Here in the U.S., communities see a light at the end of the COVID-19 tunnel. With the vaccinations now occurring across the country, health officials are optimistic that the outbreak could be under control by the end of this year.
But the pandemic won't be over. Across the globe, the virus will still be circulating widely, even surging, in many countries.
Health experts agree that, to end the pandemic, the world needs to immunize a large percentage of Earth's population. And that population needs to be distributed evenly, not clustered in wealthy countries. Otherwise, we'll end up in the situation in which COVID-19 becomes a disease of the poor – that is, the virus is largely under control in rich countries but still circulating in many poor countries, says Niko Lusiani, who's a senior adviser with charity organization Oxfam.
"We don't want to sit in an island in the world where rich countries are fully immunized, while the rest of the world is dying from COVID," he says. "That's just not a morally convenient place to be for most people."
About 7 billion people live on the planet. Many of the new COVID-19 vaccines require two doses. So to stamp out the pandemic, companies need to manufacture about 12 to 15 billion doses.
Problem is, right now, the world doesn't have near that many doses and likely won't have them this year, Lusiani says. "In many pockets around the world, it's becoming increasingly likely that people will not get access to the COVID-19 vaccine in 2021."
Many families will have to wait until 2023 or 2024. And the pandemic will likely continue until then.
So why can't the world simply manufacture more doses? Lawyer Brook Baker at Northeastern University believes there's an underlying root cause: international patents on COVID-19 vaccines.
"The [vaccine] innovators hold patent rights and trade secret rights over those technologies, and they're unwilling to share them broadly to other manufacturers. So we have artificially constricted supply," says Baker, who studies how laws affect access to medicines.
The patent rights come from agreements within the World Trade Organization. Members of the WTO, which includes 159 countries, have agreed to honor patents for new pharmaceutical products at least 20 years after they're developed.
"This agreement was the brainchild of the pharmaceutical industry back in the 1980s," Baker says. "It ended up being a monopoly-based agreement, which preserves the rights of the pharmaceutical industry instead of allowing competition."
These patent laws, Baker says, have landed the world in a thorny situation, in which a handful of pharmaceutical companies have enormous power and control over a life-saving vaccine. These companies, in many ways, decide which countries get the vaccine this year — and can possibly end their outbreak — and which ones are left fighting COVID-19 with only masks and physical distancing, Baker says.
"That's no way to respond to a pandemic emergency. It's actually not a very good way to respond to the need for medicines in general," he says.
Many leaders of lower-income countries agree with Baker. Back in October, India and South Africa asked the WTO for a waiver — to lift the patent restrictions on COVID vaccines and medicines until the pandemic is over.
But many rich countries, including the U.S., Canada, Japan and Norway, have blocked the waiver, saying there's no evidence that patent protection is inhibiting access to COVID vaccines.
"A temporary waiver would have zero impact on the COVID-19 pandemic. You wouldn't have a single vaccine more available now for COVID-19," says Thomas Cueni, director general of International Federation of Pharmaceutical Manufacturers in Geneva.
Cueni says the problem isn't patents but rather that the world just doesn't have the manufacturing capacity to make enough doses for everyone this year. "When you look at global vaccine manufacturing capacity, both India and South Africa among the 10 largest vaccine manufacturers in the world," he says. And there is "no idle capacity"
A big reason for this maxed out capacity is that some vaccine developers, such as AstraZeneca and Johnson & Johnson, are already sharing their patent recipes with a few large manufacturers in India, South Africa and Brazil.
These special agreements ensure that at least some people in poor countries, up to about 20 percent, will likely receive the vaccine this years, says Andrea Taylor at Duke Global Health Institute.
"Patent sharing is definitely good, and we have seen manufacturing capacity really open up, in Southeast Asia and Latin America. So that's really encouraging," she says. "But I'd like to see more [vaccine manufacturing] capacity open up in sub-Saharan Africa."
In addition, many researchers and activists point out that manufacturing isn't the only aspect of vaccine distribution that patents can block. In the past, with other diseases, patents have delayed the delivery of vaccines and kept prices so high that they're unaffordable for many countries.
Because, lawyer Brook Baker says, the same patent rights that allow companies to keep their vaccine recipes a secret also allow them to charge much more than the actual cost of a vaccine since no one knows the true cost.
"That means, companies can charge whatever they want while controlling the supply," Baker says, despite the fact that the U.S. taxpayers have already paid for part of the development and manufacture of these vaccines. "The U.S. government has de-risked the product development," Baker says. "It paid for clinical trials. It expedited the regulatory process, and it has invested in and expanded manufacturing capacity.
"I don't want to sound facetious, but what has the private industry done that's so critical that they get monopolies?"