As part of President Biden's plan to address the global Covid-19 pandemic and inequitable distribution of vaccines, medicines, and tests to many parts of the world, he convened a global summit held virtually on Wednesday.
Biden has asked for endorsement of a set of targets and commitment to directly address one or more of them. These targets fall terribly short of the ambition that's needed to stop this global pandemic. The targets also downplay the obligations of rich countries to reverse the horrific consequences of vaccine, testing, and therapeutics apartheid that they--and the biopharmaceutical industry--have engendered.
Premature endorsement of incomplete and inadequate targets is the wrong approach.
Vaccines: too few too late
Although Biden's 70% target goal for vaccinating all populations by September 2022 seems appropriately ambitious, this goal should be reached even earlier, during the first quarter of 2022 based on existing supply projections. There should also be an ambitious 40% intermediate coverage goal for the end of 2021, and an ultimate goal of getting even further than 70%.
The main mechanism for increased supply in the targets document is accelerating delivery of the 2 billion doses already promised to low- and middle-income countries for 2021 and securing another 1 billion doses through purchases and dose-sharing, presumably for delivery in early 2022. Given that 4 billion people live in low-income and lower-middle-income countries and the two-dose regimen needed to fully vaccinate them, 3 billion doses is a partial target at best.
Moreover, the money identified for getting shots into arms--$3 billion in 3021 and $7 billion in 2022--seems woefully inadequate. Vaccinating large populations, including people in rural and hard-to-reach locations, will require health system strengthening, an expanded and trained workforce, and community-based health care workers to overcome pockets of vaccine hesitancy.
Inexplicably, the summit targets do not mention the need to overcome intellectual property barriers and to mandate--or forcibly incentivize--vaccine technology transfer from reluctant, uncooperative rightsholders. It is confounding to me that there is underutilized vaccine manufacturing capacity in other regions of the world and that governments refuse to mandate and fund technology transfer.
Although the Biden administration has verbally committed to the vaccine portion of the temporary World Trade Organization proposal by India and South Africa to waive intellectual property rights on Covid-19 health technology, it has abrogated its responsibility thus far to finalize a waiver text--now it ignores the need to forcefully address IP barriers and technology transfer as key aspects of its summit targets. Vague references in the targets to supporting sufficient global and regional production and expanding manufacturing and tech transfer have no teeth.
There needs to be money on the table to support expanded vaccine manufacturing capacity in lower-income country regions along with direct support for the newly established WHO Technology Transfer Hub. The U.S. should also commit to using all of its existing powers to put enforceable tech transfer commitment into research grants, mandate tech transfer via the Defense Production Act, and exercise its Bayh-Dole march-in and government-use licensing rights.
Deficient targets for oxygen, testing, therapeutics, and PPE
Oxygen is an essential, lifesaving therapy for people hospitalized with Covid-19. Hundreds of thousands of patients have died, gasping for breath with inadequate oxygen supplies. Not only are there problems of oligopolistic control of and overpricing of oxygen, there is a need for more secure sources of oxygen supply. The targets for oxygen must be much more concrete so no more lives are lost because of inadequate or delayed access to it.
The target for testing is distressingly short of need. Testing one person a day out of 1,000 would result in only 36.5% of people being tested in a year. Even the more specific target of delivering 1 billion tests by 2022 is unclear as to timing and insufficient in quantity. Testing is currently exponentially greater in rich countries, where tests are being widely deployed in schools, workplaces, and public venues. We need testing targets for lower- and middle-income countries that can help identify outbreaks and help with control. In the very near future, the world will need widespread community and home testing to identify early infections and start people on outpatient treatments.
The target for therapeutics is also underspecified. The focus on 18 million treatments for severe, inpatient cases may be appropriate, but there is no real identified target for existing or pending outpatient treatment. Monoclonal antibodies are available in rich countries, but global supplies are limited, prices are high, and administration by infusion is difficult. Moreover, most monoclonal antibodies have already been advanced purchased by the U.S. and other rich countries. The stated goal of $1 billion for medicines in 2021 and $2 billion in 2022 is relatively meaningless without knowing the price of procured medicines and the quantity delivered.
The goals for personal protective equipment are similarly inadequate. Although a target ensuring personal protective equipment is certainly appropriate for health workers, masks are widely available for the general population in rich countries. There should be a target to dramatically increase the supply and availability of high-quality masks in target countries.
'Build Back Better' targets are grossly incomplete
The Build Back Better targets in the documents listing the summit targets only address health security financing and political leadership, asking mainly for resources to finance a global health security financial intermediary fund with almost no specification of what the money would be used for beyond funding urgent preparedness needs and building surge capacity and resilient supply chains in all regions.
Restricting global aspirations for addressing the global Covid-19 pandemic to vaccine donations and partial responses to needs for oxygen, testing, therapeutics, and PPE does a grave disservice at a time when more decisive leadership is needed. The most dramatic deficiency in the global pandemic response thus far has been letting private industry use intellectual property rights to artificially restrict supplies, grossly overprice products, and preferentially supply rich countries, resulting in millions of deaths, massive economic losses, and terrible social disruption. It has also allowed the development of new variants that have complicated and may ultimately undermine efforts to defeat Covid-19.
The Biden administration should jettison its summit targets and instead engage proactively with leaders, especially from the Global South, to identify a bolder set of actionable targets that would simultaneously reverse private sector control over Covid-19 health technologies and massively increase coordinately public investments in defeating the pandemic in all corners of the world. The time for real leadership is now.
