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Medical Apartheid and the COVID-19 vaccines (ENCORE)

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The world is struggling to contain COVID-19, as variants continue to emerge in countries where the virus is spreading unchecked, killing thousands. Not only could widespread vaccination campaigns help slow the emergence of new variants, they would save countless lives. So why can’t countries in the global south access the novel COVID-19 vaccines?

We take a deep dive into the WTO and international patents and we talk about the similarity between the current battle and the prior fight for access to antiretrovirals during the HIV pandemic. We also take a look at what needs to change in order to create a more just medical system, not just in the United States, but around the world.

Image Credit: Universities Allied for Essential Medicine

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  • Leena Menghaney, South-Asia Head for Medecins Sans Frontiers’ Access Campaign
  • Achal Prabhala, coordinator, AccessIBSA project
  • Priti Krishtel, health justice lawyer and co-founder of I-MAK
  • Marcela Cristina Vieira, Project Coordinator of the Knowledge Network for Innovation and Access to Medicines, Global Health Centre
  • Merith Basey, Executive Director at Universities Allied for Essential Medicines


The Making Contact Team

  • Host: Salima Hamirani
  • Interim Executive Director: Jessica Partnow
  • Staff Producers: Anita Johnson, Monica Lopez, Salima Hamirani


Special Mini Episode: Moderna vaccine trial volunteer Jeremy Menchik

Jeremy Menchik volunteered for Moderna’s vaccine trials, wanting to help end the COVID pandemic. However, as Moderna continues to hold patent rights and refuses to openly share their vaccine technology, Jeremy began to feel conflicted. He has since publicly quit as a volunteer and urges others to do the same, until everyone can freely access the vaccine. Listen to our interview with Jeremy on this special edition of making contact, an extra to our larger show on vaccine equality.



Salima Hamirani: I’m Salima Hamirani. And on today’s Making Contact:

Race for the Vaccine: It’s a date with destiny tonight a race that could make history. As rich countries hurry to protect their own people from COVID-19, the developing world must try to keep up.

Salima Hamirani: We’re almost two years into the pandemic and still much of the world hasn’t been able to access life-saving COVID vaccines or medicine.

Race for the Vaccine: Jamaica is normally a favorite, not this time with just 5% of its population vaccinated or 9% South Africa is looking to break monopolies held by the big pharmaceutical companies. So countries like Bangladesh can produce vaccines for themselves

Salima Hamirani: And without the vaccine, people in the global south are dying. So why won’t the global north share its medical technology.

Race for the Vaccine: Over a hundred government support the call to lift vaccine patents, but not Germany putting profit before lives. And no way says great Britain, holding millions of doses more than it needs. The United States says it’s in favor, but Hey, leadership’s about action, right? Just ask Uganda with less than 1% of its people vaccinated. You’ve got to say folks. No change at all

Salima Hamirani: stick around. We’re about to take a deep dive into the world of patents, international medals. And the global fight against COVID-19.

Race for the Vaccine: We all want to see an end to the pandemic until every country is vaccinated, the only winner is the virus.

Fade out Music

Part 1.

Salima Hamirani: So we’re talking about global vaccine access today on making contact. And I think out of all the pieces that I’ve produced this one had the most confusing legal jargon around patents and intellectual property rights and trade. But it is really easy to get lost in the details. And really the issue is the impact of corporate monopolies on people’s lives. In India, for example, where there have been at least half a million COVID deaths and access to medicines and vaccines was very limited.

Leena Menghaney: So the way developed countries and global health actors had looked at access to COVID-19 vaccines was they would vaccinate every single adult person in their countries. While developing countries could live with just vaccinating healthcare workers, the elderly and the vulnerable populations.

Salima Hamirani: That’s Leena Menghaney, a treatment activist with doctors without borders. And you heard her right. From the very start, the global north planned to vaccinate everyone. But the global south was expected to get by with limited vaccinations.

Leena Menghaney: And that is a disparity, the double standards of public health that we can afford to vaccinate and we want to vaccinate our entire adult population, but developing countries can live with vaccinating, just partially their population you know.

They also looked at manufacturing capacity and the tied up all the companies, big companies, vaccine companies, whether it’s Moderna, Pfizer, AstraZeneca, whoever was producing the vaccines, were all tied up by high-income countries.

Salima Hamirani: Then the situation in India became even more deadly because of the Delta variant of COVID

News Clip: India has reported more than 40,000 new cases in a day. And this is not a sudden rise. The number has been rising for almost a week now. In the last six day, India has breached the 40,000 mark every day, 40,000 new cases every day

Leena Menghaney: In March. It started in March. I remember that day when, you know, I started to feel everyone around me was getting sick. Every second person I was hearing had a parent or family member getting sick with COVID. By mid April, it became very clear that India was going through a massive surge. You had 4,000 people dying a day and those were government figures. You probably have much higher figures and unaccounted for deaths

News Clip: body after body being brought into this crematorium in India’s national Capitol New Dehli. That has seen a huge surge, not only in cases that in fatalities as well, family members pulling out bodies, such as this one from ambulances lined up in this crematorium ground and taking them for cremation.

Leena Menghaney: And at that point India said, hang on. Why should we be just vaccinating just 10 – 20% of our population? We need to vaccine as fast as we can and all adult population

Salima Hamirani: That sentiment was global, especially as a poorer countries, watched Northern countries lift COVID restrictions and just return to life as normal

Leena Menghaney: people wanted to vaccinate developing countries. Africa union wants to vaccinate all its people. So they said, hang on. We are vaccinating everybody. And that’s when we ran over vaccines very quickly.

Marcela Cristina Vieira: So one of the things that we have been doing is checking COVID-19 vaccine access.

Salima Hamirani: That’s Marcela Christina Vieira She’s a project coordinator of the Knowledge Network for Innovation and Access to Medicines at the Global Health Center in Geneva.

Marcela Cristina Vieira: And that information has been pretty difficult to find, but from the sources that are publicly available, it clearly shows that most of the current available vaccine doses are going to high-income countries. And very few are going to low-income countries. So, we see a clearly unfair distribution of the vaccines according to income level. Uh, high income countries, they have secured enough vaccine doses to vaccinate about 350% of their population while low-income countries they have only enough doses to vaccinate 3% of their population.

Salima Hamirani: That’s a huge disparity, especially since, when the pandemic first hit activists were working to make sure the vaccines were accessible.

Achal Prabhala: Uh, everyone understood this stage, I think, that vaccines would be key to surviving the pandemic and exiting it.

Salima Hamirani: That’s Achal Prabhala, he works on access to medicines and vaccines and Brazil, India, and South Africa.

Achal Prabhala: So there was lots of money that went to these vaccines and this money was public money. It was taxpayer money,.

And when this money started going to vaccine companies. It wasn’t actually clear as to who could get these vaccines once they were developed. And we wanted to make sure that in as unusual a situation as the pandemic, we were being very careful to set these contracts up to succeed right from the start. Which is why there was a whole lot of activity in March and April, when some of these contracts were just being negotiated, to try to press them to put the right kind of conditions in on the ground floor, right at the start

Salima Hamirani: And the activist weren’t just focused on contracts. There was even a whole international system set up at the start of the pandemic to ensure that the vaccines will be fairly distributed. It was called COVAX. Here’s Priti Kristhel, the executive director of an organization called I-MAK.

Priti Krishtel: COVAX is a donation mechanism. It stands for COVID-19 Vaccines, Global Access. And what Kovacs is supposed to do is they’re supposed to purchase vaccines for distribution in 92 countries around the world using money that’s donated by government and charitable foundation,

Salima Hamirani: but all of these early efforts to insure access, they didn’t work.


Salima Hamirani: Governments in the global north had no control over the contracts they developed with pharmaceutical companies, even though they’d funded the technology in the first place.

Achal Prabhala: Not only where the contracts without any access provisions, they were made to expressly forbid the funders of these vaccines from interfering in setting the price or in any other way, controlling the undisputed monopoly control vaccine manufacturers would have over the vaccines they eventually developed.

Salima Hamirani: Second: Even though Kovacs was meant to fairly distribute vaccines, it had to compete with the market. Here’s Marcela Christina Vierra,

Marcela Cristina Vieira: the countries, even if they were saying that they were supportive of a such mechanism in parallel, they were doing bilateral, uh, purchases directly with the vaccines manufacturers. Uh, and then given the limited availability of supply of the vaccines, there’s just not enough doses to vaccinate everyone. Those bilateral agreements, they really undermined our global location mechanism.

Salima Hamirani: And, as Priti Krishtel argues, we should not have relied on a donation mechanism in the first place where we hoped pharmaceutical companies would do the right thing.

Priti Krishtel: If there’s only a finite amount of supply if I’m Pfizer, am I going to give it to a donation mechanism for 92 lower income countries? Or am I going to sell to the highest bidder? And that’s exactly what they’re doing. They’re selling to the us and Europe. And it’s also worth noting. At best, uh, the targets being set for Kovacs are really only to reach 20% of the populations of those countries. So it is not an aspirational target. It is a baseline


Salima Hamirani: for the rest of the show. We’re going to try to understand why governments don’t have any control over the technology taxpayers fund, like medicines, which means we’ll do a quick dive into patterns. And then we’ll talk about how our patent system was exported around the world. Understanding that patent system gives us a chance to fix it and deliver the lifesaving medicines people so desperately need.

MUSIC fade out

So the first big question, because everyone I talked to said that vaccines were developed with public money. So how did the patents end up in the hands of big pharmaceutical companies, private companies, Here’s Achal Prabhala.

Achal Prabhala: This is an excellent question. This is the logical question that anyone who hears this information should ask. How it is that public money gets funneled to a private corporation for private gain without any accountability Back to the public is a story that begins in the 1980s with something called the Bayh-Dole act in the United States. So senators Evan Bayh, and Bob Dole, who once ran for president of the United States, created a monumental piece of legislation called the Bayh-Dole act, which essentially encouraged public institutions, not just government institutions, but all public institutions involved in research and development of any kind of invention, including pharmaceutical inventions to compulsorily hand over their inventions or their research at some stage to private corporations to bring to market.

They believed that this was the most efficient way to ensure that useful research could be commercialized. And they equated the commercialization of research with its utility and availability to people in America and beyond. They were essentially handing over not just large amounts of money sometimes, but actual products of research

Salima Hamirani: The vast majority of research, all of the pre-clinical trials, and some of the clinical trials are done in public institutions with public money which is also where most of the financial risk lies. Here’s Marcela Christina Vieira.

Marcela Cristina Vieira: And then once you have a technology that seems to have more potential to actually become a product, then it’s taken by the private sector. Somehow the way that the system works allows the intellectual property rights to be fully owned by the later stage.

Achal Prabhala: it’s been happening for the last 30 or 40 years. What changed in the pandemic is that the Trump administration then, and then the Biden administration subsequently had to justify what they were doing for the pandemic. And so instead of hiding these vast, essentially federal subsidies, To the private pharmaceutical industry, they had to publicize them. That is why for the first time, I think we’re aware of the extent of taxpayer money. That’s going into these drugs rather than as, before having to fight with freedom of information requests and really dig deep and work hard to simply understand what the extent of federal funding and public funding was to any one of the major treatments that has come to market, uh , in the last couple of decades,

Salima Hamirani: of course, other countries have different legal systems and values around inventions, some of which don’t privilege private corporations. So how did our ideas of patents get exported to the rest of the world. And why do other countries have to follow our laws? Stay tuned. We’ll talk about international patents right after the break.


We’re just jumping in to remind you that you’re listening to making contact. If you like what you’re hearing about global vaccine access, you can subscribe to our podcast and get behind the scenes information at Follow us on Twitter. Our handle is making underscore contact and an Instagram. We’re making contact radio project. And now back to the show.


Salima Hamirani: Welcome back. So just before the break, we talked about how the patent system loosely works in the United States. Let’s take a look at how we exported that system to the rest of the world, because before we got other countries to follow our patent system, some of them had their own independent manufacturers that produce their own medicines, India, for example, which still produces most of the generic medicine in the global south.

Leena Menghaney: It started very interestingly with Gandhi. Gandhi in world war two, had this idea that India should start manufacturing medicines and he encouraged one of his followers to study chemistry. The idea was that India should be self sufficient in everything, including the manufacturer of medicines.

And by the seventies, what we saw was that India had this massive population medicines that were being imported were extremely expensive out of the range of governments and people more expensive than the United States. And at that time, the Indian government made up its mind that it would change its patent law. And they said, no monopolies on food and medicine. So they removed big pharma’s monopolies and they did a second thing.. They poured a huge amount of public investment into building capacity to manufacture medicine into R and D into just synthesizing compounds and making them. No one will give us the technology. No one would give India the other technology.

Neither the Russians, neither United States, Germany, UK, no one wanted to give technology to India. India developed on its own technology.

Salima Hamirani: So for a while, India was able to produce affordable cheap medication that wasn’t bound by international patterns. But then in 1995, that all changed. Here’s Achal Prabhala.

Achal Prabhala: The creation of the world trade organization took that sovereign choice away and it created a one size fits all mandate that every one of the 165 member countries of the world trade organization had to conform to.

Salima Hamirani: Patents over medicines had become extremely lucrative for pharmaceutical companies in the United States.

Achal Prabhala: In fact so lucrative that the people who created it said this works so well here, we should take it abroad and export it to the rest of the world. And they did that through the world trade organization. By the nineties, the way that economies had reconfigured them themselves, if you didn’t trade, you didn’t exist

Salima Hamirani: now countries could technically ask for what’s called a compulsory license. If they really need a medication that no one could afford, or they could break patents, but they would then face consequences.

Achal Prabhala: and the way that they enact that is to create all kinds of problems. If there are other negotiations going on, they stall them. There are threats that they can put out to these countries. You know, often the financial power of the United States and the EU is a really big cudgel.

And they use that cudgel to take swings at many of the countries that they’re trying to bully or threaten to say effectively, yes, it’s in the law and it’s legal for you to do, but if you do that, then we’re going to push your head into the sand.

Salima Hamirani: The consequences were especially problematic for poorer countries who couldn’t afford to go up against the United States and Europe and the problems with the WTO and imposing an international patent system became obvious, immediately

Achal Prabhala: That coincided unfortunately, with the understanding that HIV and aids had moved from being a fatal disease, that affected primarily what we thought off in the eighties and early nineties as gay white men in the United States and Europe to being a third world problem where the largest numbers of people who are HIV positive or who had AIDS were living in countries in Sub-Saharan Africa or in Asia or in Latin America, where absolutely nobody could afford this miracle treatment that emerged in 1996 called antiretroviral therapy, which costs $10,000 a year.

And this was an early warning, a very stock early warning, of the effects of this regime of pharmaceutical monopolies.

Salima Hamirani: Here’s Leena Menghaney

Leena Menghaney: So already antiretrovirals were this class of medicines that were saving lives in developed countries, but you can very clearly see in Africa, and Asia the people were dying and what we were doing, was we were writing wills for people and they would just die.

And we would, you know, figure out what to do with the children, with the property

Salima Hamirani: organizers in the global south immediately United to fight back against the monopolies controlling HIV medication.

Leena Menghaney: This was treatment action campaign in South Africa that was leading from the front. This was ABIA in Brazil, the Indian network of positive people in India.

These are all organizations of people of color who were leading the HIV aids movement. And they said, no, hang on. We can’t live with these double standards. They cannot be a certain standard in the United States and a different standard for Africans or Asians. And what we did was we got together and we challenged the intellectual property monopolies of big companies like Pfizer.

And that should sound familiar to people because we are exactly at that point in the COVID-19 battle because Pfizer has a monopoly on their MRNA vaccine.

Salima Hamirani: And right now, activists in the global south are once again fighting for equal access to lifesaving medicines during a global pandemic, which is killing thousands of people.

Leena Menghaney: It’s difficult. It’s an emotional issue for a lot of people to watch this happen again after HIV aids. And that is exactly why we felt that we had to change the system. With HIV aids we saved millions of human lives. Um, with antiretrovirals produced in countries like Brazil, Thailand, and India, but at the same time, we could not change the system.

And I think this is something that you question about a system. How can it outlive us a system that has watched so many of us die, whether for cancer, for HIV aids or hepatitis C. I, I don’t think so. People have actually watched someone die due to a lack of those medicines and it changes the way you think about human lives.

Salima Hamirani: So how do we change the patent system to end the show? We’re going to look at some solutions. The first solution is a short term fix, particularly for COVID. Here’s Achal Prabhala

Achal Prabhala: last year in October, looking at the fairly slow progress that had been made on getting any agreements that would ensure access to the vaccines and drugs that we needed in COVID the governments of South Africa and India, but really the government of South Africa actually, decided to float this very exciting proposal at the world trade organization, which they call the TRIPS waiver

Leena Menghaney: So TRIPS. TRIPS is the trade-related aspects of intellectual property rights. It has that funny name because it’s under the world trade organization.

Achal Prabhala: The provisionis to allow member countries of the WTO to suspend pharmaceutical monopolies during the pandemic. Why? So that countries then could have the ability to manufacture the drugs and the vaccines that they need in order to live, but also the diagnostics, the tests, the range of other things that you need, many of which are monopolized.

Salima Hamirani: Almost all of the international activists I spoke to said that the TRIPS waiver was the most important change we could enact right now, but Europe especially is fighting it. And while the US has pledged support, the government has done little in the way of action. Still, Achal Prabhala thinks that the TRIPS waiver can pass.

Achal Prabhala: I think on the world trade organizations part, there is also an appetite to see itself as being a responsible player in this pandemic. I think that, they feel that the failure of the trips waiver will hurt the world trade organization more permanently than its success.

Salima Hamirani: Priti Krishtel agrees. The pandemic has left the world trade organization in a bad position.

Priti Krishtel: I do think we’re going to see a movement to start to consolidate middle income country cooperation and power outside of the epicenter that is the United States or Europe. I think governments and people in their countries are extremely frustrated. And you’re talking about several billion people around the world.

Salima Hamirani: And the long-term COVID is yet another reminder that the general medical system, which relies on monopolies is not working. And for that, we need different solutions.

Priti Krishtel: When you look at a company like Moderna,. Which received at the beginning of the pandemic, $2.6 billion in federal funding for the development of the vaccine and some advanced purchase of it. It was predominantly funded by tax payers, nearly all of the development. And yet the way that contract was structured, the U S has no power. It has no ownership. It has no stake in the overall IP portfolio. It doesn’t have the ability to just take that technology back and deploy it to the rest of the world for use. That’s what we call a bad deal.

And so I think what needs to change is we need to ensure that the government has the power, the willingness, and the authority to negotiate better deals on our behalf going forward.

Salima Hamirani: One of the ways we can pressure governments and institutions to negotiate better contracts is through organizing and direct action. To end the show, we visit one such initiative taking place all across the world on college campuses.

Merith Basey: My name is Merith Basey and I’m the executive director for, uh, a student driven organization called Universities Allied for Essential Medicines. And we organize students in now over 20 different countries around the world, fighting for access to lifesaving medicines. Mostly those developed on university campuses with tax payer money.

It actually started at the height of the HIV aids movement. So in 2001, with an HIV aids drug called D4T that was developed on Yale university campus in Connecticut. Some young students had realized that this drug developed on this campus was priced too high for people primarily at the time in South Africa and other lower income countries to afford it. And they decided that they didn’t want their university to be complicit in the deaths of south Africans and other people around the world. So, they organized in conjunction with other sort of civil society groups. They won. Basically, they got the university to change the license with Bristol-Myers Squibb, which was the pharmaceutical corporation. And this led to an over 90% reduction in the price of that medication.

Salima Hamirani: Currently, the group has joined a larger collective focused primarily on access to COVID vaccines.

Merith Basey: We started in March, 2020, really early. And we put out a call for volunteers and we had a response of 300 people from 29 different countries. And then later on, we became a founding member of something called the People’s Vaccine Alliance.

Salima Hamirani: And they have two basic demands for the U S government in particular.

Merith Basey: And so the first is like lift the patent monopolies basically. So there shouldn’t be monopolies and investing also for Joe Biden, they need to be investing more money in global manufacturing that could be here in the U S but it also should be, should be abroad


Salima Hamirani: because patent law can be confusing and complicated. They’re using creative ways to reach people.

Merith Basey: We decided some of the methods that we’ve been using for the past year and a half is because we’re partnered with a group called the center for artistic activism. They use creativity and culture to impact power that’s kind of their frame. Because IP, patents, technology transfer, it just goes over… I mean, to be honest, it should go over most people’s head cause it’s very wonky and it doesn’t really explain anything. So we came up, we borrowed the message from the Care bears “sharing is caring.” This image of people dressed up as Care bears holding this big banner that saying, you know, “come on, Joe Biden sharing is caring free the vaccine, share the recipe with the world.”

If you had ice cream, you had a great recipe for ice cream in your friend in India, wanted to make the ice cream. You’re not going to send ice cream to India. You’re going to share the recipe. Right?

One of the other things we did really early on was we discovered that Dolly Parton had given a million dollars to the university of Vanderbilt. We changed the words to one of her famous songs, you know, Jolene to vaccines. And we had people from all over the world, sort of lip sync to the song and had these musicians who were part of a sort of artist collective come together and rerecord the song.

Vaccine Song

Salima Hamirani: Meredith says that they found a lot of people are looking for a place to organize and vent their frustration during the pandemic. And that really all you need to participate is the desire,

Merith Basey: In the last year and a half, what is inspiring is that we’ve had more students than ever before sign up to organize. And I think people need to realize that they have a voice. It doesn’t matter if you don’t understand the technicalities, because ultimately it’s an issue of justice. We believe and certainly I believe that no one should be sick because their poor or be poor because they’re sick.

Salima Hamirani: That was Merith Basey from Universities Allied for Essential Medicines talking about global vaccine equity.

We have a lot of information on our website about the TRIPS waiver and organizations working to try to create a more just medical system. To learn more or to get involved, visit us at


And that’s it for today. Special, thanks to the people’s vaccine alliance for use of their sound at the top of the show, the making contact team includes Anita Johnson, Monica Lopez, Sabine Blaizin, Jessica Partnow And I’m Salima Hamirani. Thanks for listening to Making Contact.


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