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Vaccine Inequity: Meet the Doctor Refusing a Booster as Rich Nations Get 16x More Doses Than Poor

StoryOctober 28, 2021
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Wealthy nations have received over 16 times more COVID-19 vaccines per person than poorer nations dependent on the COVAX program backed by the World Health Organization, according to a new Financial Times analysis. COVAX, which was set up to ensure global equitable access to vaccines, has delivered only 400 million doses after promising 1.4 billion this year. Higher-income countries struck separate vaccine deals with manufacturers, leaving COVAX with less negotiating power. While the United States rolls out booster shots and stockpiles six vaccines per person, less than 3% of people in low-income countries have received at least a single dose. Infectious disease expert Dr. Monica Gandhi says she will not receive a booster as a healthcare worker because of the global vaccine inequity, and argues the push for boosters “detracts from the fact that we in no way have fulfilled a moral and ethical obligation to the world.” We also speak with Kate Elder, senior vaccines adviser for Doctors Without Borders, who says that it is a structural issue caused by global leaders who are not “equitably sharing vaccines around the world.”

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman, with Nermeen Shaikh.

Rich countries received 16 times more COVID-19 vaccines per person than poorer nations dependent on the WHO-backed COVAX program, which was set up last year to give people in poor countries equitable access to vaccines. That’s according to a Financial Times data analysis compiled by UNICEF. Officials in the African Union predict COVAX will deliver less than a quarter of the two-shot vaccine doses needed for more than 1.3 billion people in Africa by the end of the year, as here in the United States the discussion moves from third to fourth booster shots for the immunocompromised.

We look now at how less than 3% of people in low-income countries have received even a single dose of the vaccine. We’re joined by two guests. In New York, Kate Elder is with us, senior vaccines adviser for Doctors Without Borders. And in San Francisco, Dr. Monica Gandhi, an Infectious disease physician, professor of medicine at UCSF/San Francisco General Hospital.

Dr. Gandhi, you’ve said you will not receive a booster as a healthcare worker because of the global vaccine inequity. Explain.

DR. MONICA GANDHI: Yes. So, when President Biden announced that every American should get a booster by September 20th in mid-August, it was actually a huge surprise to many infectious disease experts, for two reasons. One is that the vaccines are actually holding up extremely well, especially in those less than 65, against severe disease. And, in fact, that kind of messaging can reduce confidence in the vaccines.

The second reason was the incredible global vaccine inequity, that there are many promises made by rich countries and the administration — at the G7 meeting in early June, the rich countries pledged that there would be a 2 billion dose donation to other countries, and that hasn’t really even been touched in terms of fulfilling that pledge. And then, at high-level meetings, like the U.N. meeting in September, these pledges are made again. But we have about six doses for every American stored up. We have — that’s true of many rich countries. And it just — the complete ignoring of that sort of lets — that moral and ethical failing blew a lot of people’s minds, to be honest, to talk about boosters.

And then, if we think about what’s been going on in this country for the last three months, the conversation has been almost exclusively about boosters and how to mix and how to match. And, you know, it’s important. It’s important for Johnson & Johnson people. It’s important for those over 65. I think those are the two groups that the data is very clear. But what it does is it detracts from the fact that we in no way have fulfilled a moral and ethical obligation to the world. And let’s forget about moral and ethics just for a minute. It is — where do variants come from? They come from places in the world with high transmission. So we are also not doing the right thing by public health.

So, right, I am not — you know, this is a very public stance. But I am a healthcare worker. I am fully vaccinated. I got vaccinated early. And I can’t bring myself to take a booster unless some of this gets better and is corrected.

NERMEEN SHAIKH: Well, Kate Elder, you’ve been working on this issue of vaccine equity since the pandemic began, of COVID-19 vaccine equity. Just lay out: What are the main obstacles to enabling more of the world to gain access to these vaccines? And what is preventing, to this day, pharmaceutical companies from sharing their technology with the World Health Organization’s mRNA tech hub and other capable manufacturers around the world?

KATE ELDER: Yeah. Good morning. Thanks very much for talking about this important issue.

I mean, as Dr. Gandhi just said very, very clearly, right now we’re in a global crisis, not only of moral and ethical magnitude, but really just of a rationale, a scientific rationale for emerging from this pandemic. Everybody around the world, of course, wants to emerge from this pandemic, and global leaders have not decided to take the route that’s most scientifically sound to do that, which is equitably sharing vaccines around the world.

From the start of this pandemic, although there were very lofty claims and platitudes about future COVID-19 vaccines at that time — vaccines, of course, weren’t available, but there were global leaders that came together from the European Union, with the leadership of WHO, to say that future COVID-19 vaccines would be considered global public goods, and they would be shared equitably around the world, and we would not repeat mistakes of the past. You know, unfortunately, those declarations were made, and then high-income country governments turned around and went forward in the pursuit of shoring up stocks for their domestic use at an incredible speed, which saw us that in a very short period of time we had most of these theoretical vaccines at that time already spoken for by high-income country governments, by the wealthiest governments, so that when we did see these vaccines start coming off the line, the production line, they were already promised to the wealthy. And that’s why we’re in this situation right now where, you know, about 60% of adults in the wealthiest countries have received their first dose, whereas just about 3% of people in low-income countries, in the poorest countries of the world, have received their first dose.

Now, I mean, the barriers to really rectifying this, it’s very clear. I mean, first, we need the vaccines that are available, that are sitting in cold storage rooms, that are not being used, urgently redistributed to places where we need them. There is a tremendous volume of excess doses right now here in the United States. We calculate that by the end of 2021, the U.S. government might have about half a billion excess doses here in the U.S. That’s including if people get their boosters. We need to redistribute those doses rapidly to the places that are begging for supply. That’s the acute step that needs to happen.

Secondly, we need to make sure that the places, the regions that have been left behind, regions like the Africa region, the Middle East, are given the tools to make vaccines themselves. Right? So, there’s an issue of supply, and there’s an issue of being able to make more supply now and for potential future pandemics, as well. So, regions like the Afro region, governments like South Africa have been asking for the technology to be able to make these vaccines themselves. Now, that would be the second step that needs to happen. We need the transfer of technology and the supporting elements around it, the know-how, the training, to be transferred from the companies that have it to the places that are capable for making these vaccines.

And then, thirdly, we need the intellectual property barriers lifted. Right? There are IP barriers around these vaccines, and we need those immediately waived so that governments and other manufacturers can pursue making these vaccines themselves, so that we don’t perpetuate this crisis.

Now, the reason I think it — it’s very straightforward, the reason why the technology transfer is not happening, despite the call from WHO. And, of course, the World Health Organization is the global custodian of health. They know the best route for emerging from this pandemic. They have established these mRNA technology transfer hubs and invited companies to share their technology with them. And there are a number of companies that have lined up, are waiting in the queue to receive this technology. Of course, the originator companies are not sharing willingly that technology. I mean, you know, they what to hold onto it for their own commercial interests.

But it’s important to remember that much of this technology was developed with public financing, U.S. taxpayers. Just using one company as an example, Moderna, Moderna received about $10 billion in U.S. taxpayer funding to stimulate the research and development and also in advance purchases of those vaccines. So, really, the public has a very high stake. But, of course, the companies are looking to hold onto that technology. It’s very lucrative. Pfizer is estimated to make $33 billion in 2021. I think the estimates for Moderna are about $20 billion in revenue. So they’re going to really hold onto that technology, despite it being in the world’s best interest for it to be shared.

AMY GOODMAN: I want to underscore this point of the amount of U.S. funding that has gone into the development of these vaccines, yet they have kept their recipes proprietary, private. And I want to put this question to Dr. Monica Gandhi. The Sammies were just announced, the sort of Oscars to people in government service. Among those who won for Federal Employee of the Year, Dr. Kizzmekia Corbett, an amazing African American woman, a scientist, and Barney Graham, for their work, both of which led to the development of the coronavirus vaccine at record speed, both at the Vaccine Research Center of the former National Institutes of Health. They were working for the U.S. government. How is it possible that at this point, when even if you just look at the United States completely in a selfish way, if you will, just protect the United States — we have learned from this pandemic if you don’t deal with this pandemic globally, the U.S. can never be protected — the idea that the U.S. has poured so much funding in the research of these vaccines and guaranteed buying of these vaccines, in the case of Pfizer, and yet they refuse to make available the secret sauce, the recipe, that would allow many pharmaceutical companies to make these vaccines around the world?

DR. MONICA GANDHI: Yes. I mean, I think there’s two comparisons that come to mind. One is the field of pre-exposure prophylaxis, PrEP, to prevent HIV infection. In this case, actually, there was a drug that was made by a pharmaceutical company, but that was only the tip of the iceberg. The U.S. government funded all the clinical trials to show that tenofovir disoproxil fumarate/emtricitabine, which is this drug that Gilead had, was effective to prevent HIV infection. There have been many congressional urging of Gilead to make this drug freely available, since these were essentially — all the major clinical trials were funded by the U.S. government. And the company very promptly made a more expensive drug and marketed that. It is critical to say that we funded, especially Moderna. There was public funding put into this. And it was literally, like you just said, with our taxpayer dollars. And the fact that they won’t share this technology with places that are just ready and willing to receive it, so that they will not only make it for their own countries but make it for others, is one of the — I mean, I just have to say that my mind is constantly blown by this degree of injustice.

And then, you know, the other thing that I want to remind us is October 2020 was the time when India and South Africa appealed to the World Trade Organization. They anticipated that there could be waves in their country. India had been spared, actually, up 'til that point. They knew the technology was coming. And they said to the World Trade Organization, “Ensure, please, that we get a waiver, that there's a waiver made on the intellectual property of these life-saving vaccines,” because there is a waiver that’s possible in the setting of life-saving technology in the middle of something as globally urgent as a pandemic. The WTO said no. And then, on March 7th, you can literally watch the wall of new infections that happened in India and the subsequent death and suffering for the next two months, that could have been completely averted by having that request honored. This is so reminiscent of HIV infection that it is a living nightmare to watch, that 10 years into HIV, when most of the problem was in sub-Saharan Africa, that we were still arguing over TRIPS and patent waivers.

And one thing I do want to say about Pfizer, Pfizer makes a very life-saving medication called fluconazole, which was essential to prevent one of the severe opportunistic infections in AIDS. And in the late '90s, they made a billion dollars in one year over this life-saving, easy-to-make medication. So this is not new. The problem is it's tragic, and right now we’re getting lots of boosters into Americans’ arms so that they can, you know, travel and not have a positive test. And, like, there’s something really incorrect going on here. So, you’re right about the public investment.

NERMEEN SHAIKH: And, Kate Elder, can you talk about one effort that was made earlier this week? On Tuesday, BioNTech signed an agreement with Rwanda and with Senegal and a Senegal-based manufacturer to begin construction of an mRNA vaccine manufacturing facility in Africa by the middle of next year, mid-2022, but this is bypassing the World Health Organization’s mRNA vaccine tech transfer hub in South Africa. Could you comment on that and whether you think it’s significant and may have a significant effect, an important effect, on vaccinating Africa, which is one of the lowest — has one of the lowest rates of vaccination?

KATE ELDER: I think it is — you know, it’s an interesting development. It’s probably partially in response to the tremendous pressure that has been mounted by civil society, by advocates for access to COVID-19 vaccines, in the face of companies really acting very reprehensibly in terms of prioritizing sales to the wealthiest and prioritizing their supply to the wealthiest, while the developing world goes without. So, it is a notable development.

There are challenges with it, however. There are limitations. I mean, one, you know, what is the scope of this agreement? The challenge with having it be so privately brokered, with no transparency, is that we don’t know the terms and conditions around it. Will that facility ultimately have the ability to share with others? Will that facility have the ability to sell beyond Africa, or will there be a very certain limitation of where the doses can go? This is the challenge when deals are brokered in secrecy and there’s no transparency around the ultimate — what ultimately comes out in the contracts, is you just don’t know the terms and the scope of it. So, I mean, many of these, what we would call, voluntary technology transfer or voluntary initiatives by industry come with significant limitations. They come with limitations of geographic scope. They come with limitations of what the recipient company can do with that product, with that technology. So, although it is notable and it’s exciting to hear that a plant will be developed in Rwanda and there will be partnership in West Africa to Senegal, there’s a lot of questions.

I mean, I think we have to go back to the point of there are globally agreed-upon forum and processes that are done intergovernmentally, led by developing countries themselves, that have been established with the support of the World Health Organization, which, you know, of course, WHO truly knows what’s needed in the face of this pandemic. The mRNA hub, led by the South African government with support from WHO, is an end-to-end plan, an end-to-end plan where it included components of training staff, it included components of making sure the regulatory landscape was set for these vaccines. It had a longer-term vision, as well. I mean, that is the process that we need to look towards. That is the process that has the future in mind, rather than something that is, you know, fully steered and controlled by pharmaceutical companies, because at the end of the day we know pharmaceutical corporations have a very specific mandate. I mean, their mandate is to serve their shareholders and to commercialize, to the extent possible, their products. So, I mean, I think it’s notable, but we need a lot more. And it’s particularly notable that WHO has set up this tech transfer hub, and yet none of these originator companies have volunteered to come forward and actually participate.

AMY GOODMAN: Finally, Dr. Monica Gandhi, your thoughts on the Merck story, that said it will share the formula for its COVID-19 drug molnupiravir with poor countries, allowing manufacturers to produce the cheap generic?

DR. MONICA GANDHI: Yeah, I mean, I’m excited about Merck making that announcement. One thing is that molnupiravir is a treatment, and at that point you’ve already contracted the COVID-19 infection. Prevention is always better than treatment. So, vaccine availability would be better than treatment, but, yes, this is an example, at least, to the other pharmaceutical companies about what to do.

AMY GOODMAN: Well, I want to thank you both for being with us, Dr. Monica Gandhi, infectious disease physician at UCSF/San Francisco General Hospital, and Kate Elder, senior vaccines adviser with Doctors Without Borders, Médecins Sans Frontières.

And that does it for our show. On Saturday afternoon, I’ll be moderating a live discussion with Edward Snowden, Laura Poitras and Glenn Greenwald as part of the virtual War on Terror Film Festival. It will be 1:30 Eastern Standard Time. You can check out the details at

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Democracy Now! produced with Renée Feltz, Mike Burke, Deena Guzder, Messiah Rhodes, María Taracena, Tami Woronoff, Charina Nadura, Sam Alcoff, Tey-Marie Astudillo, John Hamilton, Robby Karran. Special thanks to Julie Crosby, Miriam Barnard, Denis Moynihan. I’m Amy Goodman, with Nermeen Shaikh.

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