Give up the third dose to help poor countries?

While in affluent countries a third dose of the vaccine is administered in the hope of better coping with new variants of SARS-CoV-2, low-income countries are struggling to give their populations a first dose, which is a major risk. fertile ground for the appearance of new variants. What can be done to reduce this inequity? Skip the third dose? Or act more globally by forcing vaccine manufacturers to license patents that would allow all countries with facilities to produce COVID-19 vaccines?

“You have to do both: give a third dose to people at risk and health workers, and vaccinate African countries,” says Dr. Don Vinh, microbiologist-specialist in infectious diseases at the MUHC. “The roughly 30 million doses needed for the third dose in Canada will not solve the dose shortage in Africa, where there are more than 1 billion people who need to be vaccinated. Rather, we must force vaccine manufacturers, who have taken advantage of the situation and public resources to develop their vaccine, to suspend their intellectual property rights over their vaccine to allow the manufacture of vaccines in bulk for the rest of the world. . “

“Rejecting the third dose at the individual level to help poor countries is not going to change much. From the moment that vaccine manufacturers began to insist that a third dose was needed, Canada would not have done well not to administer this third dose. It would have been politically suicidal for any government not to do it. It is at the level of international platforms where public health priorities should have been defined, knowing that a third dose may be useful for certain immunosuppressed people in particular, but that in terms of general health, the therapeutic benefit of the third dose has nothing to see. to do with the therapeutic benefit of a first dose for someone who has never been vaccinated, “says Marc-André Gagnon, professor at the School of Administration and Public Policy at Carleton University, in Ottawa.

“We would not ask ourselves this question if, in the beginning, the vaccine manufacturers had agreed to issue licenses while ensuring the transfer of adequate technology so that production could be carried out correctly. These firms would have taken advantage of the fact that there would be more laboratories that had produced their vaccine and paid them royalties, and thus we would have made the most of the vaccine manufacturing capacities to participate in the war effort. . We assume that in the middle of a pandemic that would happen, but it did not happen ”, he explains.

From the moment that vaccine manufacturers began to insist that a third dose was needed, Canada would not have done well not to administer this third dose.

As is known, COVID-19 vaccine manufacturers, with the exception of AstraZeneca, categorically refused to license and share their patents with the COVID-19 Technology Access Group (C-TAP) which was created in May 2020 by the world. Health Organization (WHO) with the aim of pooling the patents associated with COVID-19 technologies and thus allowing anyone who wants to produce vaccines to use these patents by paying royalties to the owner of said patents.

Pfizer and Moderna jealously protect their mRNA vaccine technology, because it is “very promising for several other treatments, particularly cancer,” Mr. Gagnon emphasizes. These companies do not want to share their technology at this time for fear that their future markets will be eaten, because, remember, the priority of pharmaceutical companies is not global health, but to maximize profitability for shareholders ”, he emphasized. saying.

“As long as Pfizer and Moderna have the big part of the stick, that all countries are on the lookout for their vaccines and demonstrate the nationalism of vaccines as at the end of 2020, when each country fought against its neighbor at the door of the companies.” to buy vaccines, there is little hope that they will agree to issue licenses. So we need a regulatory solution, because the market incentives are not working in the right direction, ”says Mr. Gagnon.

However, Moderna was able to develop its mRNA vaccine only with public funds and others from non-profit foundations. “The patent, which is a mechanism to encourage financing by private shareholders and encourage them to take the risk of investing, is therefore not relevant to Moderna,” adds Mr Gagnon.

Pfizer also received public funds, albeit to a lesser extent, but was able to benefit from market guarantees, meaning that its vaccine was not yet developed and guaranteed that it would offset the costs with the purchase of the vaccine even though it was unapproved. “It was a way of eliminating investment risk, and in that case, the patent was also not justified,” explains Mr. Gagnon.

“Tens of billions of public funds have been awarded to accelerate vaccine development and production. Market guarantees were put in place to ensure that private companies did their best, and as soon as possible, to develop vaccines. That has worked very well. There would have been no patent, we would have developed vaccines at the same speed. But at this time, patents are becoming an obstacle to the distribution and organization of production that can serve the priorities of global public health, ”he insists.

The basic problem is that there are vaccine manufacturing capacities in different countries, including South Africa, which has large factories, and they cannot be leveraged given the current intellectual property system. A first regulatory solution would be to suspend the TRIPS Agreement (Aspects of Intellectual Property Rights Affecting Trade) for COVID-19 technologies.

Such a suspension would give access to patents to countries that request them against the payment of royalties, and would also allow the exchange of technological experience between countries, which is currently prohibited under a compulsory license granted to a third country. However, for high-tech products like mRNA vaccines, this exchange is absolutely necessary for countries that do not have the appropriate vaccine production capacity or experience, says Mr. Gagnon.

South Africa and India proposed a suspension of the TRIPS agreement in October 2020, but it has not yet been approved by European countries and Canada, while, to everyone’s surprise, the United States supported it in May 2021.

According to Marc-André Gagnon, Canada does not support this proposal probably because “it fears retaliation from vaccine manufacturers who could express their dissatisfaction by adding new conditions on the cost of doses and supply, in particular.”

Last week, the World Trade Organization planned to discuss the suspension proposal again, but the meeting was canceled due to the spread of the new Omicron variant.

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