Meaningful action would focus on building up production capacity and supply chains everywhere, not simply to honor the basic sanctity of human life, but because the emergence of variants and new viruses threatens us all, everywhere, constantly. That threat could be eliminated by ensuring that rapid vaccination is available worldwide. If we don’t establish a better system of production and distribution, every future pandemic will split us in two.
In this moment, disparities may seem inevitable. To some degree, they are. We can’t simply ship excess doses of the mRNA vaccines around the world, for example, on account of their cold-storage requirements and relatively short shelf life. Vaccine doses that Americans opt not to take won’t end up being flown to Africa; they’ll go to waste.
It’s also true that vaccines are being produced by dozens of companies around the world, and if these companies could simply ship more doses, they would. Pharmaceutical companies don’t intentionally leave money on the table. The big pharmaceutical companies, as well as Bill Gates, have made exactly this argument: Vaccines are already being produced as quickly as possible.
But if we’re maxed out on production, this is by design. It’s the result of decisions that the U.S. has made throughout the pandemic—most notably Trump’s refusal last September to sign on to a global coalition to ensure the equitable distribution of vaccines, known as COVAX—that have perpetuated a system of pharmaceutical sales built over decades. Taxpayer money is used to fund basic science research, and then pharmaceutical companies develop products based on this research and sell them back to the government. (Medicare is the largest drug buyer, and it is not allowed to negotiate what it pays.) U.S. taxpayers have already, under Trump, contributed some $14 billion to the development and manufacturing of patented COVID-19 vaccines. That’s in addition to the billions spent over decades on the NIH-funded research these technologies are based on.
The drug industry claims that if companies such as Pfizer didn’t stand to profit in the billions, they wouldn’t have invested to advance the technologies involved in developing and producing vaccines. But this same argument illustrates the danger of such a system: Our emergency-preparedness plan for a global disaster depends on an industry that will not come to the rescue unless it stands to cash in. To rely on a handful of private companies to end the next pandemic, too, amounts to a cosmic roll of the dice—especially when those companies will not make guarantees of equitable distribution, or of production past the point at which a profit can be made.
Read: America’s patchwork pandemic is fraying even further
Adapting this system would bring us much closer to doing “everything we can” to get the world vaccinated, as Fauci suggested is the goal. Biden announced last week that his administration would take measures to waive patents for COVID-19 vaccines. This is an important, if incremental, step. “There’s a lot more that needs to happen,” U.S. Surgeon General Vivek Murthy told me. “Simply waiving intellectual-property rights does not guarantee that billions of doses will be available. We need to invest in expanding manufacturing capacity and the technology transfer; the know-how needs to actually flow from those who are making it now to those who will make it.” As the pharmaceutical industry has pointed out, making vaccines—particularly mRNA vaccines—is technologically difficult and requires investment. On its own, releasing patent rights is sort of like Tesla publishing its design secrets on Reddit. If other car companies wanted to produce exact replicas of Teslas, they could … eventually. But getting started would take a lot of time and money, and these companies wouldn’t make that investment unless they thought they could sell enough Tesla knockoffs to make it worth their while.