Advocacy Letters to Encourage Policymakers and Lobbyists to Pursue Agendas Favouring Global Vaccine Equity

By Ava den Elzen, Sixtine Dietsch, and Ella Waxman

This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.

Monday, December 4, 2023

Hon. Carolyn Bennet

Main office - Toronto

40 Holly Street, Suite 103, Toronto, Ontario, M4S 3C3

Dear Hon. Carolyn Bennet,

We write to you today as a member of your constituency regarding Canada’s role in global equity of the COVID-19 vaccine, and to ask that you call on the government to increase our support for the global availability of vaccines. We are deeply concerned about marginalized communities around the world that have experienced hundreds of thousands of preventable deaths due to lack of vaccine access and ask for a call to action in dismantling the intellectual property rights of vaccine companies that prevent the distribution of these life-saving vaccines to ‘unauthorized’ countries.

It was very encouraging to hear of the government’s recent launch of Canada’s Global Initiative for Vaccine Equity (CanGIVE) committing $317 million to bolster COVID-19 vaccine delivery to the global COVID-19 response, and the $375 million in additional funding for the Access to COVID-19 Tools (ACT) Accelerator helping to produce, develop and distribute therapeutics and vaccines for low- and middle-income countries.

These previous government responses, while attempting to help LMICs gain access to vaccines, lack insight into the lived experiences of the communities they’re attempting to help. This leads to many people in LMICs being unable to afford the vaccines given to them even if they do become available. Charitable promises to ‘donate’ vaccines to lower-income countries have been seen to fall short time and time again with a deficit of 60 million dosages of the 200 million promised to COVAX in 2022 just one example of this.

Rather than continually making failing promises and allowing countries vaccine access at our own discretion, we must give all countries the autonomy and right to manufacture their own vaccines. This is not only important from a humanitarian perspective, but will also benefit Canada both economically and socially by reducing the spread of variants and the burden of disease.

Approximately 32% of the global population has had the luxury of receiving at least two doses of the COVID-19 vaccine, however, only 1% of populations in low-income countries like Madagascar have this luxury while the proportion of Canada’s population is about ~80%. Over 700,000 additional deaths could have been prevented globally if COVAX and WHO’s 2021 COVID-19 vaccination targets had been attained, and these numbers could have been significantly reduced had all countries had less restricted patent access and the appropriate know-how required to manufacture their own vaccines.

Global solidarity is the only way to put an end to the global COVID-19 pandemic, and this cannot be achieved while pharmaceutical companies in wealthy countries such as ours are restricting the use of information and distribution of key materials for vaccine manufacturing for their profit. This means we need to invest more in establishing free intellectual property rights for COVID-19 vaccines and join countries in supporting the TRIPS COVID-19 Waiver of World Trade Organisation-enforced intellectual property rights obligations - suspending patents and clinical data for the entire duration of the pandemic.

Canada has made significant commitments to supporting the global response and the ACT accelerator, but we can do more. We believe that Canada should meet this global call to action, committing to this waiver to effectively help address the continual impacts of the pandemic globally.

We urge you to use your voice to support this request. You can do so by writing to the Minister of International Development, and calling for the government to support this waiver. Thank you for taking the time to consider our propositions. We look forward to receiving your correspondence and seeing what future actions the majority government takes to address this ongoing crisis.

Sincerely,

Ava den Elzen, Sixtine Dietsch, and Ella Waxman

Monday, December 4, 2023

Admiral Rachel L. Levine, MD

The U.S. Department of Health & Human Services

Hubert H. Humphrey Building

200 Independence Avenue, S.W., Washington, D.C. 20201

Dear Admiral Levine, MD,

We write to you today as a member of your constituency regarding the United States' role in global equity of the COVID-19 vaccine, and to ask that you call on the government to increase our support for the global availability of vaccines. We are deeply concerned about marginalized communities around the world that have experienced hundreds of thousands of preventable deaths due to lack of vaccine access and ask for a call to action in dismantling the intellectual property rights of pharmaceutical companies that prevent the distribution of these life-saving vaccines to ‘unauthorized’ countries.

It was very encouraging to hear that the Centres for Disease Control and Prevention (CDC) is partnering with healthcare organizations to build vaccine awareness. Moreover, the fact that the CDC is also trying to increase COVID-19 vaccine access through the Bridge Access program allowing for people without health insurance to get COVID-19 vaccines is very promising.

However, these responses are substantially underfunded. We can see government funding poorly managed even at a municipal level, where millions of dollars could be redistributed to target global health issues that will consequently benefit the US both socially and economically. The decision to spend 1.6 billion dollars on vehicles when the Federal Government already has 450,000 cars and investing nearly the same amount (2 billion) to address the health, humanitarian, and economic impacts of COVID-19 in Africa is shameful. These previous government responses, while attempting to help LMICs gain access to vaccines, lack insight into the lived experiences of the communities they’re attempting to help. This leads to many people in LMICs being unable to afford the vaccines given to them even if they do become available.

Charitable promises to ‘donate’ vaccines to lower-income countries have been seen to fall short time and time again with 82.1 million doses of the COVID-19 vaccine discarded instead of donated to Covax. We believe that rather than continually making failing promises and allowing countries vaccine access at our discretion, we must give all countries the autonomy and right to manufacture their own vaccines. This is not only important from a humanitarian perspective, but will also benefit the United States both economically and socially by reducing the spread of variants and the burden of disease.

Approximately 32% of the global population has had the luxury of receiving at least two doses of the COVID-19 vaccine; however, only 1% of populations in low-income countries like Madagascar have this luxury. 81.4% of the US population received the two doses. Over 700,000 additional deaths could have been prevented globally if COVAX and WHO’s 2021 COVID-19 vaccination targets had been attained, and these numbers could have been significantly reduced had all countries had less restricted patent access and the know-how required to manufacture their own vaccines.

We believe that global solidarity is the only way to put an end to the global COVID-19 pandemic, and this cannot be achieved while pharmaceutical companies in wealthy countries such as ours are restricting the use of information and distribution of key materials for vaccine manufacturing for their profit. This means we need to invest more in establishing free intellectual property rights for COVID-19 vaccines and join countries in supporting the TRIPS COVID-19 Waiver of World Trade Organisation-enforced intellectual property rights obligations related to patents and clinical data to be suspended for the entire duration of the pandemic.

To meet the unprecedented challenge posed by COVID-19 vaccine inequities, India and South Africa are calling on all nations to commit to their temporary TRIPS Waiver proposal allowing equitable and international progress to COVID-19 health responses otherwise impeded by intellectual property rights. The United States has made significant commitments to supporting the global response and the ACT accelerator, but we can do more. We believe that the United States should meet this global call to action, committing to this waiver to effectively help address the continual impacts of the pandemic globally.

I highly encourage you to use your voice to support this request. You can do so by writing to the Minister of International Development, and calling for the government to support this waiver.

A copy of your correspondence would be appreciated. Thank you for taking the time to attend to my letter, and we look forward to your response.

Yours sincerely,

Ava den Elzen, Sixtine Dietsch, and Ella Waxman

Monday, December 4, 2023

Mr. Stephen Ubl

PhRMA Headquarters

950 F Street, NW Suite 300, Washington, DC 20004

Dear Mr. Stephen Ubl,

We hope this letter finds you in good health and high spirits. Our names are Ava den Elzen, Sixtine Dietsch, and Ella Waxman, and we are students at McGill University in Quebec, Canada. Currently completing our semester in a global health class, we have undertaken a meaningful project focusing on advocating for more equitable access to life-changing vaccines across borders. Today, we write to you with a sense of urgency and a shared commitment to the well-being of our global community.

Firstly, we commend PhRMA's recent efforts in the fight against the COVID-19 pandemic. Your leadership in American R&D for vaccines and the noteworthy statement you made in August on the First List of Medicines Subject to Government Price-Setting have been inspiring. We echo your sentiment that "Politics should not dictate which treatments and cures are worth developing and who should get access to them." It is in that same breadth that we believe you will be receptive to hearing our proposals for how PhRMA can continue to satisfy stakeholders’ demands while fulfilling your goal to fight for lower-cost solutions for patients.

The formidable organizational capabilities of PhRMA and the pharmaceutical industry as a whole are indispensable in overcoming the challenges posed by the pandemic. However, as we navigate these unprecedented times, we believe it is crucial to reassess certain aspects of the industry's functioning. In particular, we advocate for your lobbying support of the temporary waiver of intellectual property (IP) rights to facilitate global vaccination.

We understand the importance of maintaining a profitable bottom line, and we propose that waiving IP rights can indeed align with PhRMA's long-term financial goals. The current public health crisis has rendered drug makers eligible for substantial government support, negating the need for default benefits of patent support. A temporary waiver not only creates a climate favourable to investment but also removes the threat of legal repercussions, thereby promoting a smoother path for global vaccination efforts.

While some may argue that waiving IP protections won't immediately increase vaccine supply, we have learned during this pandemic that manufacturing capacity can be established more rapidly than previously thought. Repurposing facilities and ensuring safety and quality standards can be achieved in 6 to 7 months, significantly shorter than initially perceived. Furthermore, expanding manufacturing capacity is a necessary preparation for future pandemics, ensuring self-sufficiency for nations in vaccine production.

It is essential to emphasize that countries advocating for the IP waiver are not seeking charity but the right to develop and manufacture their own vaccines without fear of legal ramifications. This move aligns with our efforts in both Canada and the United States, urging policymakers to enhance direct governmental support for pharmaceutical companies engaged in critical R&D initiatives.

Turning to the legal perspective, the Trade-Related Aspects of Intellectual Property Rights (TRIPS) has traditionally treated pharmaceuticals as an area protected by patents to incentivize innovation. However, we implore you to reconsider this stance. TRIPS explicitly states that the enforcement of IP rights should promote technological innovation in a manner conducive to social and economic welfare, calling for a balance of rights and obligations. Are we truly meeting TRIPS requirements by blocking access to life-changing vaccines and medical resources in certain countries? PhRMA, as a leading industry voice, possesses the power to influence positive change in the outcomes of health crises, ensuring a more expedited and effective global response.

We believe in the values of global solidarity and corporate responsibility. Each nation's interests are intricately linked, and during a pandemic, social responsibility can sometimes necessitate temporary limitations on profits. As we collectively face the challenges posed by COVID-19, companies must contribute to the greater good rather than allowing disproportionate profits to accumulate unchecked. No movement is led by an individual; a collective effort is necessary to achieve the largest amount of change. Global solidarity necessitates sharing vaccinations with all involved parties, ensuring a fair and just distribution of the benefits.

We appreciate the commendable step taken by Moderna in pledging not to enforce its patents during the pandemic. However, individual company pledges, while commendable, are insufficient to bring about the global changes needed. The shortage of vaccines stems not solely from intellectual property issues but also from unfortunate hurdles in production and distribution. The scarcity is exacerbated by a lack of trained personnel due to the innovative nature of mRNA technology. Simply waiting for intellectual property rights and leaving countries without the resources to establish intricate production and distribution networks to fend for themselves is not the optimal approach. Instead, a more effective strategy would involve lifting waivers and facilitating the transfer of knowledge, whether through cost-effective virtual channels or in-person hands-on training.

We firmly believe that using your power to shift government and pharmaceutical industry perspectives to waiving or relaxing intellectual property rights over vaccines, while not a cure-all, is a crucial step in overcoming roadblocks to global vaccination. As a leader in the pharmaceutical industry, PhRMA has the opportunity to champion a more inclusive and efficient path forward.

We thank you for your time and consideration of our perspectives. We remain hopeful that PhRMA will continue to play a pivotal role in the global fight against the pandemic, promoting a spirit of solidarity and shared responsibility.

Yours sincerely,

Ava den Elzen, Sixtine Dietsch, and Ella Waxman

References

1. COVID-19 Vaccine Uptake and CDC’s Commitment to Vaccine Equity | CDC. (2023, November 22). https://www.cdc.gov/respiratory-viruses/whats-new/vaccine-equity.html

2. Despite record federal lobbying spending, the pharmaceutical and health product industry lost their biggest legislative bet in 2022 • OpenSecrets. (n.d.). Retrieved 4 December 2023, from https://www.opensecrets.org/news/2023/02/despite-record-federal-lobbying-spending-the-pha rmaceutical-and-health-product-industry-lost-their-biggest-legislative-bet-in-2022/

3. House, T. W. (2022, December 13). FACT SHEET: U.S-Africa Partnership in Health Cooperation. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/12/13/fact-sheet-u-s-afri ca-partnership-in-health-cooperation/

4. How Vaccines are Developed and Approved for Use | CDC. (2023, May 22). https://www.cdc.gov/vaccines/basics/test-approve.html

5. Jecker, N. S., & Atuire, C. A. (2021). What’s yours is ours: Waiving intellectual property protections for COVID-19 vaccines. Journal of Medical Ethics, 47(9), 595–598. https://doi.org/10.1136/medethics-2021-107555

6. Okereke, M. (2021). Towards vaccine equity: Should big pharma waive intellectual property rights for COVID-19 vaccines? Public Health in Practice, 2, 100165. https://doi.org/10.1016/j.puhip.2021.100165

7. Safi, M. (2021, January 25). Hoarding Covid vaccines ‘could cost wealthy countries $4.5tn’. The Guardian. https://www.theguardian.com/world/2021/jan/25/hoarding-covid-vaccines-could-cost-wealth y-countries-45tn

8. The global impact of disproportionate vaccination coverage on COVID-19 mortality—The Lancet Infectious Diseases. (n.d.). Retrieved 4 December 2023, from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00417-0/fulltext

9. The TRIPS COVID-19 Waiver. (n.d.). Canadian Centre for Policy Alternatives. Retrieved 4 December 2023, from https://policyalternatives.ca/newsroom/updates/trips-covid-19-waiver

10. Twenter, P. (2023, January 24). Pharma’s 15 biggest lobbyists. https://www.beckershospitalreview.com/pharmacy/pharmas-15-biggest-lobbyists.html

11. What it will take to vaccinate the world against COVID-19. (n.d.). Retrieved 4 December 2023, from https://www.nature.com/articles/d41586-021-00727-3

12. Why intellectual property and pandemics don’t mix | Brookings. (n.d.). Retrieved 4 December 2023, from https://www.brookings.edu/articles/why-intellectual-property-and-pandemics-dont-mix/

McGill Perspectives on Global HealthMarch 11, 2024