The Big Pharma Holdup vs. the World’s Need For Covid Vaccines: An International Travesty

Almost two years into the pandemic, the unmet need for COVID vaccines worldwide has become an international crisis. Covax, the global immunization program, projects that it will have a total of about 1.4 billion vaccine doses by the end of 2021, far short of the 11 billion that experts believe are needed to slow the spread of the virus. The program has been hampered by production problems, export bans and vaccine hoarding by wealthy nations. Dr. Ghebreyesus, Director General of the WHO, observes that “I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers.”1 Of the 5.76 billion doses given around the world, 80 percent have been administered in high- and upper-middle income countries, with only 0.4 percent in low-income countries.2

An intense international debate is now underway at the World Trade Organization (WTO) concerning a proposed temporary waiver of intellectual property protections for COVID vaccines and treatments. As the latest Omicron variant starts to spread around the world, this debate calls into sharp focus the rights of corporate monopolies on crucial technology and their drive for maximizing profits versus the needs of countries with large vulnerable unvaccinated populations that continue to be the source of pandemic spread.

This kind of temporary waiver was introduced by India and South Africa as a WTO resolution in October 2020, and has gained the support of about 100 countries.  It is currently still under consideration by the WTO council on intellectual property rights. What happens next is still in doubt. As Deborah James, an international trade expert at the Center for Economic and Policy Research, observes:

It just shouldn’t be a trade organization that is deciding these kinds of things. You know the WTO has a default of always making decisions in favor of corporations.3

With help from the World Trade Organization (WTO) and international consultants, Afrigan Biologics and Vaccines, a South Africa-based biotech company, is racing to make a generic vaccine replicating Moderna’s mRNA-based shot. If Moderna would share information and know-how, Afrigan could produce the vaccine within a year, but it will not do so, citing intellectual property protection. Meanwhile, despite donation pledges, just 6 percent of Africa’s 1.2 billion people have been inoculated against COVID and remain a public health problem for the world.4

While drug manufacturers have been under fire for years for their exorbitant prices and costs of drugs, that continues for vaccines as well. The response from PhRMA has always been that we have to pay for the high costs of research and development that lead to these advances, but that claim does not stand the light of day, as these data points show:

+ Prices charged by U. S.-based manufacturers of COVID vaccines exceed production costs by 10-fold or more.

+ Billions of dollars have already been provided to vaccine manufacturers for all phases  of research, development, testing and manufacturing, including the innovational RNA platform (mRNA).

+ U. S.-based Moderna has projected up to $18 billion in sales for 2021 of its mRNA vaccine while billions of people continue to wait for access to COVID vaccines.

+ For comparative interest, net manufacturing costs for 100 million doses of AstraZeneca’s COVID vaccine (British-Swedish), ready for shipping, range from U.S.$  0.54 to US$ 0.98 per dose.5

Until recently, this country was an impediment to meeting global needs for COVID vaccines. The Trump administration’s policies concerning COVID vaccines were ruinous, starting with his announcement in October 2020 that the U. S. “will not participate in a global effort to develop, manufacture, and equitably distribute a coronavirus vaccine, in part because the World Trade Organization is involved,”6and later by not participating in the COVID-19 Vaccine Global Access (COVAX) Facility, a global partnership involving 172 countries supporting the development of such vaccines. More recently, the Biden administration has worked to repair the damage of those policies. He has come out in support of the WTO waiver, and has held a virtual conference with world leaders calling for recommitment to ending the COVID pandemic by September, 2022. He has also already donated 300 million doses of COVID vaccines to lower-income countries as part of a future total pledge of 1.2 million doses.

Two and one half million nurses from 28 countries have recently called for an investigation of the European Union, the United Kingdom, Switzerland, Norway and Singapore for “blocking a faster global vaccine rollout leading to the loss of countless lives.” Those countries have done so by stonewalling the patent waiver for vaccine manufacturers, whereby they would not be required to share their ‘vaccine secrets’ with other manufacturers trying to produce large numbers for vulnerable populations. The nurses’ complaint to the United Nations noted that high-income countries have procured more than 7 billion confirmed vaccine doses, while low-income countries have procured only about 300 million doses. Public health advocates around the world have described this inequity as vaccine apartheid’. 7

The temporary waiver is already supported by Doctors Without Borders, but increased support by physicians and their organizations in the U. S. and other countries would help resolve this debate for the common good instead of giving in once again to the profiteering interests of PhRMA manufacturers. Will American physicians and their organizations raise their voices toward curbing PhRMA’s holdup in defense of the public interest with Omicron coming along as the latest threat?


1. Mueller, B, Slotnik, DE. Covax, a global program to distribute COVID vaccines, cuts its 2021 forecast for available doses by a quarter. BoNew York Times, September 28, 2021.

2. Bokat-Lindell, S. The global vaccine drive is failing. Can it be saved? New York Times, September 14, 2021.

3. James, D. As quoted by Ludwig, M. Moderna refuses to share vaccine recipe with Africa as omicron rises. Truthout, November 30, 2021.

4. Wroughton, L. Frustrated by vaccine inequity, a South African lab rushes to replicate Moderna’s shot. The Washington Post, November 28, 2021.

5. Light, DW, Lexchin, J. The costs of coronavirus vaccines and their pricing. J Royal Society of Medicine, November 2021.

6. Stancil, K. ‘Nonsensical and madness’: Outrage after Trump excludes U S. from WHO-backed global vaccination cooperation project. Common Dreams, September 1, 2020.

7. Johnson, J. 2.5 million nurses demand UN probe into ‘COVID 19 criminals’ blocking patent waiver. Common Dreams, November 29, 2021.

John Geyman, M.D. is professor emeritus of Family Medicine at the University of Washington School of Medicine in Seattle, where he served as Chairman of the Department of Family Medicine from 1976 to 1990. His most recent publications are Struggling and Dying under TrumpCare: How We Can Fix this Fiasco (2019) and a pamphlet, Common Sense: The Case For and Against Medicare for All, Leading Issue in the 2020 Elections (2019).