The Moral Scandal of Vaccine Inequality Has a Name: Capitalism

August 18, 2021

Stephen Gowans

In a new editorial the British Medical Journal thunders against the monopolization of life-saving vaccines by rich countries, calling it a “moral scandal” and “crime against humanity.” Vaccine makers and “their political allies” are flayed for turning a “blind eye” “towards the innumerable deaths in disadvantaged nations” caused by their refusal to share vaccine technology with poor countries, while at the same time presenting themselves as the greatest servants of humanity. What they are really doing, the editorial fumes, is “making a killing”, both figuratively (in massive profits) and literally (in preventable deaths.)

According to the BMJ:

“Vaccine preventable deaths and illness are occurring across Africa, Asia, and Latin America at an unprecedented speed and scale” because there is an artificial shortage of vaccines, and what vaccine doses are available are being sold to the highest bidders—the rich countries.

“Contrary to claims, it is possible to make enough vaccines for the world” by sharing vaccine know-how, making vaccine technologies open source, and allowing any company, anywhere in the world, private or public, to produce vaccine doses.

“Let us be clear what is causing these deaths,” the BMJ fulminates: “a free market, profit driven enterprise based on patent and intellectual property protection, combined with a lack of political will.”

In other words, capitalism. The editorial doesn’t use the C-word, but if the argument is followed to its logical end, capitalism is the inevitable destination.

Deaths and illness are occurring in low-income countries which could be prevented if vaccine manufacturers shared their technology with poor countries and allowed them to produce the vaccines themselves.

Only one percent of people in low income countries are fully vaccinated, according to Our World in Data, while over 50 percent of the residents of rich countries have received two vaccine doses (and in some countries three. About one million residents of the United States have received three vaccine doses while health care workers, the elderly, and infirm in the world’s poorest countries have yet to receive even one.)

The disparity is due to two causes:

The rich countries’ pharmaceutical companies have exclusive rights to mRNA and viral vector vaccine technologies. Backed by their governments, they refuse to make the technology open source. If they did, spare manufacturing capacity could be engaged, and the supply of vaccines boosted, allowing a quicker roll out of doses around the world, but foregone profits for the vaccine oligopoly.

As the BMJ points out, the “world’s 30 richest nations—those able to pay high vaccine prices—have cleared the world’s shelves of doses through advanced purchase orders.”

• Canada purchased enough doses to vaccinate its citizens five times over.
• The United Kingdom secured enough doses for four times its population.
• The United States has stockpiled 100 million doses.
• Some high-income countries are administering, or planning to administer, vaccine boosters, absent evidence they’re needed, while at the same time destroying unused, expired, doses. Meanwhile, less than six percent of Africans have received even a single dose.

The real international community—over 100 countries—has proposed a temporary waiver on intellectual property protection of Covid-19 vaccine technologies. This would expand the supply of doses and expedite the roll out of vaccines to poor countries. On top of saving lives and reducing illness, a faster roll out would reduce the chances of new variants emerging that might evade current vaccines.

However, these developments, while a caress for humanity, would be a blow to pharmaceutical companies and the wealthy investors who back them. A supply shortage allows the companies to sell vaccines at monopoly prices with the attendant advantage of huge profits. Vaccine-makers argue that large margins are necessary to recover their research and development costs, but the vaccine technologies to which they have exclusive rights were produced in publicly-funded university and government labs. The truth of the matter is the companies seek large margins to do what capitalist enterprises are systemically compelled and legally obliged to do: generate profits to the highest level possible. Suffice to say, sharing technology with other manufacturers, means sharing market share. Any pharmaceutical company CEO who agreed to this repudiation of corporate responsibility would be quickly dismissed and replaced by another person whose moral qualms (if they have any) do not interfere with the pursuit of hard-headed business imperatives; namely, exploiting employees, despoiling customers, and paying out healthy dividends to the only people who matter in the calculus of capitalism: shareholders.

As for the dangers of new variants emerging, this can hardly be unwelcome to vaccine-makers. New variants, especially those that achieve “vaccine-escape”, present the pleasing prospect for vaccine company shareholders of a guaranteed future demand for new vaccines and therefore an unceasing stream of revenue stretching far into the future—the holy grail of capitalist pharmaceuticals. The prospect may be a nightmare for humanity, but it’s a pharmaceutical company CEO’s wet dream.    

Oxfam, the BMJ notes, accuses the G20 rich nations of putting the interests of pharmaceutical companies and their investors ahead of ending the pandemic. The journal adds that “Vaccine manufacturers and many rich countries are working tirelessly to block waiver discussions at the World Trade Organization”, while at the same time, the WTO drags it heels. Quelle surprise. Whose interests do vaccine manufacturers, the governments of rich countries, and the WTO represent? Not those of poor countries.

The BMJ’s moral indignation is understandable and warranted, but its failure to take its analysis far enough to confront the systemic roots of the problem leads to recommendations that leave much to be desired. While the BMJ can’t bring itself to mention the C-word, it is capitalism, its incentives, and its power to dominate the political process, that impedes the protection of public health and undermines the solution to the pandemic, not the moral or intellectual failures of business people and political leaders.

Unfortunately, while the BMJ’s diagnosis is sound, its treatment plan—the liberal use of moral suasion aimed at pharmaceutical company investors and politicians—is next to useless.  Capitalism, an amoral system, does not respond to moral appeals.

The BMJ urges vaccine company workers and shareholders to speak out.

But shareholders, who, as the BMJ acknowledges, are “making a killing”, are not going to vociferate against a system that bestows generous financial rewards upon them. Employees who protest will likely lose their jobs; that should be deterrent enough to their speaking out. 

Leaders of rich nations are exhorted to pressure vaccine companies to share their technology.

But leaders of rich countries are not morally neutral parties, hovering dispassionately above the fray, disconnected from capitalist class politics or the pharmaceutical industry. It was these very same leaders who transferred to select firms the right to exploit commercially, publicly funded vaccine technologies, as it has been their practice to do with countless other innovations churned out of public labs (the internet, GPS, AI, to name but a few.) The architects of the system are not likely to be its grave diggers, or even agents of its temporary suspension.

Moreover, the leaders of the richest country, the United States, are interlocked with the pharmaceutical industry. Its interests are their interests. Moncef Slaoui, who oversaw the US effort to develop Covid-19 vaccines and therapeutics, held executive posts for many years at the pharmaceutical giant GlaxoSmithKline, a company in which he held $10 million in stocks. He was also a member of the Moderna board and had $12.4 million in stock holdings in that company. On top of these pharma-connections, he was a partner in Medicxi, a venture capital firm that specializes in biotech investments. Alex M. Azar II, his boss, worked for three years as president of Eli Lilly’s subsidiary in the United States.

As for the Biden administration, it has numerous direct and indirect connections to the pharmaceutical industry, and to Pfizer in particular. As Lee Fang has reported in The Intercept:

• Eric Lander, the White House science adviser, holds up to $1 million in shares of BioNTech, Pfizer’s vaccine partner. Lander has recently proposed a pandemic preparedness plan which pivots mainly on providing public funding to vaccine-makers to stockpile vaccines for use against potential pandemic pathogens.
• Susan Rice, Biden’s domestic policy adviser, holds up to $5 million in shares of vaccine-maker Johnson & Johnson and up to $50,000 in shares of Pfizer.
• Anita Dunn, who until recently was Biden’s senior advisor, is managing partner at the consulting firm she co-founded, SKDK, which does public relations and advertising work for Pfizer.

Pfizer is a top client of Albright Stonebridge Group, a consulting firm founded by former Secretary of State Madeleine Albright.  ASG counts among its former employees a number of high-level Biden administration figures, including:

• Linda Thomas-Greenfield, US ambassador to the United Nations.
• Jeffrey DeLaurentis, Thomas-Greenfield’s deputy.
• Victoria Nuland, Undersecretary of State for Political Affairs.
• Wendy Sherman, Deputy Secretary of State.
• Uzra Zeya, Under Secretary of State for Civilian Security, Democracy, and Human Rights of the United States.
• Molly Montgomery,  Deputy Assistant Secretary in the Bureau of European and Eurasian Affairs
• Philip Gordon, Vice President Kamala Harris’s national security adviser.

People who spend their careers working with or for pharmaceutical interests, and have financial stakes in pharmaceutical firms, can be expected to share the pharmaceutical industry’s point of view. This is the point of view of capitalist industry–that profits are the summum bonum. No one occupies a significant position in a capitalist state without an unswerving commitment to capitalist values. Except under the most extraordinary circumstances, capitalist governments will not pressure private enterprises to negate their obligations to their shareholders in order to prevent the illness and deaths of penniless foreigners who live in what a US president once infamously called—and rich countries treat as—“shithole countries.”

The BMJ fails to recognize that the interests of pharmaceutical company investors and those of the poor countries are irreconcilably opposed. There is an assumed common interest between these two parties, namely, the end of the pandemic. Yet, while the end of the pandemic would certainly benefit the poor, both in poor and rich countries, it would not benefit the vaccine oligopoly. Restricted vaccine supply and the monopoly pricing it allows, the opportunity to provide vaccines to a vast global market, and the prospect of an ongoing stream of revenue in vaccine boosters and vaccines for new variants, are manna for the pharmaceutical industry. For rich countries—those that produce vaccines or have purchased more doses than they need—the current state of affairs offers them leverage over the have-not countries; the have-not countries are dependent on the rich counties for access to vaccines, helping to ensure their continued pliability and openness to exploitation by the rich countries.

Clearly, a temporary waiver of patent rights would harm pharmaceutical company profits and deny rich countries their leverage, and therefore, it is naïve to expect pharmaceutical companies and interlocked political elites to voluntarily submit to demands that they sacrifice their interests for the good of the bulk of humanity. The whole idea of capitalism as an exploitative system is that the bulk of humanity exists as a means to the profit-making ends of a microscopic minority of billionaires. Profits, not people. To be sure, the Biden administration has withdrawn its objection to a temporary suspension of patent rights, but this may be a concession of little consequence. Germany and other rich countries continue to fight the proposal strenuously, and the WTO is slow-rolling the issue. If and when the waiver is approved, the damage it can do to vaccine oligopoly profits will be severely limited.

There is another reason for capitalist industry to oppose a temporary waiver. The lifting of patent rights would acknowledge what no capitalist proponent wishes to acknowledge, namely, that capitalism, or at least its intellectual property protection provisions, can produce suboptimal, even harmful, outcomes for the welfare of the majority of the world’s population. The capitalist zeitgeist holds, in contrast, that capitalism is philanthropic, a blessing for humanity. Once it is established that a pillar of modern-day capitalism is harmful for public health, it becomes easier to make the case that the system of wealth accumulation in the hands of a miniscule elite of billionaires and their servants is harmful in other ways as well—for example, in anthropogenic global warming and the promotion of war. Might calls be made for the suspension, or worse, elimination of capitalism as a danger to humanity? In other words, the notion that patent rights ought to be suspended even temporarily is equivalent to the idea embedded in the Communist slogan, “people, not profit”—to wit, that the explicit aim of capitalism is to produce profits for a minority, not to enlarge and protect the interests of the majority of the planet’s inhabitants. It doesn’t take a genius to see that a people-centered system is, from the point of view of the bulk of humanity, preferable to one whose sole aim is to satisfy the wealth accumulation imperative of a tiny elite of uncrowned monarchs. Arguing that the intellectual property rights this minority has conferred upon itself need to be suspended in the interests of the rest us, is a potential opening for a system-challenging  discussion. The BMJ editorial has provided that opening. It’s up to the rest of us to carry it forward.

Capitalism makes a suboptimal form of public welfare the possible, but never necessary, incidental outcome of profit-making. Optimal public welfare based on the elimination of the exploitation of humans by humans, and not profits, needs to become the sole organizing principal of society. The development of Covid-19 vaccines was made possible by public planning and spending. The leaders of rich countries recognized that capitalism was not up to the task of developing new vaccines. The costs were prohibitive and the risks just as great. Investors will not to risk their capital on an enterprise with a high probability of failure. Thus, a kind of socialism was pressed into service, under the rubric of Operation Warp Speed, to develop vaccines and therapeutics, in which the public assumed the risk. However, this was a socialism harnessed to capitalist requisites. Once the vaccines were developed, they were licensed exclusively to a  vaccine-making oligopoly. The costs and risks were socialized; the benefits privatized. But rather than privatizing the fruits of socialized innovation, vaccine technology could have been socialized and produced for need, not profit. The disincentives to sharing vaccine technologies would have been few, if any, under a system of production for need.

Under the same system, the question of how to address the pandemic would not have been biased, from the start, in favor of a techno-fix that amounted to an attractive vaccine and therapeutics business opportunity, rather than in favor of public health and social measures, which China and Vietnam demonstrated are sufficient to eliminate community transmission of the virus and which the WHO has repeatedly endorsed as a proven method of pandemic control. It now appears that vaccines may be incapable of preventing transmission of the virus; it is now obvious that the vaccine strategy—based on the notion that vaccines are the exit ramp from the pandemic—is clearly incapable of rescuing humanity from the pandemic. The end of the pandemic lies, as the director of the WHO, Tedros Adhanom Ghebreyesus announced on August 4, in “a comprehensive approach of vaccines in combination with proven public health and social measures that we know work” (emphasis added.) As the WHO has also pointed out, had rich countries acted quickly and decisively to implement public health and social measures in February and March 2020, the pandemic would have been averted. The rich countries failed to abort the pandemic in embryo, but in allowing a crisis to be born, created many lucrative business opportunities. 

The route to a system based on need, not profit, does not follow along the path of moral suasion and speaking truth to power. No matter how much they’re pressured, wolves will never act as sheep. Too often it is believed that any action, no matter how unlikely to bear fruit, is better than no action, but that’s doubtful. Actions which address symptoms (IP protections), and not causes (the capitalist interests IP protections serve), bring only temporary relief at best, and usually not even that. Actions which demand capitalists ignore the imperatives of capitalism to act as socialists—as if socialism is achievable within a capitalist framework—are quixotic. Pointless actions may be worse than useless if they foster illusions about where the problem lies and therefore what the possible solutions are.

To be sure, capitalist pharmacy is a moral scandal and crime against humanity, and not only in its production, pricing, and distribution of coronavirus vaccines, but in its operations from alpha to omega. A system designed to yield profit, not to protect and promote health, routinely produces suboptimal human health outcomes, if not outright harm. This is a virtual axiom. Recognizing that the problem is production for profit, carried out by private enterprises, organized by markets, and under the political control of governments dominated by plutocrats, is the first step on the road to a solution.  Another step is recognizing the promise inherent in the alternative: production for use organized by a consciously prepared plan, carried out by publicly owned enterprises, and under the political control of governments guided by democratic, not profit-making, concerns. In this kind of system resides any hope humanity has for solving its most daunting problems: the pandemic, climate change, the threat of terminal war, and the unnecessary poverty of most of humanity.