During the summer of 2009, fear was rampant across the world. A new virus—a swine flu from Mexico that typically infected pigs—was sickening humans. As case counts rose and deaths followed, a pandemic was officially declared. 

As soon as the p-word was deployed, rich countries got to work pre-negotiating and massaging contracts with manufacturers for not-yet-existent vaccines. In an attempt to curb hoarding, the World Health Organization tried to persuade vaccine-purchasing countries to donate a portion of their doses to poorer ones, but, as one scholar later noted, the WHO and developing nations “had little leverage to influence developed countries other than rhetoric about equity, justice, and solidarity.” By the autumn, after vaccines had been developed, under 80 million doses had been donated to 77 countries in need—fewer than the total that had been administered in the United States at the time. The rest of the promised vaccines were only shipped after the threat the virus posed turned out to be much less devastating than feared. 

Vaccine inequity in the face of a viral-induced crisis is nothing new, and the Covid-19 pandemic has been no different. Last year, as 2020 drew to a close and the first vaccines became available, wealthy countries leapt at them hungrily. “It was clear that stockpiling was going to happen,” says Fifa Rahman, a civil society representative for the WHO Access to COVID-19 Tools Accelerator (ACT-Accelerator), an initiative aimed at providing pandemic resources to developing countries. Rich countries signed advance contracts with manufacturers, cornering the market and hogging doses before less wealthy countries could stand a chance. By late January, Canada had secured enough doses to vaccinate its population more than nine times over. Poor countries were pushed to the back of a lengthy queue. 

According to the Global Dashboard for Vaccine Equity, which is jointly run by the United Nations, WHO, and the University of Oxford, as of December 14 a little over 8 percent of people in low-income countries have been vaccinated with at least one dose. The majority of African countries have fully vaccinated less than 5 percent of their populations, compared with around 70 percent in the UK and 60 percent in the US. Wealthy countries have so many to spare that they’re rolling out third doses at warp speed. 

Vaccine nationalism has been blamed for this gaping chasm: Leaders put their own country first, with the qualifier to help others after. Sridhar Venkatapuram, a senior lecturer in Global Health and Philosophy at King's College, London, compares it to being on a crashing airplane: You’re supposed to put your own oxygen mask on before helping anyone else, so that you remain capable of helping your neighbor. But what if the masks are only provided to first-class passengers? “It's definitely one of the fundamental issues here: that the game that people were playing regarding access to vaccines was about nation-state first, their own people first—and this is fundamentally incommensurate with a pandemic that is about interdependency,” he says.  

While rich countries hoarded doses, Covax, a joint initiative from several UN bodies formed to provide vaccines to poor countries, was supposed to be a knight in shining armor. Dreamed up at the beginning of 2020 by the heads of two Gates-funded nonprofits over scotch and nachos, Covax’s raison d’etre was to guarantee equal access to vaccines for all nations and to prevent the exact scenario the world is in right now. And at the year’s outset, the plans looked rosy: Over 190 countries had signed up to donate and receive vaccine doses through the initiative. 

Then things began to go wrong. The initiative’s main supplier, the Serum Institute in India, which manufactures the Pfizer and AstraZeneca vaccines, couldn’t deliver on its promises; cases were skyrocketing domestically in March 2021, forcing it to pare back exports. Negotiations with vaccine makers like Moderna and Pfizer to sell doses to Covax became drawn out. Covax officials were forced to shift their goal of delivering 2 billion doses from this year to 2022. Despite its initial commitments, Covax expects to miss its target for 2021 by nearly a third.

But some think Covax was never going to meet its lofty goal. According to Venkatapuram, in early 2021, Covax officials were putting out PR statements to hide what was really going on behind the scenes. “They were using their communications to essentially speak to rich country leaders and rich countries, and to try to get them to join and cooperate, while not giving us a really good indication of the kind of precarious situation that we were in,” he says. 

A spokesperson for Gavi, the nonprofit that oversees Covax, challenged this characterization, telling WIRED by email that “despite constant shifts in regulatory timelines, available doses, and other factors, Covax has always maintained regular communication with participating economies including with respect to changes in supply volumes, schedules and timelines.” (The organization typically does not release the names of spokespeople.) 

As vaccine shipments failed to materialize, ambassadors of vaccine-poor countries were desperately contacting Covax to find out when they could expect their share. Rahman says she and her colleagues questioned Covax heads: When were vaccines coming for, say, Senegal? And, she recalls, they would respond with something like: “There are many moving parts.” “I’ve started to despise this phrase of ‘there are many moving parts,’ because to me it means they don't know what's going on,” she says. 

Rahman feels that those overseeing Covax weren’t coordinating with the authorities in the very countries they were trying to send vaccines to. Indeed, due to failure to consult adequately, many poor countries were forced to throw out thousands of expired doses for lack of the infrastructure required to store and transport them. If they had properly communicated with local authorities on the ground in these countries, this could have been avoided, says Rahman. “It's just sort of a colossal clusterfuck, of not being organized in terms of indigenous knowledge.”

But Gavi’s spokesperson told WIRED that Covax “has been very vocal about the need for greater transparency from donors and manufacturers on when doses will be made available as without this information recipient countries cannot effectively plan for a successful, large-scale roll out. It is the case that often doses in the past have been offered to COVAX with less than 10 weeks’ shelf life and that these have, under the principle of no doses left idle, have been offered to countries that have been deemed capable of absorbing them at short notice. When accepted by countries, these have subsequently been shipped.”

Covax’s goal for 2022, the spokesperson said, will be “to help all countries it serves meet their national vaccination targets.”  

Right now, the World Trade Organization enforces patents on trade-related intellectual property rights, or TRIPS—an international legal agreement between all the organization’s member nations that ensures a minimum standard of IP protection that a country must provide. In the case of Covid vaccines, it currently means that only those companies that hold a patent can make them. 

But a handful of countries, including India and South Africa, have been calling for the WTO to temporarily waive Covid-19-related IP rights. Lifting them would mean that poorer countries could freely copy the vaccine technology and access the technical how-to guide for making them. In order to suspend these rights, all member countries of the WTO would need to agree to it. Over a hundred countries have backed the proposal, but there’s a divide within the organization: Representatives from rich countries argue that ensuring patent protection is critical to keeping pharmaceutical companies innovating, and those from poorer countries argue that these patents ultimately prevent cheap access and cause unnecessary death. (Owing to concerns about the Omicron variant, the WTO indefinitely postponed its meeting to discuss the TRIPS waiver, meaning it’s far from a settled matter.) 

Advocates for the waiver say that expanding vaccine production in these countries now means they will be better prepared for the inevitable next pandemic—and not reliant on the generosity of rich nations. For example, for decades, Africa has had to import 99 percent of its vaccines due to lack of manufacturing capacity. 

Frustrated by the lethargy, a biotech company in South Africa called Afrigen Biologics and Vaccines is attempting to create an mRNA jab similar to Moderna’s with the help of the WHO. The original plan, as part of a WHO initiative to establish the first Covid mRNA vaccine technology transfer hub in Africa, was to receive the vaccine formulae of companies with successful mRNA vaccines to fast-track their own version based on similar technologies, says Afrigen’s managing director Petro Terblanche. “That didn't happen,” she says. According to Terblanche, Moderna refused to share the necessary information, citing intellectual property rights. “What I didn't expect is how Big Pharma would fight for territory in a time like this,” Terblanche says. 

In November 2021, the company forecasted that it would make $17 billion to $22 billion in sales from its vaccine in 2022, although company officials have said they won’t prosecute anybody found to be infringing on its Covid-related patents while the pandemic is ongoing.

So Afrigen took all the publicly-available information and made their own vaccine candidate, which closely resembles Moderna’s. “We operate completely with freedom and no IP infringement,” Terblanche says. But once the pandemic ends, the freedom that Moderna has provided will lapse, and without it, Afrigen will no longer be able to distribute the vaccine in a commercial setting, she says, although the company won’t be able to retroactively take legal action against them. Still, she continues, without Moderna's insider knowledge, the process has been much slower. “It would have been easier [with it], there is no question about it,” she says. There are certain technical components that Afrigen’s team has to test themselves, which is time-consuming. They won’t have a vaccine ready before July 2022, she estimates. 

One day, this pandemic will recede, and its immediate dangers will become the lore of history books, but the effects of the inequity will endure for poorer countries. According to the United Nations Development Programme, by the year 2030, eight out of 10 people pushed into poverty by the pandemic are projected to live in the world’s poorest countries. For women and girls, particularly, vaccine inequity exacerbates existing socioeconomic inequalities. For example, a low vaccination rate means that young people are kept out of school longer, which in turn means that they are at an increased risk of early marriage or forced labor. And there’s been a near 40 percent spike in maternal deaths in low- and middle-income countries due to disrupted healthcare. 

To prevent inequity of this scale from happening when the next pandemic arrives, the interests of the whole world—not just the countries with the money and resources—need to be prioritized, says Venkatapuram. “Even in this pandemic, where there's hundreds of millions of people dying, the default function of the global system is to think about national interest first.” 

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