Scientists clash over ethics of global vaccine roll-out

International mechanisms for sharing COVID-19 vaccines have come under fire from scientists around the world for reinforcing rather than combating inequity in global health provision, and for encouraging parochial nationalist responses to the pandemic.

The ethical furore has led to finger-pointing among public health experts eager to attribute blame for shortages in the supply of vaccines at national level.

Big pharma, with the support of wealthy countries, has continued to block a move supported by the majority at the World Health Organization (WHO) to waive intellectual property rights restrictions in order to enable poorer countries to produce their own generic vaccines.

Even a softer option to lift restrictions on trade in ‘essential medical goods’ proposed by the Ottawa Group, which includes Australia, Brazil, Canada, Chile, the European Union, Japan and Kenya, was shot down by the United States at the WHO’s final General Council meeting of 2020, which had been extended by a day to discuss the pandemic.

As many poorer countries struggle to lay hands on supplies of the vaccines, experts from South Africa and India, which have led the drive to lift intellectual property rights restrictions on vaccine production, have lambasted the WHO itself, as well as a number of the international mechanisms established under its auspices to promote equitable access to remedies for the virus.

In South Africa, scientists are also divided among themselves, with a number of influential opinion-formers accusing the government, and public health academics supporting it, of producing propaganda to protect the ruling party’s own reputation rather than an effective vaccine programme.

India’s permanent representative to the World Trade Organization (WTO), Brajendra Navnit, noted earlier this month that the progress made by the WHO’s COVID-19 Technology Access Pool initiative, which promotes the voluntary contribution of intellectual property, technology and data to support the global sharing and large-scale manufacture of medical products to combat the virus, had been inadequate.

Decrying the secrecy surrounding the initiative’s efforts, he also said that their limited scope encouraged “nationalism rather than true international collaboration”.

Accordingly, Navnit urged adoption of the waiver under the world body’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement not only in the interests of global health, but also to “re-establish [the] WTO’s credibility”.

‘Complete nonsense’

In South Africa, where, according to Marietjie Botes of the law school at the University of KwaZulu-Natal, the government acted in line with a “top-down regulatory approach” promulgated by the WHO, the credibility of the world body has also come under fire.

“There is a narrative that the WHO has kept on top of this … and that African governments have been successful because they were very proactive,” said Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand (Wits) in Johannesburg. “As far as I’m concerned, it’s complete nonsense.”

Botes, who is the co-author of an independent report on the country’s response to COVID-19 commissioned by the South African government, acknowledged strategic failures, including the “lack of a dedicated forward-planning coordination of structures” and the “seemingly haphazard way” in which medical experts were recruited to the body established by the government to advise on containing the outbreak.

Subsequently, the South African government has been slammed by leading public intellectuals in the scientific community for failing to look beyond the COVAX facility established by the WHO, France and the European Commission to ensure an equitable global supply of vaccines to combat the virus.

Describing the government’s vaccine acquisition policy as “wholly inadequate”, a group of nine senior public health experts, including academics from the University of Cape Town and Wits University, as well as Glenda Gray, president of the South African Medical Research Council, said: “It beggars belief that South Africa, against all reasonable expectations, finds itself in this group [of the poorest nations which are dependent on COVAX for their vaccine supply], since it is not a poor country, despite the best efforts of a corrupt political class to ensure that moniker.”

Accusing the government of “a frantic cover-up”, the academics further suggest that the scientists recruited to advise the government on its vaccine strategy have been “dragooned into the specious approach of the department”.

The critics conclude that “it is to the discredit of the advisory committee that it appears to have been enlisted in this exercise. Its members have the ability and expertise to produce a transparent and accelerated vaccine acquisition strategy … That such a strategy is lacking puts them in the invidious position of having to reaffirm their scholarly credibility and ethical composure.”

However, notwithstanding the high moral tone adopted by these experts, other voices in the debate pointed to how scientific ethics may also importantly be shaped by the context of an unfair international political and economic system.

Thus, in defence of the South African government’s position, Barry Schoub, who is the chair of the Ministerial Advisory Committee on COVID-19 vaccines, noted “the grotesque selfishness of high-income countries” and stressed the importance of international solidarity: “Pandemic infections can only be controlled if they are controlled globally…”

A global public good

The importance of global equity in responses to the pandemic has also been stressed by the South African ambassador to the WTO, Xolelwa Mlumbi-Peter, who said that vaccines should be a “global public good”.

Similar ethical concerns have exercised the minds of senior scientists advising on multinational public health efforts.

Anne Cambon-Thomsen of the French Institute of Health and Medical Research noted the “challenge to values” faced by the European Union due to a lack of preparedness for managing the pandemic at continental level.

Meanwhile, Ngoy Nsenga, who coordinates the WHO’s COVID-19 response in Africa, hit back against scientists who, in his view, had sought to devalue the roles played by national governments on the continent in combating the virus: “It’s a little bit frustrating to us, this kind of [idea] that Africans can’t do it by ourselves.”

It is an ethical position that has also been promoted by a group of African and European scientists who have campaigned to strengthen Africa’s own capacity to produce and use the kind of advanced knowledge that may be deployed to contain the outbreak.

Referencing data produced by the People’s Vaccine Alliance, which noted that only one out of 10 people in nearly 70 low-income countries are likely to get vaccinated in 2021, Ernest Aryeetey, the secretary-general of the African Research Universities Alliance (ARUA), and four senior academics at Norway’s University of Oslo said: “The challenges of vaccine and immunisation inequalities clearly illustrate the fundamental need for… long-term investment in African universities as the continent’s key knowledge institutions.”

The point was recently affirmed by globally renowned epidemiologist Quarraisha Abdool Karim, associate scientific director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and vice-president of the African Academy of Sciences. Noting how the present success in developing a vaccine at record pace had been made possible not only by the interests of big pharma but also on the back of past efforts to advance epidemiological knowledge around the world, she highlighted Africa’s difficulties in obtaining the fruits of such knowledge on a genuinely democratic basis.

Stressing the importance of mutual interdependence and solidarity in efforts to manage the pandemic, she nevertheless pointed out “how fragile we are in Africa when we don’t drive innovation – when we don’t drive things that we need and we have to join the queue with better-resourced nations… and we’re likely to see that with vaccines as well”.