Myths of Solidarity

Paul Chaplin is the CEO of Bavarian Nordic, the company that owns the Jynneos vaccine shown to be most effective against mpox. He declared that he was proud to meet urgent health needs in the DRC. Stella Kyriakides, the European commissioner for health and food safety, stated that the EU was pleased to be acting “in partnership and global solidarity” with Africa.

However, at around one hundred thousand doses, this first donation of mpox vaccines to arrive in the DRC was a small fraction of the three million doses that the country says it needs. It also came after several planned deliveries from the United States were delayed, and a full eighteen months after the central African country declared the outbreak to be an epidemic. In that period of time, the United States has been amassing a huge stockpile of the jab, after making plans to accumulate seven million doses by the middle of last year.

It was already clear that the “donations model” for the provision of vaccines doesn’t work for countries in the Global South. In repeated health crises, we’ve seen it fail disastrously, never more so than during the COVID-19 pandemic, when pharma CEOs secured huge profits by selling almost exclusively to higher-income countries, which then hoarded vast amounts of vaccines.

By the time some people in the UK were getting their booster jabs for COVID-19, three-quarters of health workers in Africa still hadn’t received their initial doses. More than a million people in low- and middle-income countries lost their lives because those parts of the world weren’t prioritized for the supply of vaccines. It seems clear that this dangerous dynamic is playing out again, with action only belatedly being taken now that mpox poses a threat to Western countries.

A Broken Model

The donations model allows pharma companies to maximize their profits, as rich countries often buy doses at roughly the market rate before packaging them off to lower-income countries. In a world of busy news cycles, those companies and the states that purchase their vaccines also get to posture as incubators of advanced science for the global good, with “charitable” programs obscuring the need for more fundamental change.

While Bavarian Nordic says it has pledged to donate forty thousand mpox vaccines itself, the company has been clear that it expects richer nations and institutions to step in to meet demand. The company is reportedly charging $200 per patient for the double dose needed, even though this vaccine was developed with hefty US taxpayer funding and similar jabs can sell for less than 3 percent of the price.

Without doubt, more donations are needed now. But that cannot be a cover for ignoring the demands of people in the Global South who have for decades campaigned against unjust global trade laws. Those laws suppress manufacturing in the Global South and lock countries into dependency on actors in the Global North.

At the center of this broken model is a set of regressive intellectual property rules that allow pharma companies to monopolize life-saving medical equipment. Codified in the document known as TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights), these rules stem from the lobbying efforts of US pharma corporations who wanted to head off competition from the emerging medicines industries in newly independent colonies.

Established at the World Trade Organization in 1995, these rules made it much harder for other countries to build up industries for the production of medicines, solidifying US and European market dominance. This control has brought with it disastrous results: from the decision of pharma companies to price most of Africa out of access to HIV treatment, to the industry’s habit of ignoring diseases until they pose a threat to the Global North.

Challenging the System

This is the status quo that countries in the Global South are railing against, while powerful vested interests are battling to keep it in place. The outbreak of mpox has come during negotiations over a new global pandemic agreement, which in theory is supposed to respond to the lessons of COVID-19 and the disastrous inequalities it exposed.

Lower-income countries are demanding action and investment to transfer technology for the production of medicines, as well as an end to Big Pharma’s patent monopolies in future crises.

Inevitably, the industry and its backers in the United States and Europe are trying to block any measures that would have teeth. Yet the legitimacy of the status quo is gradually being undermined.

This is made clearer by the fact that many countries are now taking matters into their own hands. This year, Colombia’s left-wing government issued a compulsory licence to pave the way for cheaper generic versions of dolutegravir, a key HIV medication.

Another challenge to the intellectual property regime comes from a groundbreaking new program that seeks to develop mRNA vaccines. With support from the World Health Organization, a South African biotech company and a Brazilian public scientific research institution are working to develop vaccines for diseases that mainly affect people in the Global South. They will then share their work, patents and all, among fifteen low- and middle-income countries.

Initiatives like this are coming under heavy pressure from the pharma industry, with UK multinationals GSK and ViiV challenging the Colombian government’s compulsory license in court. Pharma lobbyists at one point also advised investors to give up on the South African mRNA program and leave the job of making vaccines in Africa to a European company. Yet the Colombian government and the mRNA vaccines program have both held their ground so far.

When it comes to mpox, producers in the Global South are also making the case for progress. Just weeks after a Bavarian Nordic official suggested that production of its vaccine in Africa would be “technologically unfeasible,” a South African company reported that it had begun talks to manufacture vaccines against the virus.

Transformation, Not Tinkering

For these initiatives to be more than just cracks in the system, there will have to be substantial investment and technology transfer from rich nations. Achieving this will require huge political pressure, certainly in the countries most directly affected, but also in the Global North.

Solidarity with those worst affected by the current set up should be reason enough to act. But it should also be easy for us to point out that we have a shared interest in taking on a pharmaceutical system whose main agents are accountable to their shareholders rather than those who depend on their products.

We saw this starkly demonstrated during the pandemic, when the stranglehold of pharma companies over production and the drip-drip supply of donations gave COVID-19 more chances to spread and mutate, prolonging and worsening the global health crisis for all. We see it too in the heavy pressure that pharma monopolies put on our health budgets.

Governments and the big firms are now congratulating themselves for delivering a small fraction of the mpox vaccines needed to protect people in the DRC and neighboring countries. It’s clear that the old, neocolonial forms of charity and tinkering around the edges will not suffice.

Activists and health workers in the Global South are demanding much more: an upending of the entire system constructed in the interests of Big Pharma. It’s in all our interests that they win.