The Covid-19 pandemic has exposed the power of transnational corporations to extort our deeply unequal world in many ways, however nowhere is this more stark than in the global vaccine rollout. As of August 2021, around five billion Covid-19 vaccine doses had been administered worldwide; 75% of those were in ten countries, while only 4% were in low-income countries. Critics - including from the likes of UN World Health Organisation Director General Tedros Adhanom Ghebreyesus have described this situation as a kind of vaccine apartheid.

One where the rich world can get their populations vaccinated and have life return to normal while the economies of the Global South remain firmly within a pandemic that is still killing around 8,000 people a day, most now in low-income countries with large unvaccinated populations. A recent report from the UN Conference on Trade and Development estimated that a delayed vaccine rollout would carve $1.5 trillion off incomes across the Global South by 2025.

One common response to this problem has been the accusation of vaccine hoarding by rich countries, noting that poor countries are at the "back of the queue" to get vaccines. Similarly, here in Aotearoa the National Party has consistently highlighted how New Zealand has been at the "back of the queue" because we got our vaccines orders in late.

These responses to this problem stem from a larger issue: we have a vaccine queue because there is a material shortage of vaccine doses, and we have a material shortage of vaccine doses because the handful of companies that control the intellectual property of these vaccines have refused to share it with other manufacturers around the world that are ready and able to increase the supply of these vaccines. Vaccine manufacturers across the world have demonstrated their available capacity to scale up production and end the pandemic, however they have been prevented from doing so by intellectual property protections.

Drug Barons

Vaccine intellectual property is big business, generating extraordinary wealth for those who control it. According to one analysis by Oxfam, shareholders of Pfizer, Johnson & Johnson and AstraZeneca received $US26 billion ($NZ42 billion) in dividends and buybacks in the 12 months to April 2021, enough to vaccinate 1.3 billion people (equal to the entire population of the African continent).

These figures are likely to continue to grow in 2021 and 2022, with primary vaccinations continuing in middle- and lower-income countries, while rich countries put their orders for boosters (an overall more profitable market for pharmaceutical companies, making "queue jumping" more likely). Nine individuals with significant shareholdings in these companies have been made billionaires since the beginning of the pandemic, while the Chief Executive Officers (CEOs) of Moderna and BioNTech (that manufactures the Pfizer BioNTech vaccine) now have a personal wealth of over $US4 billion each.

Once the scale of public investment in Covid vaccine development is taken into account - according to one study this had reached €93 billion ($NZ149 billion) - it is difficult not to see this as a major transfer of public wealth to a subsidised corporate sector.

NZ's Questionable Role At WTO

At the global level, intellectual property is primarily regulated by the World Trade Organisation (WTO) Agreement on Trade-Related Intellectual Property Rights (TRIPS). TRIPS requires all countries to enforce intellectual property protections, including patents for pharmaceutical technologies. The TRIPS Agreement came into force in 1995, and, as campaigners demanding access to "generic" (i.e., non-brand) HIV/AIDS medications will tell you, has only limited flexibility when things like a pandemic crop up.

That pandemic has now been with us for almost four decades, however transnational pricing strategies made medicines too expensive for the majority of sufferers worldwide. Decades of activism at the national and global levels did eventually lead to some loosening of TRIPS rules, leading to a peak of global HIV/AIDS-related fatalities in 2007 and a slow decline of those figures. It is certain that had pharmaceutical companies acceded to demands from developing nations whose populations had been ravaged by HIV/AIDS that the fatality rate would have come down much sooner.

In October 2020 India and South Africa submitted a communication to WTO members calling for the temporary suspension of TRIPS patent protection rules for covid vaccines and medicines that prevent and treat Covid-19. Before long, this motion enjoyed wide support from developing countries, with the majority of the world's population unable to understand why the profits of a handful of transnationals should be put in front of their lives.

Developed countries however refused to support the proposal. However New Zealand's refusal to support the waiver was particularly galling, considering public statements made by NZ Prime Minister Jacinda Ardern calling for an equitable vaccine rollout. In July 2021 she co-authored an op-ed in the Washington Post with several other world leaders, including South African President Cyril Ramaphosa and Canadian Prime Minister Justin Trudeau, arguing that:

"Where you live should not determine whether you live, and global solidarity is central to saving lives and protecting the economy. A managed flow of the vaccine - including for humanitarian settings and other vulnerable countries such as the least developed countries and small island developing states - is the wise and strategic course of action and will benefit countries around the world".

Strangely the "managed flow of vaccines" that Ardern and Ramaphosa et al mentioned seemed to explicitly favour wealthy countries. By 8 September 2021 COVAX, a global vaccine distribution project championed by rich countries that had aimed to distribute two billion doses to poor countries by the end of 2021, had only distributed 240 million doses (later that month COVAX revised downwards its projection to 1.425 billion doses by the end of 2021).

NZ Took Doses From COVAX

New Zealand was criticised on the international stage for taking doses from the COVAX facility, despite the fact it was intended to help the vaccine rollout in low-income countries

While New Zealand's successful 2020 lockdown had garnered its international reputation to implement evidence-based public health advice, refusing to support the WTO waiver put New Zealand at odds with the demands of the majority of the world's population. In January 2021 a group of 42 organisations and experts - including the NZ Nurses Organisation, NZ Council of Trade Unions, CAFCA, Amnesty International, Oxfam and Doctors without Borders - wrote an open letter to Prime Minister Jacinda Ardern calling on the NZ Government to take the lead and support the waiver:

"We have seen throughout 2020 how the pandemic has acted as a handbrake on human development and economic growth, sending economies into the severest depression in more than half a century, and leading to a sharp global increase in unemployment, not to mention the pandemic's severe health impacts that have already claimed more than two million lives globally... If 2021 is going to become the 'year of the vaccine' then the international community must take serious action. The team of five million needs to join the team of seven billion".

Other actions included a petition, videos, and a range of op-eds. In early February, a group of 36 Indian health organisations and 50 respected individuals wrote to the New Zealand Ambassador calling on New Zealand to support the WTO waiver. Their letter was prescient, observing that:

"It is now clear that the longer the virus circulates in unprotected populations, the more likely it is that mutations will occur. These mutations can affect all countries - including countries opposing the waiver proposal - and prolong the pandemic. In the face of such a crisis, New Zealand's silence is untenable and self-defeating".

Trade Minister Damien O'Connor replied in late February 2021, noting that NZ had welcomed the TRIPS waiver discussion at the WTO. The letter highlighted existing flexibilities within the WTO, including voluntary licensing, compulsory licensing, and technology transfer, however noting "the role that intellectual property plays in incentivising investment in the development, manufacture and distribution of new technologies".

"Third Way"

It soon became clear that NZ was indeed part of a smaller group of countries attempting to develop a "third way" proposal that explored what was possible under the existing framework, with the cooperation of the pharmaceutical companies. This approach was championed by new WTO Director-General Ngozi Okonjo-Iweala, who argued that there was a path to increase access "through facilitating technology transfer within the framework of multilateral rules and by pharmaceutical companies striking licensing deals to allow other manufacturers to produce vaccines and other products".

Campaign group It's Our Future accused the NZ Government of "running interference for the rich nations and companies that have refused to address issues around vaccine equity".

In April a letter signed by 175 former world leaders and Nobel laureates - including former NZ Prime Minister and United Nations Development Programme Chief Helen Clark - was received by Okonjo-Iweala, urging her support for a WTO waiver as "a vital and necessary step to bringing an end to this pandemic".

By this time, the delta variant was resulting in a second global wave that was proving much deadlier than the first. With pressure growing on the US to play a leadership role, on 5 May 2021 the Biden Administration announced that it would now support an intellectual property waiver at the WTO for covid vaccines.

While this was narrower than the Indian and South African proposal it was nonetheless a significant development on the global stage, as many of the world's largest pharmaceutical companies are domiciled in the US (specifically in tax haven Delaware). This news appeared to move fast - in a matter of hours New Zealand's policy had also undergone an about-turn, by tweet no less.

While NZ campaigners were thrilled at the decision, it was unclear why the New Zealand government had waited until the US changed tack before it could do the same. Was our foreign policy really so subordinate to US demands? The release of documents under the Official Information Act in August 2021 added specific detail to this narrative. In December 2020 the Minister of Trade wrote to a senior official from the Ministry of Foreign Affairs and Trade (MFAT) asking "what is our position on the TRIPS waiver?" The response was clear: "We don't support the waiver".

An MFAT briefing sent on 10 February 2021 underscores that "NZ has economic interest in protecting property rights and investments of innovative New Zealand health sector companies such as Fisher & Paykel Healthcare (FPH)". It is unclear whether this protection had been specifically requested by FPH or was the result of ongoing support and engagement.

Demand for medical equipment pushed FPH to a record profit in the 2021 financial year of $524 million, an 82% increase on the previous year, while JB Were's 2020 NZ Equity Ownership Survey showed that global demand for FPH shares saw FPH shares increase from 4.2% of total offshore ownership to 8%.

Would Remaining Holdouts Like A Free Trade Agreement?

As of 1 November 2021, 80% of global Covid fatalities have been since India and South Africa submitted their call for a temporary waiver of WTO intellectual property rules. The TRIPS waiver is shaping as one of the global flashpoints highlighting the need for WTO reform for the institution to maintain its relevance. While US campaigners are criticising the Biden Administration for doing too little to show leadership, the major holdouts on supporting a TRIPS waiver today are the UK and the European Union. The New Zealand government is currently in the process of negotiating free trade agreements with both.

In October 2021 the NZ and UK governments announced an agreement-in-principle. However as with other recent trade negotiations, they have refused to release any text. For the UK this is a major post-Brexit opportunity to work towards membership of the Comprehensive and Progressive Trans Pacific Partnership (the TPPA's phoenix agreement after the US departure).

According to publicly-released information about that Agreement's intellectual property (IP) chapter, "no other commitments in the IP chapter will require changes to IP regulatory settings for either New Zealand or the UK".

In other words, NZ has not sought to use this as an opportunity to put pressure on the UK to support the TRIPS waiver and, with it, global vaccine equity. Negotiations between NZ and the EU have proceeded more slowly, however, opposition is strongest in Germany, which has a large domestic vaccine manufacturing industry. While parties struggle to form a viable Government there, global vaccine access was not discussed at all during recent election campaigns.

All of this came to a head at the WTO Twelfth Ministerial Conference, originally scheduled to take place 8-11 June in Kazakhstan, then shifted to 30 November to 3 December in Geneva. For the Global South, this was a major test of whether the current global trading rules are fit for purpose. At the time of writing, it remained to be seen if countries like NZ and the US would push the remaining holdout countries to end vaccine apartheid and supercharge manufacturing capacity, or would they turn a blind eye, allowing rich nations to capitalise on an uneven global recovery, where new strains of covid thrive, creating an ongoing market for covid booster vaccines.

Since this was written, the outbreak of the Omicron Covid-19 virus variant caused the very last minute, and indefinite, postponement of the WTO Ministerial Conference. Ed.