Thread by @DrLukeMcDonagh

A thread:
1) Oxford University, as a world-leading public institution, has a special duty to the global public. Instead of focusing on the £400m Vaccitech IPO, Oxford should show global leadership and support the India/South Africa WTO TRIPS IP waiver.

blogs.lse.ac.uk/covid19/2021/0…

2) Credit where it is due: Oxford/AZ have acted more ethically than other providers such as Moderna and BioNTech/Pfizer. A bilateral licensing deal is in effect between Oxford/AZ & Serum Institute India (SII). However, bilateral agreements, while positive, are ultimately limited.

3) Although SII has manufactured tens of millions of doses of the vaccine for India and developing countries as part of the international COVAX scheme, this falls woefully short of the billions of doses that are required.

4) The terms of the AZ-SII agreement are not public but there are indications that they are restrictive & problematic. In March supply problems arising from AZ’s failure to meet production targets led AZ to seek to import to the UK millions of vaccine doses made in India at SII.

5) Were it not for AZ’s UK and European production shortfalls, these doses would, presumably, have been made available to developing countries (via COVAX).

6) That AZ would attempt to prioritise UK supply needs over those of developing countries calls into question the ultimate value of the agreement between AZ & SII. (In any event, the Indian government banned the export of the SII doses due to the worsening Indian situation.)

7) Very few vaccines are being manufactured at all in Africa & Latin America. Relying almost exclusively on a single producer – SII in India – to provide for COVAX has proven woefully inadequate. Resolving the production/supply problem will take time but it is not insurmountable.

8) True, the manufacturing processes for COVID vaccines are complex; delays in the supply of materials can create bottlenecks; successful production requires a lot of know-how. Recent wasteful production at a US factory manufacturing the Johnson&Johnson vaccine demonstrates this.

9) But these issues mask the real problem: not enough productive supply has been built or is being built right now. And even where surplus supplies of Oxford/AZ and other vaccines exist, they are being hoarded by Western countries.

10) In other words, we know that the private market and the wider world trade system (of which intellectual property (IP) is an integral part) is set to fail the Global South. A course correction is therefore required.

11) India and South Africa first put forward the World Trade Organisation (WTO) TRIPS IP waiver proposal in the autumn of 2020, when it became clear that Western countries had already bought up most of the expected vaccine doses for 2021.

12) Although sometimes referred to in shorthand as a ‘patent waiver’, it is in fact a broad package that would see not only the temporary waiver of patents, but the sharing of trade secrets/knowhow, & much-needed investment in building up pharma capacity in the Global South.

13) The impact would not be immediate. It would take many months before vaccine manufacture can begin at entirely new or vastly repurposed facilities.

14) Yet other factories can be brought up to speed much more readily. In India the potential exists to scale up manufacturing capacity at several non-SII factories. The same is true at Bangladesh’s Incepta plant.

15) But to do this requires what the waiver proposes: giving legal clarity on IP rights and facilitating technology transfer of know-how. Without this, the relevant investments will not be made.

16) When India-SA made their proposal, the UK, US and EU assumed each private patent-holding company (Moderna, Pfizer, AZ, etc) would be able to produce the doses they had promised. As the EU has discovered, this has proven utterly mistaken.

17) The waiver proposal has been continually rejected by the key Western countries. Even if they acknowledge that the TRIPS IP waiver could accelerate access to COVID vaccines in the short term, they argue the waiver could undermine the IP system’s incentives for R&D.

18) Defenders of the status quo tend to understate the risks of the current pandemic & overstate the risk to the overall IP system from the waiver proposal, which is limited and temporary.

19) It is worth recalling that much COVID-19 R&D has in any event been de-risked by public funds – in the case of Oxford/AZ and NIH/Moderna, key inventions were made at public institutions using public money.

20) So, it is far from clear that we are in a ‘normal’ incentive/reward situation. The argument that the COVID-limited TRIPS IP waiver will de-incentivise R&D in all other areas of science/tech (where IP protections remain unaffected) is unconvincing.

21) Pharma companies note that they are already cooperating to boost production – for example, the agreement between Johnson & Johnson and Merck to boost US production of the J&J vaccine. This is certainly positive, but these efforts remain grossly inadequate to world needs.

22) If we go on as we are, we will certainly fail to vaccinate the global public. The WTO IP waiver was first proposed in autumn 2020, showing that the shortage and resultant nightmares in India and Brazil were foreseeable (and to some extent foreseen).

23) While poor public health decisions in India and Brazil have exacerbated the pandemic, this does not absolve other powerful actors from their responsibilities. The West has the power to do much more; all our efforts thus far, even where positive, fall well short.

24) The UK, US and EU governments must help organise and fund the building of productive capacity in the Global South now, or the India crisis will be replicated all over South Asia (just as the Brazil crisis is being repeated all over Latin America).

25) And as a major patent and trade secret owner, Oxford University/Vaccitech ought to take a greater leadership role on technology transfer and sharing of know-how - bilateral deals (with e.g. SII) are simply insufficient.