promote “technology transfer” from academia to industry. Although it has never done so to date, the federal government can withdraw exclusive patent rights from one manufacturer in order to grant additional licenses to others in situations when doing so is in the public interest.

If ever there was such a situation, it would seem to be now. In addition to many states seeming incapable of distributing the vaccines rapidly or equitably, there’s the glaring problem of a vaccine shortage in the United States. Moderna and Pfizer are already significantly behind their target to deliver 100 million doses each by the end of March. As of February 7, less than ten percent of the U.S. population had received even one dose of a vaccine, let alone the necessary booster.

Drug companies and their political allies argue that any attempt to take control of manufacturing output and set prices would undermine incentives for innovation, not just for coronavirus vaccines, but for future life-saving products. Maybe that argument is plausible in some situations, but it’s almost laughable when applied to these vaccines. That’s because the vaccine manufacturers didn’t pay for the vast majority of the breakthrough science that made their shots.

In the case of the Pfizer and Moderna vaccines, the messenger, RNA technology, or mRNA, was developed with funding from the National Institutes of Health and private foundations. Janssen, AstraZeneca, and Novavax developed their vaccines with $4.3 billion from the U.S. Biomedical Advanced Research and Development Authority (BARDA), a division of the U.S. Department of Health and Human Services. Fully 99 percent of Moderna’s $2.5 billion research and development costs were paid for by BARDA. (The other one percent of funding came from Dolly Parton).

Even so, when Moderna’s vaccine was nearing approval, the company announced it would charge whatever it pleased. The company walked that statement back in the face of public criticism, but it’s still charging between $10 to $50 per dose depending on volume agreements. Pfizer’s vaccine costs approximately $20 per dose. The U.S. government has agreed to purchase AstraZeneca’s vaccine for under $4 per dose. Americans are paying twice for the privilege of being vaccinated: first for the basic research and development and then again when their taxes and insurers pay for the shot.

Marching On

While current prices may be affordable for wealthy Americans, they are wildly out of reach for low- and middle-income countries. Compulsory licensing, march-in rights, and the Defense Production Act recently invoked by President Biden may help to ramp up production of COVID-19 vaccines. Unfortunately, none can solve the problem of prices, or the stockpiling of vaccine by wealthy nations while poorer countries remain unable to purchase them. Currently, two key options are in play to address universal access.

The first is COVAX, a program coordinated by several nonprofit non-government organizations, including Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations and the World Health Organization. COVAX relies on both wealthy and poor nations to commit to buy vaccines in order for COVAX to use its purchasing power to negotiate lower prices. The COVAX program reports that it has secured nearly 2 billion doses to be delivered by the end of 2021.

The second option is a “people’s vaccine,” supported by the People’s Vaccine Alliance, a coalition of U.S. and international organizations including Public Citizen, Oxfam, Free the Vaccine, Global Justice Now, UNAIDS, and many others. The alliance supports a vaccine that is “available to all, everywhere, free of charge.” It is asking all pharmaceutical companies working on COVID-19 vaccines to share their technology and intellectual property through the WHO’s Technology Access Pool. More than 100 world leaders, health experts and economists sent an open letter in November to then President-elect Biden calling on him to support the people’s vaccine. For its part, the Biden Administration has vowed to rejoin the WHO and COVAX, but has not yet expressed a position regarding the people’s vaccine

The need for a people’s vaccine is evident as the limitations of COVAX come into focus. By relying on market mechanisms to enhance access, COVAX is already running into problems as wealthy nations use those same market mechanisms to their own advantage, circumventing COVAX by making their own bilateral agreements and, you guessed it, driving prices up. Canada, which has purchased enough of the vaccine to immunize its citizens five times over, recently came under fire for a deal to take 1.9 million doses from COVAX by the end of June. Oxfam reports that rich nations “representing just 14 percent of the world’s population have bought up 53 percent of all the most promising vaccines so far.”

While a “people’s vaccine” might sound like a communist plot, it’s worth remembering that two of the greatest public health triumphs in history were the global eradication of smallpox and the near-total elimination of polio. Vaccines for both diseases were, in effect, people’s vaccines, developed without patents and distributed globally at minimal cost through international agreements and cooperation.

Scientists around the world, at universities, private companies and government laboratories, have been working nonstop to develop vaccines that could save the world from COVID-19. Most will receive nothing more than their paychecks and the satisfaction of knowing the part they played in stopping the pandemic. Maybe the well-paid C-suite executives of manufacturers and their shareholders could consider the public relations value of making the vaccine available at cost.

More likely, the Biden administration will need to step in, both in terms of ramping up U.S. production and pushing for international agreements that will guarantee poorer countries can get their citizens vaccinated. Whatever it takes, the White House needs to act soon. “Ending this pandemic is one of humanity’s great races,” as Tedros Adhanom Ghebreyesus, WHO Director General, put it in a recent address. Whether we like it or not, the nations of the world will win or lose that race together.

Our ideas can save democracy... But we need your help! Donate Now!

Shannon Brownlee is a lecturer at George Washington University School of Public Health. Jeanne Lenzer is the author of The Danger Within Us; America's Untested, Unregulated Medical Device Industry and One Man's Battle to Survive It.