Yves here. Obviously Big Pharma killing people en masse in low income countries by not allowing them to acquire Covid vaccines is an atrocity, yet all too true to form. Not only are drugmakers refusing to issue waivers to allow low income countries to manufacture under a low-cost vaccine license or waiver, they are going to charge them more than EU member states to buy them!
And the bean-counters may further hope that by having Covid not contained in large swathes of the population will lead to more new variants, increasing the need for a Covid vaccine shot annually.
But there may be an upside to this dark picture. Vaccine apartheid will force poor countries to use other approaches, like preventatives and prophylactics: Vitamin D, zinc, ivermectin, hydroxychloroquine, aspirin, quercetin, progesterone…So the rest of the world will find out, on their backs, what works and doesn’t work. Hopefully enough countries will find good treatments so that the death and disease cost of experimentation as opposed to vaccination won’t be as high as the authors fear.
By Anis Chowdhury, Adjunct Professor at Western Sydney University and University of New South Wales (Australia), who held senior United Nations positions in New York and Bangkok and Jomo Kwame Sundaram, a former economics professor, who was United Nations Assistant Secretary-General for Economic Development, and received the Wassily Leontief Prize for Advancing the Frontiers of Economic Thought. Originally published at Inter Press Service
At least 85 poor countries will not have significant access to coronavirus vaccines before 2023. Unfortunately, a year’s delay will cause an estimated 2.5 million avoidable deaths in low and lower-middle income countries. As the World Health Organization (WHO) Director-General has put it, the world is at the brink of a catastrophic moral failure.
Vaccine Apartheid
The EU, US, UK, Switzerland, Canada and their allies continue to block the developing country proposal to temporarily suspend the World Trade Organization (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement to enable greatly increased, affordable supplies of COVID-19 vaccines, drugs, tests and equipment.
Meanwhile, 6.4 billion of the 12.5 billion vaccine doses the main producers plan to produce in 2021 have already been pre-ordered, mostly by these countries, with 13% of the global population.
Thirty two European and other rich countries also have options to order more, while Australia and Canada have already secured supplies enough for five times their populations. Poor countries, often charged higher prices, simply cannot compete.
Big Pharma has also refused to join the voluntary knowledge sharing and patent pooling COVID-19 Technology Access Pool (C-TAP) initiative under WHO auspices. Thomas Cueni, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Director General, snubbed the launch, claiming he was “too busy”.
Pfizer’s CEO dismissed C-TAP as “nonsense” and “dangerous”, while the AstraZeneca CEO insisted, “IP is a fundamental part of our industry”. Such attitudes help explain some problems of alternative vaccine distribution arrangements such as COVAX. According to its own board, there is a high chance that COVAX could fail.
Suppressing Vaccine Access
Despite knowing that many developing countries have much idle capacity, Cueni falsely claims the waiver “would do nothing to expand access to vaccines or to boost global manufacturing capacity”, and would jeopardise innovation and vaccine research.
Big Pharma claims manufacturing vaccines via compulsory licensing or a TRIPS waiver “would undermine innovation and raise the risk of unsafe viruses”. US Big Pharma representatives wrote to President Biden earlier this month claiming likewise
Both Salk and Sabin made their polio vaccine discoveries patent-free, while many contemporary vaccine researchers are against Big Pharma’s greedy conduct only rewarding IP holders regardless of the varied, but crucial contributions of others.
Big Pharma’s Price Gouging
Vaccine companies require contract prices be kept secret. In return for discounts, the EU agreed to keep prices confidential. Nonetheless, some negotiated prices were inadvertently revealed, with a UNICEF chart listing prices from various sources.
Reputedly the cheapest vaccine available, Oxford-Astra Zeneca’s is sold to EU members for around US$2 each. Although trials were done in South Africa, it still pays more than twice as much, while Uganda, even poorer, pays over four times as much!
US negotiated bulk prices, for Moderna and Pfizer-BioNTech vaccines, are much higher, at US$15.25–19.50 per dose in several contracts, yielding 60–80% profit margins! Moderna will charge the rest of the world US$25–37 per dose.
Hypocrisy
Quite understandably, most developed countries opposing temporary TRIPS suspension have provisions in their own IP laws to suspend patent protection in the national interest and for public health emergencies.
Canada, Germany, France and others have recently strengthened their patent laws to issue compulsory licences for COVID-19 vaccines and drugs. European Council President Charles Michel announced that the EU could adopt “urgent measures” by invoking emergency provisions in its treaties.
Similarly, in the US, 28 US Code sec. 1498 (a) allows the government to make or use any invention without the patentee’s permission. To handle emergencies, the 1977 UK Patents Act (section 55) allows the government to sell a patented product, including specific drugs, medicines or medical devices, without the patentee’s consent.
When avian flu threatened early this century, the US was the only country in the world to issue compulsory licences to US manufacturers to produce Tamiflu to protect its entire population of over 300 million. The drugs were not used as the virus was not brought over either Pacific or Atlantic Oceans.
Biden Must Act
By helping developing countries expand vaccine manufacturing capacity and access existing capacity, US President Biden can earn much world appreciation overnight. US law and precedence enables such a unilateral initiative.
The Bayh-Dole Act allows the US government to require the owner or exclusive licensee of a patent, created with federal funding, to grant a third party a licence to an invention. Moderna received about US$2.5 billion from Operation Warp Speed, which dispensed over US$10 billion.
Moderna was founded in 2010 by university researchers with support from a venture capitalist. It has focused on mRNA technology, building on earlier work by University of Pennsylvania scientists with National Institutes for Health (NIH) funding.
The vaccine developer also used technology for previous coronavirus vaccines developed by the NIH. The NIH also provided extensive logistical support, overseeing clinical trials for tens of thousands. Moderna has already announced it will not enforce its patents during the pandemic.
Thus, POTUS has the needed leverage. The Bayh-Dole Act applies to Moderna’s vaccine, enabling the Biden administration to act independently and decisively against vaccine apartheid.
Sharing Knowledge Crucial
Developing countries not only need to have the right to produce vaccines, but also the requisite technical knowledge and information. Hence, the Biden administration should also support C-TAP, as recommended by Dr Anthony Fauci.
When the Medicines Patent Pool (MPP) was in similar trouble, the Obama administration came forward to put US-owned patents into the pool while encouraging drug companies to help improve developing countries’ access to medicines.
President Biden knows that early US support was critical for the MPP’s eventual success. It dramatically increased production and lowered prices of medicines for HIV, tuberculosis, hepatitis C and other infectious diseases in developing countries.
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>and would jeopardise innovation…would undermine innovation
Jonas Salk must be spinning in his grave. What they mean is – being people that can’t invent anything and can only see things thru their tiny little $$$-discerning lens – nobody would do anything if there wasn’t some ginormous pile of money to accrue to them for it.
People who do invent things, real things that is, don’t do it to become rich. They often do become rich, but they can’t help themselves in any case. Whatever they did, it was all they did. It was an obsession whose coin happened to land on the correct side.
But the Managerial Class, they don’t know anything, they haven’t the tiniest shred of creativity, so all they understand is themselves. Basically amoebas whose whole purpose in life is to gorge themselves. So everybody else must be like that, they are sure.
… soulless killers
Good one!
It’s interesting isn’t it how when we accuse others as Biden did with his well reported comments to Putin, we really are reflecting our own faults.
The shock of the pandemic is officially a spent force, and the “we are all in this together as the human family” camaraderie it inspired along with it. In its place, the reversion to type of Big Pharma and the West in general. Biden, as the leader of the “free world”, is the skipper of a morally half sunken ship, will he salvage what remains above water, I for one am not holding my breath.
OK, I’m going to run the risk of looking as though I’m advocating publicly strangling kittens or something, by saying that I think this article is incoherent and confused, and actually obscures the problem rather than illuminates it. The authors don’t pretend to have any medical, epidemiological or other technical knowledge, and being angry, in the end, is not a sufficient qualification for being heard.
They seem to be trying to make three points. First, and most powerfully, it’s true that wealthier nations have blocked proposals to lift IP controls, which would be a necessary, but certainly not sufficient, condition for more vaccine production elsewhere. I suppose that if you are a former United Nations ASG, in a position dedicated to neoliberal development economics, then it must seem logical that, as soon as artificial barriers are removed, the private sector will sweep into action and all problems will be resolved. But we know it’s not that simple: European countries have had huge problems producing vaccines in quantity, and the roll-out has been very slow: just this week the French government announced that they were setting up massive vaccination centres to be run by the Army because public opinion is simply not prepared to accept more delays. When I think of some of the African countries I know (the DRC, for example or Sudan) with poor or non-existent infrastructure, limited medical services, limited knowledge of where their populations even live and few facilities for safe and speedy vaccination anyway, I think of the difference between decisions made around conference tables in air-conditioned rooms and announced to the media, and the actual hard work of getting things done. It’s perfectly fair and reasonable to criticise the IPR restrictions, but it’s dishonest to pretend that lifting them will magically solve the problem.
Second, wealthy nations have been quick off the blocks to order vaccines for their populations. It’s hardly possible to argue that this was wrong: which government is going to tell its population that it is deliberately ordering fewer vaccines than it needs in order to free up resources for others? (It’s striking that China India and Russia, with half the world’s population, are not mentioned here). It’s obviously grotesque that Uganda is paying more than the EU for vaccine doses (assuming that’s true) but presumably that reflects the EU’s ability to order in bulk: it’s hardly the fault of the EU governments themselves.
Third is the implicit suggestion that wealthy nations have somehow been “unfair” in ordering large quantities of vaccines. All the vaccines I’m aware of require at least two doses, and there is a need for redundancy because demand and supply are seldom exactly balanced. Moreover, most governments are ordering for future years as well, because there’s no confidence that the virus won’t come back. No government, I suspect, could say to its population “we’re not ordering any vaccines for 2022 because we want to give somebody else their turn.” Which is really the nub of the question. There aren’t enough vaccine doses in the world now, and there won’t be for some time, to stop people dying. From where I sit, and from where most of you sit, there are people in our own countries dying because they can’t get vaccinated. The honest argument here would be that western states should let some of their citizens die in order to free up vaccine doses for other countries. But that would be impossible for a former UN ASG to say, I suppose.
There is a scandal here, but it’s to do with the pharmaceutical industry, and the structure of the national and world economies more generally. There are also massive practical problems to solve. Neither of these is going to be solved by a speech from Biden, and neither is really the responsibility of national governments responding to the demands of frightened populations. Pity, because there’s a good, powerful, technically-informed piece of analysis that could have been written here.
I regard your point 1, which is essential to your case, to be utterly misleading. Drugs do not have to be made in Africa to be sold to low income countries.
India is a significant manufacturer of generics.
China is so dominant in the manufacture of generics that it has been depicted as a threat to the US due to lax FDA supervision of manufacturing.
Brazil has a significant generics industry: https://ocw.mit.edu/courses/electrical-engineering-and-computer-science/6-901-inventions-and-patents-fall-2005/projects/brazil_gen_drug.pdf
Cuba is a world recognized leader in biomedicine and is developing its own Covid vaccine.
Yves wrote: I regard your point 1, which is essential to your case, to be utterly misleading. Drugs do not have to be made in Africa to be sold to low income countries … India is a significant manufacturer of generics.
There are things you don’t know. I’m not David but I’m going to butt in here. I hope this helps —
[1] Background for starters: Vaccines are not drugs. Big Pharma had largely given up developing new vaccines, because pre-COV19 they were insufficiently profitable by Big Pharma’s bloated expectations. This isn’t just insider baseball. It’s one of two big reasons Fauci and the NIH invested in a ten-year relationship working with Moderna on their mRNA vaccine technology.
[2] Drugs — small, stable molecules, which are what Big Pharma does — and generics and the capability to manufacture them have about as much relationship to producing novel synthetic biology-based mRNA vaccines like the Moderna and Pfizer products as the capability to build clockwork has to do with what’s necessary to produce microprocessor chips. These are two different worlds.
[3] Even the genetically-engineered adenovirus vector vaccines — the AZ and Sputnik V — are fairly novel tech as far as the West is concerned. AFAIK, prior to COV19, the only adenovirus vector vaccine in use in the West was for rabies in dogs. The Russians have more expertise with adenovirus vectors — and have the 30-year backlog of experience, too, from the genetic engineering projects done by Biopreparat, the old Soviet bioweapons program, which did quite a few things in terms of genetic engineering ahead of the West.
[4] Back to Big Pharma. It does have big pockets, of course. So it can buy its way into an mRNA vaccine technology via its Biontech subsidiary — and was probably interested in the profit possibilities for things like “cancer vaccines” (the other big reason Fauci and the NIH were working with Moderna), which would be enormously profitable.
[5] Big Pharma doesn’t really grok synthetic biology, however. In fact, synbio threatens its small-molecule business model to some extent.
Part of the EU’s problem has been precisely because France’s Macron — a Goldman Sachs PMC-type, in full-blown arrogance and ignorance of the technical specifics — insisted that Sanofi, the French Big Pharma company, should get a big slice of the EU’s COVID19 vaccine support. Sanofi was unequipped to execute and proceeded to fall flat on its face, which led to part of the EU’s vaccine shortfall now.
[6] What specifically makes the COV19 vaccines produced via synbio non-fungible technology currently?
The original post has this: “The Bayh-Dole Act allows the US government to require the owner or exclusive licensee of a patent, created with federal funding, to grant a third party a licence to an invention … The Bayh-Dole Act applies to Moderna’s vaccine, enabling the Biden administration to act independently and decisively against vaccine apartheid.”
So, firstly: okay, POTUS probably could do all that under Bayh-Dole, though this is still the neoliberal U.S. so it probably won’t happen. I’m not going to defend that.
Secondly: however, if POTUS did break the patent on Moderna’s mRNA vaccine, it wouldn’t make a bit of difference. The real bottleneck is the immensely complicated microfluidics technology required to engineer the lipid capsules that carry the Moderna mRNA vaccine into a patient’s system. That’s the real secret sauce.
Okay, you may say, break the patent on Moderna’s custom-designed microfluidics technology. Well, there are related problems there. Firstly, in order to make the microfluidics tech, there’s a whole chain of equally complicated manufacturing capabilities required for that — the complicated tools to make the complicated tools — and what exists in the world today is already being scaled up as fast as it can for Pfizer-Biontech and Moderna.
[7] Furthermore, I suspect the Bayh-Dole Act wouldn’t cover breaking those companies’ patents.
Still, for argument’s sake, let’s assume that the Biden administration in an unlikely fit of non-neoliberal humanism breaks the law and dismisses the arguments of the companies that currently own the microfluidics-building technologies.
It still wouldn’t make any difference in any significant time-scale. Starting from a standing point, with U.S. government-enforced technology transfer, it would take India and Brazil 9-18 months to achieve the necessary manufacturing capability. The ability to manufacture drug generics, such as you cite, has nothing to do with this kind of technology.
[7] In far less time, however, these countries could have licensed and built plants to produce the adenovirus vector vaccines (AZ, Sputnik) or deactivated COV19 virus vaccines (Sinovac).
In the meantime, the U.S. — a failing empire — has just given away one of the last technologies that it still has a lead in. For nothing. As you like to say, na ga happen.
[8] NC spends a lot of time pointing out, rightly, the incompetence and arrogance of the PMC and Harvard Business Graduate-type thinking.
Indeed, one of the fascinating lessons of the COV19 pandemic has been watching the buffoonish incompetence and arrogance of the neoliberal PMC types in the EU assuming that all the vaccine-related technologies are fungible from country to country, and they can simply sign their contracts and issue their edicts and everything will fall into place without paying any attention to the technical specifics of the vaccine technologies.
As David writes: “if you are a former United Nations ASG, in a position dedicated to neoliberal development economics, then it must seem logical that, as soon as artificial barriers are removed, the private sector will sweep into action and all problems will be resolved. But …European countries have had huge problems producing vaccines in quantity.”
That’s because the PMC types in the EU have arrogantly not bothered to educate themselves about any of the specifics of the technologies involved, and have assumed those technologies are fungible and equally distributed and distributable from country to country. They’re not. Don’t be like them; educate yourself.
Like I say, I hope this helps.
There is a lot to unpack here, but time is limited. Vaccines are not drugs. True, but Big Pharma has largely given up on developing much of anything except their stock prices. This has not always been completely true, but very little that Big Pharma developed before it was blessed with that appellation was done de novo, in house. Back in the day Hoffman-LaRoche funded the Roche Institute of Molecular Biology on their (now disappeared) campus in Nutley, NJ. RIMB was a biomedical equivalent of Bell Labs (RIP), where a half-dozen or more investigators were elected to the National Academy of Sciences based on work they did there. Did RIMB contribute to the bottom line of Hoffman-LaRoche? Probably, but not so much that the stock price responded as needed by a latter-day C-Suite. Burroughs Wellcome supported George Hitchings and Gertrude Elion, with very significant, Nobel Prize-winning results. Now? Big Pharma buys Little Pharma (of varying sizes), which as often as not was funded initially by NIH (keeping the discussion here on US-based work) through extramural grants, including traditional platforms (e.g., R01, R21, R37) and others (e.g., SBIR-Small Business Innovation Research and STTR-Small Business Technology Transfer awards). The SBIR Program was begun in 1982, soon after passage of the Bayh-Dole Act of 1980. The latter opened the gates, so to speak, so that now we as taxpayers pay for biomedical advances multiple times. First, when NIH funds the foundation, and subsequently as Little Pharma and Big Pharma cherry pick what they believe will be “winners.”
“Synthetic biology” is a protean term that has too many meanings to be, well, meaningful. In the present context, there is nothing about an mRNA vaccine that is not obvious, going all the way back to the Central Dogma of Molecular Biology (Francis Crick, 1957): DNA makes RNA makes Protein. RNA-based therapeutics have been “a thing” in development for 30+ years. Incremental technical improvements in the synthesis and delivery of functional RNA have led to the promise of RNA therapeutics.
And while it is true that mRNA vaccines are (relatively) novel, there is nothing at all remarkable about them based on the past 60+ years of research on gene expression and protein synthesis in prokaryotes and eukaryotes. They are certainly not transcendent in the sense that a microprocessor transcends a mechanical clock. There is essentially nothing in the manufacture or delivery of mRNA vaccines that is not commonly used in thousands of molecular biology laboratories all over the world, which is not to say there is nothing proprietary involved or that this is not technically demanding. This is also true of the “genetically engineered” adenovirus-based vaccines. My laboratory used essentially the same adenovirus platform to express a large muscle protein in cultured chicken cardiomyocytes 15+ years ago, and the technology was not new then. Whether the non-replicative adenovirus will present cellular or immunological problems in and of itself is a somewhat open question.
Unlike synthetic biology, microfluidics does have a real meaning, and variations on the technique have been extremely powerful in elucidating the behavior of cells and tissues in environments that better approximate the natural environment, whether that is inside a multicellular organism or part of the external world at large. That “immensely complicated microfluidics technology” is required to “engineer the lipid capsules that carry the Moderna mRNA vaccine into a patient’s system” is an exaggeration. On the contrary, vaccine mRNAs are loaded into lipid nanoparticles (LNPs) for delivery as the active portion of each vaccine (Moderna and Pfizer/BioNTech). These vehicles are called nanoparticles, but they are not to my knowledge generally prepared using “microfluidics.” Rather, they are prepared using procedures that would recognizable to a molecular biologist who has used any number of commercial preparations to deliver RNA and DNA into living cells. These are widely known and widely published. The techniques for nanoparticle production at scale are undoubtedly demanding, but they are not necessarily exotic or immensely complicated.
The exact compositions of these LNPs have not been specified but, based on previous research on the delivery of therapeutic RNA molecules, they are likely composed of positively charged (cationic) lipids, phosphatidyl choline, cholesterol, and polyethylene glycol-lipid. Phosphatidyl choline and cholesterol are normal components of viral envelopes (which are made by the host cell during viral replication and packaging) and animal cell membranes. Both the mRNA and the components of LNPs are likely to act as adjuvants (an adjuvant is an additive to a vaccine that strengthens the host immune response and generally allows for minimization of the amount of immunogen included in each dose). The mechanisms of the fusion/entry of LNPs with host cells after inoculation have not been described in detail, but the underlying cell biology is well understood. The LNP fuses with the host cell membrane and delivers its cargo (mRNA) directly into the cell (cytoplasm) or is taken up as a vesicle (endocytosed). The confirmed, key result is that the spike mRNA construct is delivered to the cytoplasm and translated into protein on normal cellular ribosomes. The protein is then processed (chopped up into smaller pieces by the proteasome) and presented on the cell surface of antigen presenting cells, which initiates the immune response that in theory will be active against SARS-CoV-2 and, if all goes as hoped, begin the end of COVID-19.
The most important point about mRNA- and adenovirus-based vaccines is that they are experiments, not that they are the result of some quantum leap in biology that can be managed only by “the best and the brightest” (where have I heard that before?). They are necessary experiments under the circumstances but experiments nevertheless. That this has been thoroughly de-emphasized throughout the past year is a potential error in judgment (I’m being generous here) by our soi-disant betters at NIH, CDC, the Executive Branch, and Big Pharma that may come back to haunt all of us with a vengeance. Anyway, as far as I know the mRNA-based Zika vaccine has not really worked. Yet.
So, in summary, mRNA (and adenovirus) vaccines are either obvious or ingenious, depending on your point of view. Their production is technically demanding, but not beyond the ken of thousands of molecular biologists, biochemists, medicinal chemists and the institutions around the world, public and private, in which they work. There is no good reason that these essential, if experimental, vaccines cannot be produced simultaneously and at scale in any country with the necessary technical and labor infrastructure. There are many such countries, not all of them in the Global North.
Terrific, KLG. It took me back many years when I was doing a little research in this area. I remember that there was a hitch in the Central Dogma, that DNA makes mRNA makes protein, where the information in the protein can not get back out. But I can’t quite remember in what way the Central Dogma breaks down.
Small error in your statement. When you mention US taxpayers, this must be restricted to state taxpayers, as federal taxes do not pay for anything. Federal taxes are not used or necessary for federal spending, though they are essential for state spending. Ref: J D Alt: Paying Ourselves to Save the Planet; short and sweet.
You are right, of course, that there are many countries outside the West which can and do manufacture drugs: that’s well known. Indeed, in links yesterday there was an interesting story about the Indian authorities giving priority to their own population, and so holding up deliveries of vaccines to the UK. Whilst this seems ultimately a case of the US itself being difficult again about exports of key equipment, and so reducing overall supply, some of the further links from the BBC story quote experts discussing the enormously complex nature of the pharmaceutical supply chain:
“Dr Sarah Schiffling, an expert on vaccine supply chains at Liverpool’s John Moores University, says the pharmaceutical supply chain is very complex.
“Even when demand is very high, new suppliers can’t spring up as quickly as they would in some other industries, or at least those new suppliers would not be trusted.”
In other words, whilst there’s no doubt that the whole of the world’s pharmaceutical industry will have to be mobilised, and that this absolutely requires, among other things, the loosening of IPR restrictions, this is not a case where what I call a “Kumbaya” solution will help. All joining hands, signing documents and feeling good about yourself won’t save a single life. If you’ve ever been involved in international crisis management efforts, you know that the gap between political agreements and what actually happens on the ground is immense, and can be unbridgeable. I mean, how are you actually going to get millions of doses of vaccine from Brazil to the border area between Uganda, the DRC and South Sudan, where there are no roads and no medical facilities, and everything has to move by helicopter? Who would pay and how would you avoid corruption? How do you provide security for the transit of material which is worth probably more than gold at the moment and how do you guard against fakes? Organised crime is already getting in on the act, as the South Africans have found.
These problems are not insoluble, with enough effort and resources, although they would require international cooperation on a massive scale. But they are practical problems, not simply problems of human greed or wickedness that can be resolved by making appeals to world leaders, or writing articles full of innuendo and suggesting that there are easy and quick solutions.
I’m wondering anyone’s thoughts on this imaginary & at the very least considerably unlikely scenario I found myself pondering while reading this, which is, what if an epidemiologically significant amount of the populations in various wealthy countries publicly declared their refusal to take any vaccine until everyone in the world has sufficient access to the vaccines? I definitely appreciate any responses anyone would like to offer.
The so-called “West” is morally deficient, ethically challenged, and deservedly repellent. I feel loathsome in my belonging to It.
I’ve sent off this article to the Prime Minister and the Minister of Finance in Canada.
2023. Oh, goody. The longer this pandemic exist, the greater the chance that this pandemic will change enough to make the vaccine worthless, or the disease more infectious or lethal. It would not be a surprise.
I am waiting for this to happen, which will give “them” evermore profit.
Was I dreaming? I thought I read here that the University of Oxford wanted to give the rights to the AstraZeneca vaccine away and instead went along with the three other
vaccine makers. I wonder if this could be relevant. If I am remembering correctly.
”..Vaccine apartheid will force poor countries to use other approaches, like preventatives and prophylactics: Vitamin D, zinc, ivermectin, hydroxychloroquine, aspirin, quercetin, progesterone…So the rest of the world will find out, on their backs, what works and doesn’t work. Hopefully enough countries will find good treatments so that the death and disease cost of experimentation as opposed to vaccination won’t be as high as the authors fear…”
This is the big secret of the past year. National hospitalisation/death rates already tell the story of early intervention with simple generics (some of which have been safely used to treat underresearched tropical diseases for 70 years without issue.. in case you weren’t sure that it’s all about the $$$)