On July 15, Andrew Goldstein, a primary care doctor in New York City, stepped out for his lunch break, dressed in his scrubs, to take part in a march headed toward the German Permanent Mission to the United Nations, accompanied by around 200 other protesters. That week, protests were held nationwide to mark Angela Merkel’s final visit to the United States and to bring attention to her key role in blocking the TRIPS waiver for the COVID-19 vaccine at the World Trade Organization.
As a doctor, Goldstein explained, “I feel that I’m complicit, and I don’t want to be, in a system that’s very profit-driven. So I think it’s important for health workers to show up.” In front of Pfizer’s New York headquarters, protesters later blocked traffic in an act of civil disobedience. At the same time, a die-in took place in front of the White House in Washington, D.C. There, activists laid out body bags in front of a giant puppet of Angela Merkel. Protests were also held in front of more than a dozen consular offices across the country.
The European Union, and Germany more specifically, is seen as the main stumbling block in the fight for the TRIPS waiver, which was first proposed by the governments of South Africa and India in October 2020 and has now become a rallying cry for global vaccine equity. The waiver would temporarily remove certain rules under the WTO’s Trade-Related Aspects of Intellectual Property Rights Agreement, or TRIPS, to allow for the lifting of patents on vaccines, equipment and technologies related to COVID-19.
On May 5, in a widely heralded victory for the access to medicines movement, the Biden administration announced that it would support a waiver on vaccines. Even though what President Biden proposed was much more limited than the proposal put forth by South Africa and India, the waiver had become “respectable.” “Suddenly it was mainstream,” said Jaume Vidal, senior policy advisor at Health Action International. This move was also seen as an unprecedented shift for a country that has long supported the most stringent possible protections for the pharmaceutical industry.
Arthur Stamoulis, executive director of Citizens Trade Campaign, who helped organize the die-in as well as other events during Merkel’s visit, noted that campaigners on both sides of the Atlantic saw Merkel’s valedictory final tour to the United States as “a prime opportunity to put direct pressure on her and to encourage the administration to do the same.” Activists were pleased with the attention garnered in the press. Stamoulis pointed to the fact that the New York Times’ lead story on Merkel’s visit featured a photo of the protest in Washington, D.C. and images of the protests featured heavily in German media.
Despite these victories, however, there was disappointment in the lack of a direct political outcome. The Merkel-Biden press conference at the end of the visit made no mention of the TRIPS waiver. According to Stamoulis, the issue reportedly came up in private with Biden, “but there was clearly no resolution to it.” With elections in Germany set for September, activists see little chance of Merkel changing positions; there was a lot of pride in Germany around the success of the BioNTech vaccine and there is a strong ideological belief in her party in the importance of patents for innovation.
But with Merkel’s exit imminent, some are looking elsewhere on Germany’s political stage, including toward the German Green Party, which is currently climbing in the polls and could form part of a governing majority come September. Lara Dovifat, international campaign manager for Doctors Without Borders’ Access to Medicines Campaign, who is based in Germany, sees the success of the Green Party as a “prime opportunity to make the issue of waiving patents and creating better access to life-saving medical tools” an election issue.
As activists in the United States take stock of recent events, they may look to pivot toward renewed pressure on the Biden administration. Since his May 5 announcement, many feel that the president is not doing enough. Biden invited the CEO of Pfizer as his guest to the G7 in June, and the United States has reportedly remained silent on the issue at recent WTO TRIPS Council meetings.
However, Arthur Stamoulis believes that with the Delta variant advancing quickly, the potential threat of more lockdowns, and California even reinstituting its mask mandate, Americans might be forced to finally reckon with the fact that “no one is safe until everyone is safe.” Brook Baker, a senior policy analyst at Health Gap, would like to see Biden work directly with the initial sponsors of the waiver, South Africa and India, to force Europe to negotiate.
The waiver in Europe
Marc Botenga is a Belgian member of the European Parliament where he is part of The Left coalition. In March 2020, he brought a resolution before Parliament in support of the TRIPS waiver. Having spent time in South Africa while working in global health, he was inspired by members of the Treatment Action Campaign, who successfully advocated for access to HIV/AIDS medications in the late 1990s and early 2000s. He saw how “patents and intellectual property rights in general were a massive break on access to the treatments that we had at the time.” This time, he said, “Either you would have strong public action on intellectual property rights or the dynamics were going to be very similar.”
When Botenga initiated his proposal, he continued, “There seemed to be this window of opportunity because you had a number of important policy figures in the European Union actually declaring that the vaccine should be a common good.” His resolution supporting the waiver passed with a strong majority in the European Parliament in June.
Yet when he first brought forward the resolution, Botenga said he felt “very lonely,” and thought that there was “no way we’re going to win this inside Parliament.” He credits the work of grassroots activists in the eventual success of the proposal, noting the role of the People’s Vaccine Alliance in Europe, which has organized rallies around the continent and has used social media to mobilize citizen engagement, as well as Doctors Without Borders, in influencing many of his colleagues.
Meanwhile, Jaume Vidal emphasized the positive response of parliamentarians with whom he began meeting with in November 2020. “When you do advocacy, it’s rare when you can say ‘we won,’ but in this case we won,” Vidal added. “We approved the resolution that pharma didn’t want approved.”
Unfortunately, this victory remains mostly a symbolic one, as parliament doesn’t set policy at the WTO. That is the job of European Commission, which represents the interests of the European Union on the global stage and has been setting the agenda with regards to Europe’s position on the waiver. Doctors Without Borders’ requests for meetings with commissioners have been repeatedly denied, though they have spoken with lower level officials. Dimitri Eynikel, coordinator of the policy team for the Access to Medicines Campaign in Europe, said this is frustrating, particularly when Doctors Without Borders was so directly involved in helping to deliver aid to EU countries during the pandemic.
They also know that the real discussions are happening at the highest levels. According to a report from May by the Corporate Europe Observatory, a list of meetings held by five commissioners with “direct stake in vaccines and medicines,” including President von der Leyen, showed a clear pattern of meetings only with pharmaceutical companies and their lobby groups, or with pharma-friendly organizations such as the Bill and Melinda Gates Foundation.
It was thus a disappointment but not a surprise to Botenga and others when the Geneva Health Files recently revealed a confidential communication from the commission showing a bad-faith approach to waiver negotiations that misrepresented the parliament’s strong support. The European Union also introduced its own proposal at the WTO in June, which, according to activists, simply reiterates existing flexibilities; many therefore view it as a diversionary tactic to delay talks on the waiver.
Meanwhile, while the chancellor was in Washington, German Health Minister Jens Spahn was reiterating Germany’s strong anti-waiver position in Geneva. “I am sure that next year, we will have a surplus of production,” Spahn told members of the World Health Organization. To global health activists, this laissez-faire attitude in the midst of a global health crisis of this magnitude is untenable. Spahn, however, like many opponents of the waiver, claims that it is technological know-how, not freeing up patents, that will increase production and availability of vaccines.
The push for manufacturing
Yet, as Doctors Without Borders’ Dimitri Eynikel explained, this is a false choice. Activists are well aware that the waiver alone will not deliver the necessary vaccine doses. But pressure on the waiver can be maintained while activists also push for the necessary tech transfer. In the United States, a group of American health and humanitarian organizations have called on President Biden to implement a global manufacturing program as part of his 2022 budget. Biden could use the Defense Production Act, Bayh-Dole Act or other legislation, as Public Citizen has argued, to “scale up manufacturing, license patents and know-how to the World Health Organization’s Technology Access Pool.”
Biden has already employed the Defense Production Act to allow Merck to produce Johnson & Johnson’s vaccine. Globally, the World Health Organization plans to set up production hubs around the world, and, on June 21, announced the first hub in South Africa. On July 21, Pfizer announced an agreement with South African company Biovac for production of its vaccine. Yet activists emphasize that, despite the company touting this move, this is a type of license that does not actually provide the South African manufacturer with independent ability to produce the vaccine.
Brook Baker has suggested that the Biden administration could use the threat of the waiver, in the meantime, to bring pharmaceuticals to the table. According to intellectual property law and medicines policy expert Ellen ’t Hoen, countries that have financed the development of vaccines should be the ones truly pushing companies to transfer their technology. This means the United States, which contributed almost a billion dollars in public funding to Moderna, Germany, which contributed to the Pfizer/BioNTech vaccine, and the U.K., with its support for the Oxford/AstraZeneca vaccine.
Meanwhile, activists are hoping that pharmaceuticals could still be compelled to transfer know-how and technology to the WHO’s COVID-19 Technology Access Pool. During the AIDS pandemic, government pressure became intense enough, according to Baker, that pharma came to the table and began providing voluntary licenses under threat of further government action.
A reason for optimism
Despite the obstacles facing the movement, Eynikel said that he feels some optimism, in part because of strong levels of awareness and engagement in the United States. But it’s not just there. “My impression for lower and middle-income countries is that they are in it for the long haul,” he explained. “They want structural change now. This debate won’t go away anymore. I think that’s something that high-income countries, including European Union member states, still haven’t realized yet.”
This was echoed by Boane Twala, a legal researcher at Section 27 in South Africa. “This is extremely reminiscent of the AIDS pandemic when it first began,” she explained via e-mail. “However, the difference here is that the South African government has adopted a more proactive approach which is commendable.”
Activists in the Global South have been heavily involved since before the waiver was introduced. They’ve written letters of appeal to the European Commission, to missions, embassies and world leaders; they’ve also organized protests in front of embassies of countries opposing the waiver.
It is unconscionable that — with only about 1 percent of Africans fully vaccinated and death rates soaring on the continent — pharmaceutical executives have been caught discussing how they can, instead, boost profits in the Global North by raising prices from approximately $19.50 per person for the current round of doses to $150-175 per person for booster shots.
As Eynikel points out, we have, over the course of the pandemic, asked many companies to make important sacrifices to protect our health, including shutting down completely for periods of time. Why, then, “can’t we ask the same of the pharmaceutical industry, the companies who have the tools to end the pandemic for everybody, everywhere?”
With the WTO TRIPS Council in recess for summer, activists in Europe expect activities to quiet down until September, when the council reconvenes. These meetings, as well the World Health Assembly at the end of November, will present renewed opportunity for activism around the issue. Meanwhile, in the United States, where activists are reviving pressure on their own government, President Biden’s top vaccine diplomat, Gayle Smith, told the Financial Times on Wednesday that she was urging U.S. vaccine makers “to support the development of low-cost manufacturing hubs overseas.”
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Activists in the United States welcomed the move. In a statement from Public Citizen, Peter Maybarduk, director of the organization’s Access to Medicines Program, stated: “We are heartened by Coordinator Smith’s support for regional production hubs.” But some warn that, despite this positive step, there is still much work to do. “I’m afraid the administration will need to intervene much more forcefully to achieve the knowledge sharing that’s needed to end the pandemic,” Arthur Stamoulis said.
The question, when it comes down to it, therefore remains, as Eynikel put it: “Can the government go against private interests to protect the public interest?” Activists are holding out hope that, with the Delta variant wreaking havoc and the broken promise of global vaccine equity becoming ever more glaring, the answer to that question might, against all odds, still be a “yes.”
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