Vidya Krishnan is a global health reporter who works and lives in India. She is the author of “Phantom Plague: How Tuberculosis Shaped our History.”
In his 1947 novel “The Plague,” Albert Camus wrote that all a man can win, in the conflict between plague and life, was knowledge and memories.
From syphilis and tuberculosis to COVID-19, our collective knowledge and memories have taught us that laws become the vehicle for injustice. Regardless of the type of pestilence or the time in history, we know patients reliably get divided along a predictable architecture of inequality, with race playing a huge role in who survives and who perishes.
In this latest plague, the contentious law that’s brought the Global North and the Global South to a head is about the regulation of intellectual property (IP) on vaccines — one in which former German Chancellor Angela Merkel played a major role. As we head into yet another preventable wave of a preventable infectious disease, her stance on an IP waiver for COVID-19 vaccines will be one of her defining legacies as a world leader.
In 2021, as she left office after sixteen years, Merkel was lauded for steering Europe with steady hands during a complicated period, for invoking Christianity and welcoming a million refugees to Germany, and for putting science before politics — unlike many leaders.
A theoretical quantum chemist by training, she won praise for bringing “compassion and an insistence — unusual among politicians, even in the time of COVID-19 — that decision-making benefits from evidence” and was called a “hard act to follow.” After former United States President Donald Trump was elected, the New York Times even saw fit to give her the title, “Leader of the Free World.”
But Merkel’s position on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver for vaccines was an acid test of her commitment to human rights and social justice. And heading into the third year of a pandemic that’s claimed over 15 million lives, it’s debatable if she deserves this title.
The first COVID-19 vaccine was approved in December 2020. And experts in India and South Africa had proposed a TRIPS waiver even before then. Yet three years into the pandemic, with over 12 approved vaccines and around 150 more in the pipeline, almost 3 billion people are still waiting for their first doses.
Nearly 14.91 million perished in the 24 months between January 2020 and December 2021— most of the deaths occurring in 20 Black and Brown nations. The highest death toll occurred in India, despite it being the pharmacy to the world. And therein lies the rub.
This month marks a year since India’s traumatizing second wave in which — by conservative estimates — 2.7 million people died in a four month period. The numbers are staggering and the losses unconscionable, especially given that Indian pharmaceutical companies have been manufacturing COVID-19 vaccines at a fraction of the cost for the World Health Organization’s (WHO) COVAX facility.
The decision to tie up vaccines in patent monopolies and centralize manufacturing left the burden of vaccinating the rest of the world on Indian companies. But during the second wave, India had to halt vaccine exports to over 90 developing nations, sending the pandemic response in a tailspin.
Now, we’re globally witnessing parallel pandemics.
The proposed waiver is now supported by more than 100 nations, including the United States, more than 140 former heads of state, Nobel laureates and the Pope, all of whom have called on Germany to back waiving of intellectual property rights on COVID-19 vaccines and transfer vaccine technologies.
With Merkel’s Christian Democratic Union Party at the forefront, Germany has consistently argued for IP as a driver for innovation and, therefore, for monopolies as an unassailable right of the country’s thriving pharmaceutical industry, deeming the right to health in the middle of a once-in-a-century pandemic violable.
Despite “no-strings attached” taxpayer investments in the development of vaccines — Germany has awarded $445 million to BioNTech and $298 million to CureVac — the government in Berlin has staunchly supported keeping them locked in patent monopolies. BioNTech single-handedly hauled in over 5.3 billion euros between April to June 2021 and estimates annual revenues at 15.9 billion euros this year.
Even while stating that intellectual property isn’t a barrier to increased global production, Germany altered its patent laws early in the pandemic, giving more powers to its Federal Ministry of Health.
By May 2021, while the U.S. and New Zealand had come around to supporting the TRIPS waiver, Germany responded by suggesting industry-led and controlled solutions like donations, allowing a deadly status quo to persist. The European Union’s counter proposal to the waiver was noted by humanitarian medical organization Doctors Without borders as a ploy “to delay and distract from moving forward with the TRIPS waiver.” And patent lawyers in India and South Africa also believe this was a deliberate attempt to delay the negotiation, allowing pharmaceutical companies to slowly increase capacity to manufacture at scale, thereby negating the need for a patent waiver altogether.
In June 2021, months into the COVID-19 pandemic and weeks ahead of the G7 summit, all eyes were on Germany’s outgoing leader. Merkel stood “in the way,” said Human Rights Watch, referring to an intellectual property waiver on COVID-19 technologies, making it harder for the world’s poor — mostly Black and Brown nations — to get access to vaccines.
Overall, the EU, United Kingdom and Switzerland — along with a coterie of other fence-sitters, including the U.S. — have blocked meaningful progress to end the pandemic in Africa, Asia, Latin America, and the Caribbean. For 20 months, between the bystanders and the naysayers, global health leaders and institutions — all based in the Global North — leisurely negotiated the terms for a TRIPS waiver over the course of two years, as the death toll mounted.
This week, the standoff reached its peak as, finally, a compromise deal regarding a waiver was struck at the World Trade Organization. The agreement, on paper, leaves room for governments to compel pharmaceutical companies to share their vaccine recipes for the next five years, but realistically, low- and middle-income countries haven’t had success in compelling litigious Big Pharma, let alone within a five year period. It also falls short of a demand by India and South Africa to exempt all COVID treatments and diagnostics.
But campaigners were disappointed at the result. “It is hard to imagine anything with fewer benefits than this, as a response to a massive global health emergency,” said James Love, director of Knowledge Ecology International.
For those of us in the Global South, our knowledge and memories teach us that power doesn’t negotiate, compromise or extend flexibilities. It also teaches us that one doesn’t have to operate with great malice to inflict harm. The refusal to act urgently and with empathy does the job.
At the time India’s deadly second wave hit, only 4 percent of the population had been vaccinated because the country was supplying WHO instead, having delivered around 66 million vaccine doses to 95 countries. Over a four-month period, millions of Indians were swallowed by the plague, and after all the screaming and crying faded, this is what we remember: Vaccines were available, and India was producing them for the world, as millions of us perished.
From the viewpoint of India — and the postcolonial nations of Asia, Africa and Latin America — Merkel looks like a deeply flawed leader, and one who contributed mightily to leaving the vulnerable unprotected.
This is the moral crime of our generation — not too different from denial of salve to the African-American sharecroppers enrolled in the Tuskegee syphilis study, repeated again in the 1990s during the HIV epidemic when African nations, at the epicenter of the crisis, were the last to receive antiretrovirals.
Decisions by Western powers — especially Germany, which had the influence to break the vaccine gridlock — have inflicted incalculable misery on Black and Brown nations.
This is Merkel’s lasting legacy.