More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry’s Role in Widening the Access Gap

https://ijhpm.com Int J Health Policy Manag 2022, 11(12), 3101–3113 doi 10.34172/ijhpm.2022.6942 Original Article More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry’s Role in Widening the Access Gap ID ID Luciana Correia Borges1 , Henrique Zeferino de Menezes2 , Eric Crosbie1,3* ID Abstract Background: An effective response to the coronavirus disease 2019 (COVID-19) pandemic entails a comprehensive strategy that ensures equitable access to all COVID-19-fighting technologies. To achieve this goal, the international community has acknowledged immunization as a public good. However, a trend of grossly unequal dose distribution emerged, owing, among other factors, to pharmaceutical companies’ profit-driven actions, jeopardizing the mechanisms built to increase vaccine access. The contradiction between public health interests and corporate discretion in determining vaccine dose distribution poses critical concerns about the health risks associated with lengthening the duration of the pandemic and the eventual liability of companies for violations of human rights. Methods: To evaluate the risks posed to the COVID-19 immunization program, data on vaccine allocation and delivery, vaccine dose application, immunized populations, and the volume of Advanced Purchase Agreements (APAs) between countries and pharmaceutical companies were compiled and assessed. A descriptive analysis was then conducted to analyze the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines. Results: When the data is broken down by income (as of June 2021), it shows that high-income countries (HICs) have already crossed the COVID-19 Vaccine Global Access (COVAX) 20% immunization threshold. However, countries of all other income levels have yet to achieve this mark for fully vaccinated people. Upper-middle-income countries (UMICs) have approximately 3%, low- and middle-income countries (LMICs) have approximately 2% and low-income countries (LICs) have less than 0.1% of fully vaccinated people per hundred. The supply shortage is expected to last until the second half of 2021. Conclusion: As a result of the COVAX failure, a health gap emerged with countries living in a pre-immunization period for an extended time. The existing conflict between the international response to tackle COVID-19 and corporate profitdriven behavior contributed to prolonging pandemic, especially in Africa. Accordingly, there is a need to approve an international treaty that targets the activities of all actors, including the pharmaceutical companies, in protecting human rights and the right to health realms. Keywords: Pharmaceutical Industry, COVID-19 Pandemic, COVID-19 Vaccine, COVAX Facility, Human Rights, World Health Organization Copyright: © 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Borges LC, de Menezes HZ, Crosbie E. More pain, more gain! The delivery of COVID-19 vaccines and the pharmaceutical industry’s role in widening the access gap. Int J Health Policy Manag. 2022;11(12):3101– 3113.  doi:10.34172/ijhpm.2022.6942 Background The coronavirus disease 2019 (COVID-19) pandemic has killed more than six million people globally,1 leading to a severe social, economic, and humanitarian crisis with immeasurable effects – including increases in extreme poverty2 and hunger, resulting in starvation,3 sicknesses, and death; forced migration and displacements4; and worsened health conditions of marginalized and disproportionally affected populations. Thus, states, international organizations, civil society, and companies are tasked with addressing the pandemic and, in the process, establishing international obligations to strengthen human rights and, in particular, securing the right to health. Since the beginning of the coronavirus pandemic, the international community has responded to the outbreak Full list of authors’ affiliations is available at the end of the article. Article History: Received: 14 November 2021 Accepted: 1 August 2022 ePublished: 20 August 2022 *Correspondence to: Eric Crosbie Email: of COVID-19 by building a comprehensive multilateral framework while reiterating the importance of mitigating the social and human costs that resulted from the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) spread.5 The most ambitious and vital goal, involving national governments, international organizations, and pharmaceutical companies, was encouraging the production of effective and safe therapeutics and vaccines. To that end, several collaborative mechanisms such as the COVID-19 Technology Access Pool (C-TAP) and the COVID-19 Vaccine Global Access (COVAX) were launched in the first half of 2020 by multiple actors with different expertise, alongside making considerable resources available for subsidizing vaccine research and development (R&D) to accelerate the market registration of COVID-19 immunizations. Borges et al Key Messages Implications for policy makers This study prompts policy-makers to consider the following factors when developing policies nationally, regionally, and globally to secure equitable access to life-saving technologies: • Nationally, countries, especially low- and middle-income countries (LMICs), should strengthen their productive capacities in the pharmaceutical sector to reduce dependence on foreign suppliers. • Regionally, governments in LMICs can strengthen their cooperation mechanisms to improve epidemiological control and establish shared procurement instruments for essential medicines, vaccines, and other high-demand technologies. • Globally, all governments should jointly demand more effective cooperation instruments and initiatives to reduce the risks of shortages of vital supplies during public health crises. • Globally, all governments should demand an international pandemic response (binding) treaty that defines enforcement mechanisms that encompass responsibilities for governments, society, and corporations – clearly referring to pharmaceutical companies. Implications for the public This study underscores the challenges international organizations face when tackling severe public-health pandemics, specifically when regards to multilateral initiatives that rely on comprehensive multistakeholder collaboration. The most critical lesson is that society must demand the full realization of the right to health and hold not only national governments accountable but also the international community, organizations, and corporations, most notably pharmaceutical companies, to fulfill their particular responsibilities. Furthermore, it is crucial to understand that in a pandemic, such as coronavirus disease (...truncated)