Archbishop Thabo Cecil Makgoba has an idea he thinks will help President Joe Biden save countless lives and restore the battered international image of the United States. Makgoba, the Anglican archbishop of Cape Town, is advising the new president to use the immense wealth and power of the United States to ensure that South Africa and other countries that desperately need an effective coronavirus vaccine have access to it.
“I would say to President Biden: You have an amazing opportunity to be a force for good in the world,” Makgoba told The Intercept. “So we are appealing to you to also open the hearts … and look at those that are suffering and ensure that there is access, particularly to the global south, to this lifesaving vaccine.” Makgoba is specifically requesting that the Biden administration make the Moderna vaccine available in South Africa.
Under a law known as Section 1498, the U.S. government has the right to override a patent at any time as long as the company receives “reasonable compensation.” The provision would allow the U.S. to permit low-cost competition on the vaccine, for which Moderna received almost $2.5 billion in federal funding.
Makgoba has his sights set on the Moderna vaccine in part because it is 94 percent effective at preventing symptomatic cases of Covid-19. Until last week, South Africa was preparing to begin injections of the Oxford/AstraZeneca vaccine. But the government halted the rollout this week because that vaccine has been shown to provide only minimal protection against a variant of the coronavirus first discovered in South Africa, which now accounts for 90 percent of the cases there. On Wednesday, the national minister of health, Dr. Zweli Lawrence Mkhize, announced that the country instead plans to begin vaccinating health care workers with the Johnson & Johnson vaccine, which has yet to be approved by any country.
In certain parts of the world, the vaccination process — which typically involves two doses, about 3 to 4 weeks apart — is well underway. With more than two-thirds of its population vaccinated, Israel leads the way, followed by the United Arab Emirates, where almost half of the population has been vaccinated, and the United Kingdom, where more than one in five have already received a first dose. In the U.S., about 10 percent of the population has received at least one dose of the vaccine.
In South Africa, the country hardest hit on a continent that already has a higher fatality rate from the coronavirus than the rest of the world, almost no one has been vaccinated.
To Makgoba, the delay is reminiscent of another indignity. “This crisis really reminds me of apartheid,” he said. The archbishop, 61, grew up under the institutionalized racial segregation system and as a child was twice relocated. “I was told that I don’t belong and was forcibly removed to go elsewhere,” he said. “And I was, at a personal level, denied access to go into a white university because I was Black and needed ministerial approval to be in a white university. So these vaccines that are available to the global north and the West and available by Moderna reminds me that we are saying, like apartheid, ‘Hey, you guys are not human enough. Wait a bit.’”
Anticipating a vaccine apartheid, South African and Indian representatives at the World Trade Organization introduced a proposal in October that would temporarily waive some intellectual property rights for coronavirus-related products, including vaccines. The proposal, which is sponsored by 11 countries, would disrupt the usual profit-driven model that governs access to medicines.
“Our waiver says it’s OK to have intellectual property rights and it’s OK to make a profit, but it is immoral to make a profit over the lives of other people,” said Mustaqeem de Gama, a counsellor at the South African Mission in Geneva who helped draft the proposal. “Given the gravity of the situation, the number of people who have died requires us for at least for the moment to ensure that we lift the barriers to ensure that more producers can produce.”
The Biden administration has already distinguished itself from its predecessor in the realm of global health. In his first days in office, Biden announced his commitment to the World Health Organization, which Trump had threatened to leave, and said that the U.S. would be joining COVAX, an international public-private initiative to ensure equitable access to the vaccine. At a WHO executive board meeting on January 21, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the Biden administration, announced that the U.S. would “advance multilateral efforts for COVID-19 vaccine, therapeutic, and diagnostic distribution, equitable access, and research and development.”
But it is unclear whether the new administration’s commitment to expanding global access to the vaccine will extend to waiving patent protections. At a February 4 meeting of the division of the World Trade Organization that focuses on intellectual property rights, “the US reiterated that the intellectual property framework provides critical legal and commercial incentives to drive private entities to undertake the risk and make the appropriate investments,” an unofficial summary of the meeting prepared by the WTO secretariat explained.
The archbishop wrote an open letter to Fauci in late January, asking him to immediately help address the constraints on supply of the Moderna vaccine, but has not heard back from either Fauci or the biotech company.
If a legal way is paved for other companies to produce the vaccines, the mechanics of producing them shouldn’t be a problem, according to de Gama. “The issue is not capacity,” he said. “We have producers and manufacturers. Most countries import much of what they need from the developing world.” Knowledge Ecology International, a nonprofit focused on achieving justice for vulnerable populations, is currently compiling a database of companies around the world that could potentially produce coronavirus vaccines.
Moderna has already committed to not enforcing its patents. But scaling up the production of its vaccine would require sharing the proprietary knowledge about how to make it, which the company is not likely to do, according to James Love, the executive director of Knowledge Ecology International. Love said that last week he raised the idea of Moderna sharing its know-how so that other companies could produce its vaccine on a call with John Lepore, Moderna’s senior vice president of government engagement.
“He said, ‘We’re just not on board for this because if we share this know-how, people will know how to make everything we make,’” Love recounted. While the vaccine is expected to bring Moderna billions in profits, Love pointed out that “everything about that vaccine was funded by the U.S. government.”
Asked about the comment, Moderna’s Lepore wrote in an email that he couldn’t confirm it but noted that “Moderna’s messenger RNA technology is already part of over 20 clinical vaccine and therapeutic candidates, using the same underlying platform.”
Moderna is not the only company profiting from its exclusive rights to produce vaccines for Covid-19 while people around the world continue to die from the disease, and thus not the only company Makgoba is calling out. Pfizer is expected to make $15 billion from its vaccine this year, putting it on track to be one of the most profitable pharmaceutical products ever. That vaccine is also not yet available in South Africa, despite the fact that the company held some of its clinical trials there — a fact that the archbishop finds morally objectionable.
After the company’s vaccine was found to be 95 percent effective, “I would have expected Pfizer to say, ‘Yes we’ve found something that works. Here is something from the generosity of our heart based on the people that participated in your studies,’” said Makgoba. “But when they have the know-how, they say, ‘You continue with the nonpharmaceutical interventions, they are good for you. But for us, nonpharmaceuticals and pharmaceuticals are good, and we will get as much as possible for ourselves.’ The hoarding is really breaking my heart.”