The array of COVID-19 vaccines now being deployed is, as the situation in the United Kingdom demonstrates, a game-changing development in the midst of a once in a century pandemic that has taken more than 3.1 million lives. Despite some hiccups, those that have been approved for use in various Western countries—the Moderna, Pfizer, AstraZeneca and Johnson & Johnson vaccines—are reported to be preventing hospitalisation and death in 95 to 100 percent of cases for most of the coronavirus variants.

Yet, despite 12,000 deaths per day globally (likely a gross understatement because of under-counting in the underdeveloped world) and warnings that new, vaccine-resistant mutations are more likely to develop in places where the virus becomes endemic, the production and distribution of COVID-19 vaccines face obstacle after obstacle preventing billions of people getting vaccinated in a timely manner.

The first obstacle was in place well before COVID-19 even appeared. Today’s vaccine researchers built on the findings from previous deadly coronavirus outbreaks—severe acute respiratory syndrome (SARS) in China in 2003 and the Middle East respiratory syndrome (MERS) in 2012—which provided a blueprint from which to work. However, it was a blueprint only. Those who years ago had identified the need for coronavirus vaccines couldn’t obtain funding to take their research to the next level because pharmaceutical companies didn’t believe that they could make money out of them.

For example, scientists at the University of Texas developed a successful coronavirus vaccine in 2016—but it remains on ice. “We tried like heck to see if we could get investors or grants to move ... into the [clinical trial stage]. But we just could not generate much interest”, Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital, told NBC News in March last year. “We could have had this ready to go and been testing the vaccine’s efficacy at the start of this new outbreak in China. It’s tragic that we won’t have a vaccine ready for this epidemic. Practically speaking, we’ll be fighting these outbreaks with one hand tied behind our backs.”

Even when the COVID-19 outbreak began, obstacles remained. In February, Anthony Fauci, the US government’s chief medical adviser, said that pharmaceutical companies were refusing to “step up” to make a vaccine, creating a “very difficult and frustrating” situation. Hotez spoke to several “big pharma” companies the following month, “and literally one said, ‘Well, we’re holding back to see if this thing comes back year after year’”.

It took governments raining money on the private sector for the maths to add up for pharmaceutical companies. “In a business driven by profit, vaccines have a problem. They’re not very profitable—at least not without government subsidies”, Jay Hancock wrote in Forbes. “Pharma companies favor expensive medicines that must be taken repeatedly and generate revenue for years or decades.”

The Trump administration reportedly signed US$10 billion worth of deals with seven companies to provide them with a financial incentive to use their labs for the good of humanity. Among them was Moderna, a Massachusetts-based biotechnology company, which used the publicly funded research of the National Institutes of Health and received an additional $2.5 billion in government funding for research support. Pfizer, the world’s largest pharmaceutical company, received a half billion dollar German government grant and $6 billion in purchase commitments from the US and the EU.

And researchers from advocacy group Universities Allied for Essential Medicines UK estimate that public funding accounted for 97-99 percent of the development funding for the widely used AstraZeneca vaccine. As Achal Prabhala, Arjun Jayadev and Dean Baker wrote in the New York Times before the vaccine rollouts began last year:

“The vaccines developed by these companies were developed thanks wholly or partly to taxpayer money. Those vaccines essentially belong to the people—and yet the people are about to pay for them again, and with little prospect of getting as many as they need fast enough.”

Meanwhile, those trying to create alternatives that are easy to manufacture and store, and therefore can be made available more cheaply and to the greatest number of people, often have been frustrated. Hotez, working with a team in India, has just gained approval to begin Phase III clinical trials of a new vaccine. But it was a struggle to get funding—mainly because cheaper vaccines offer lower returns on investment. “We work on vaccines for diseases of the poor, that ... no-one else will make”, he told Democracy Now!’s Nermeen Shaikh on 22 April.

“When we got the COVID-19 sequence in January [2020] ... we turned that around really quickly. And then we couldn’t raise money for it, because everybody was so focused on innovation ... I said, ‘That’s great, but what if you can’t scale it, or what if there’s a safety signal? Don’t you want a simple, low-cost vaccine as a backup?’ And we just couldn’t get anybody to move. So I wound up raising money privately from philanthropies.”

The obstacles didn’t end there. Next was the new scientific knowledge being kept secret. Oxford University initially promised to donate the rights to its coronavirus vaccine research. But soon after, it partnered exclusively with AstraZeneca. Now there is the ongoing World Trade Organization refusal to allow patent waivers, which would temporarily suspend the intellectual property rights over the new vaccines, allowing more manufacturers to produce them. The proposal, first made in October by India and South Africa, was, in their own words, “an urgent call for global solidarity, and the unhindered global sharing of technology and know-how”.

Today, labs across the world are still waiting for a green light to produce and distribute doses. For example, the chair of Bangladesh-based Incepta Pharmaceuticals, Abdul Muktadir, told the ABC in March that if the intellectual property waiver were granted, the company could manufacture up to 800 million vaccine doses annually—and could produce enough this year to vaccinate all of Bangladesh and Indonesia. And that’s just one manufacturer.

Oxfam’s health policy manager, Anna Marriott, last month called it “a massive missed opportunity”. It is beyond a scandal that a waiver was not granted immediately. But the opposition of a select group of wealthy countries, including the US, Australia, Canada and member states of the EU, has prevented it for more than half a year. (Most decisions at the 164-member WTO are made by consensus, so even a small opposition can scupper proposals.) As Marriott noted:

“Rich countries are vaccinating at a rate of one person per second yet are siding with a handful of pharmaceutical corporations in protecting their monopolies against the needs of the majority of developing countries who are struggling to administer a single dose. It is unforgivable that while people are literally fighting for breath, rich country governments continue to block what could be a vital breakthrough in ending this pandemic for everyone in rich and poor countries alike.”

Thomas Cueni, the director-general of the International Federation of Pharmaceutical Manufacturers and Associations, writing in the Financial Times on 26 April, argued that intellectual property protection is not at all a barrier to global vaccine access. Rather, it is the lack of capacity to increase production quickly enough to match the unprecedented demand. “What is keeping biotech chief executives up at night is the daunting task of scaling up production”, he wrote.

There are three counter-arguments that make this claim laughable. First is Peter Hotez’s testimony that pharmaceutical company funding simply did not flow to scientists who wanted to make a vaccine’s capacity for rapid mass production a precondition of its development. That is, from the beginning, scalability was subordinate to profitability—Big Pharma considered the former a liability if it meant that the vaccine would generate fewer revenues than a more innovative alternative.  

Second is the testimony of pharmaceutical manufacturers, such as Bangladesh’s Incepta, that they could produce vaccines right now if a patent waiver were granted. Third is the situation facing the World Health Organization’s COVID-19 Technology Access Pool (C-TAP). Launched in May last year, C-TAP’s aim was to encourage companies to share knowledge, intellectual property and data with manufacturers in underdeveloped countries so that the world could indeed “scale up” vaccine production. Yet, “not a single vaccine company has signed up”, noted Selam Gebrekidan and Matt Apuzzo in the New York Times in March this year.

Maybe staying up all night worrying about scalability distracted the executives from taking concrete measures to increase global output. Whatever the reason—and it seems obvious that the reason is money—the companies that collectively received billions in public subsidies to develop vaccines have been at the forefront of preventing the sharing of information about how to produce them.

Another, related, obstacle to getting the world vaccinated is the Covax debacle. Covax, the COVID-19 Vaccines Global Access, is a dose-sharing facility that aims to get at least 20 percent of each country’s population vaccinated by the end of this year. It has thus far delivered just 40 million doses to 118 countries, well below what it intended. Its problems are several. Wealthy countries have signed private deals with the big pharmaceutical companies, taking the lion’s share of advance orders for vaccines (a confirmed 4.7 billion doses) while lower-income countries so far have procured orders for only a fraction of their populations. Nearly 900 million doses have been administered globally, but more than 80 percent have gone to wealthy and “upper middle-income” countries. Poorer countries have received just 0.3 percent, according to the World Health Organization.

Covax has secured agreements for more than 1.5 billion doses, depending on the Serum Institute of India to manufacture and export vaccines under licence from AstraZeneca. But Adar Poonawalla, the company CEO, complained last month that an “embargo of raw material exports out of the US” was hampering production. Now, with India in a devastating second wave, exports understandably have been halted—but that leaves many countries with no supply at all.

So, despite the threat of more outbreaks and epidemics, the belief that coronavirus vaccines were not profitable stymied their development in the last decade. It took a mountain of government subsidies to get them off the ground even when a once in a century pandemic emerged. Vaccines that might have been easier to produce and distribute were ignored. The pharmaceutical companies prevented the sharing of information that would allow more vaccines to be produced more quickly. And the wealthy states bought up the lion’s share of the limited supplies that have resulted.

All these obstacles mean that it won’t be until 2023, perhaps longer, that people in many parts of the world will be offered an inoculation. In the meantime, hundreds of thousands, perhaps millions, will die needlessly, and more variants will emerge that may be resistant to the first generation of vaccines.

Never forget the words that one unnamed pharmaceutical executive uttered to Peter Hotez: “We’re holding back to see if this thing comes back year after year”. In this murderous result—more than 3.1 million people dead and counting—those looking only for profits may have gotten just what they wanted.