The TRIPS Waiver Proposal: An Equal Access Debate

By Simran Upadhyay and Sri Hari Mangalam

Introduction

The Agreement on Trade-Related Aspects of Intellectual Property Rights (hereinafter ‘TRIPS’) is a multilateral agreement encompassing intellectual property such as copyrights, trademarks, industrial designs, patents, undisclosed information etc. within its ambit.[1] Each of the intellectual property rights (hereinafter, ‘IPR’) defined in the TRIPS agreement provides for a minimum standard of protection, member countries’ obligations, IPR enforcement and dispute settlement procedures.[2] The main objective of TRIPS is to reduce barriers to international trade, to protect and enforce IPRs such that it balances rights and obligations, and contributes towards promotion and dissemination of technological innovation, technical know-how for economic and social welfare.[3] Additionally, the TRIPS provisions operate so that they do not themselves become impediments in facilitating trade.[4]

Keeping in mind these objectives, on 2^nd October 2020, India and South Africa tabled a proposal before the TRIPS Council seeking a waiver from implementing certain TRIPS provisions to treat, prevent and contain COVID-19 effectively.[5] The proposal was co-sponsored by other developing countries, such as Kenya, Eswatini, Pakistan, Mozambique, and Bolivia,[6] and was supported by Sri Lanka, Egypt, Cuba, Bangladesh, Nigeria etc. [7] However, developed countries, such as US, EU, Canada, Australia, Japan and others were against it, due to which the next two meetings after the initial proposal yielded no confirmatory results.[8]

While the proposal is still under deliberation, this article aims to briefly outline its contents, highlight a third-world global south perspective in favour of its implementation and discuss the legality of the proposal. Thereafter, it analyses the other inefficacious alternatives that have been mooted, to bring home the point that the waiver proposal is the only way for the procurement of vaccines to effectively and timely treat COVID-19 in the developing nations.

The Waiver Proposal

The South Africa- India proposal specifically requests waiver for developing countries of section 1 (copyrights), section 4 (industrial design), section 5 (patents) and section 7 (protection of trade secrets) of the TRIPS agreement.[9] Under the agreement, the product’s creator enjoys fifty years of copyright protection, ten years of protection from unauthorised use of industrial design by third parties and twenty years of patent protection. [10] Essentially, manufacturers of medical devices and diagnostic equipment use protection on industrial design to keep away competitors; patents grant the creator complete control over its product and prevents third parties from selling or importing the said products. [11] Further, section 7 of the agreement ensures that the clinical trial data, along with other data submitted by the country holding rights over the product is not unfairly commercialised. [12]

Thus, a combined reading of these sections implies that the waiver clause is being pushed forth to reduce the necessity of compliance with IPR related to COVID-19 drugs, vaccines, diagnostics, medicines, medical and other technologies. Additionally, the waiver is only meant for a temporary period until the virus is contained.[13]  The idea is to provide access to the vaccines to all nations since it is the solution to an exigent situation; however, this does not mean that IPR concerning all other products would be shared. It is only a temporary solution to equitably fight a global crisis but that does not mean permanently compromising the IPR guarantees of the member nations.  This relaxation in the legal requirements will aid in timely access, easy supply of treatments and vaccines at affordable costs to countries all across the globe. 

A Third-World/Global South Perspective

In most developing countries, public funding and access to efficient technology are inadequate for facilitating production and ensuring accessibility of medical products to satisfy burgeoning demand.[14] The waiver clause will permit developing countries to buy diagnostic kits, protective equipment, medicines, and vaccines and considerably expand their production. However, in a situation where only a few companies hold intellectual property rights over the vaccine, the limited production capacity will not be enough to immunise the entire population in these developing countries.[15]

The existing TRIPS agreement has the potential of impacting the prices.[16] For instance, under IPR laws, a creator of the vaccine is granted monopolistic patent rights over their technology, production, distribution, supply and the prices of the patented subject matter for twenty years. [17] This permits the creator to charge a hefty price for its vaccine and restrict its distribution for at least the next twenty years, which further restricts the third world countries’ access to such vaccines.[18]

Presently, countries such as the UK, USA, European Union, Canada, and Japan have already signed advance purchase agreements worth billions of dollars to secure promising vaccines such as Pfizer-BioNTech, AstraZeneca for its citizens.[19] This has instilled fear among developing countries, as hoarding of vaccines will lead to vaccine nationalisation,[20] where they will face the brunt of the scarcity of vaccines. In such a situation, having access to trade secrets and technical know-how would enable developing countries to manufacture similar vaccines with the same medical formula, without being penalised for IPR violations. In the absence of prior licensing being required from the patent owner, developing countries could revamp their production facilities and also export the vaccines to other countries which are devoid of such facilities.

Developing countries have been facing a serious economic crisis due to the pandemic.[21] With such shattered economics, third world countries will be unable to make big bets and procure COVID-19 vaccines from the potential manufacturers. During the 2009- H1N1 pandemic, the self-procurement rates of vaccines for African and South East Asian nations were only 6.5% and 8.7% respectively.[22] The low rates in the procurement of vaccines were mainly because of IPR laws, which required countries to pay hefty prices, and comply with vaccine licensing procedures.[23] Developing countries got access to the vaccines four months later than the developed countries, since the latter had manufacturers within their own territories who could export their products only when domestic needs were satisfied.[24] Developed countries that did not have manufacturing facilities within the country, opted for advance purchase agreements to get priority access to the vaccines, which further blocked purchase opportunities for developing nations.[25]      It was only with the Vaccine Deployment initiative of The World Health Organisation (hereinafter, ‘WHO’) that seventy-seven developing countries could procure vaccines out of targeted ninety-six countries.[26] However, there was a substantial delay in the supply of vaccines even under this initiative due to its cumbersome procedures.[27]

Hence, taking lessons from the past, it is evident that the TRIPS obligations must not be allowed to operate as barriers for third world countries in tackling the pandemic.  If the IP barriers are present, then owners of IPRs will try to eliminate competition in the market by creating a limited supply of vaccines and will have excessive control over its pricing. However, if the waiver is granted, it will be easy to supply medical devices, vaccines, and diagnostics at affordable rates since the increased manufacturers will reduce the monopolized control over vaccine pricing.

The Legality of the Waiver Proposal

Article 73(b) permits any WTO member nation to not abide by TRIPS agreement if it is an international emergency. COVID-19 is nothing but an international emergency.[28] Further, the basic premise of waiver proposal, i.e., to give weightage to public health, flows from the Doha declaration. The declaration reinforced the idea that right to health should be given primacy over IPR, such that the TRIPS agreement should be interpreted in a manner, which does not prevent countries from taking measures to promote public health.[29] Similarly, Articles IX 3 and 4 of the Marrakesh Agreement allow the WTO members the right to seek a waiver from TRIPS obligations in exceptional situations by providing proper justifications.[30] India and South Africa have justified why COVID-19 counts as an exceptional circumstance and how IPRs are a legal barrier for timely treatment and vaccination.[31]

Above all, Article 7, which lays out the objectives of the agreement and Article 8, which talks of the agreement’s principles, permits member states to adopt measures to promote public health and prevent misuse of IPRs. However, such measures cannot be inconsistent with the TRIPS provisions.[32] In this case, COVID-19 is a health emergency and the waiver proposal counts as a measure to promote public health. The proposal does not abuse IPR guarantees since such actions are justified under the law.[33]  The agreement allows waivers for exceptional and exigent situations as per the aforementioned provisions of the Marrakesh declaration[34] and the need for equitable access to vaccines validly qualifies as one, since its aimed at tackling a global pandemic.

Recently, the UN General Assembly Resolution No. A/RES 74/274[35]and WHO’s Director-General[36] regarded COVID-19 vaccines to be ‘global public goods’. A Global public good refers to goods that have a positive impact on everyone, and are non-rivalrous.[37] Hence, the waiver proposal would be an effective way to put this idea into action by sharing technical know-how, trade secrets on COVID-19 vaccines and thereby treating the vaccine as a global public good.

Above all, the International Covenant on Economic, Social and Cultural Rights binds the WTO member countries[38] that have either signed and ratified its provisions. Under Article 12, the member states’ core obligation is to prioritise right to health, including availability of drugs, essential medicines and health care facilities.[39] The Committee on Covenant on Economic, Social and Cultural Rights has clarified that IPRs are temporary measurers which can be revoked, but human rights are fundamental expressions guaranteed over a prolonged period.[40] Hence, public interest should be given more weightage than the interests of private actors.[41]  Further, the CESCR emphasised that the international community has the responsibility to contain transmissible diseases;[42] thereby justifying that right to health in case of transmissible diseases has an extraterritorial application. By this means, the opponents of the proposal are overlooking their core obligations under Article 12 and by hindering timely access to vaccines are negatively affecting the right to health in developing nations.

Thus, the waiver proposal carves out the parameters of the dealings from the legal framework itself, which should be abided by other member countries to fulfil their obligations towards other countries.

Other alternatives which are not efficacious as the waiver proposal

The lack of affordable medicines and inaccessibility to essential vaccines in developing countries due to IPR laws has been a vexing problem.[43] Envisaging the same problems that have arisen previously, WHO undertook two initiatives – The ACT Accelerator[44] and the COVAX Facility[45] to ensure equitable distribution of vaccines and treatments for COVID-19.

The ACT Accelerator aims to pool in financial resources and bring together private as well as public experts and institutions[46] to facilitate research that will speed up the development and distribution of COVID-19 related vaccines, medicines, diagnostics etc.[47] It is a G-20 initiative announced by Mohammed Al-Jadaan (pro-tem chair) aimed at pooling global resources and ensuring equitable access to Coronavirus essentials for all member nations.[48] COVAX Facility, the vaccine pillar of ACT Accelerator, provides for equitable access to vaccines to all its participating countries,[49] the COVAX Facility essentially pools in resources from its participating countries to invest in different promising vaccine candidates.[50] GAVI, the global vaccine alliance aims to procure vaccines for developing countries through the COVAX Advance Market Commitment that has proven sufficient to immunise health workers and extremely critical patients.[51] The facility promises to distribute vaccines at the same rate and equally to both the developed and developing countries.[52] Its role is to leverage the in-equitabilities in scale caused due to the participation of developed nations and ensure lower income nations have similar sway.[53] However, the ACT Accelerator has been facing financial gaps to fulfil its goal,[54] very few countries have contributed towards it[55] and many countries such as the US, Russia and China have simply refused to join the Facility.[56] COVAX still needs a total of 156 countries to reach its targeted procurement of two billion doses of vaccine by the end of 2021.[57]  Additionally, COVAX aims to provide vaccination for 20% of a country’s total population; however, this might be inadequate in countries with severe outbreak.[58] It may not be able to meet the required goal just like WHO was unable to during the 2009 HIN1 pandemic initiative undertaken.[59] As mentioned earlier, many developed countries have already signed multiple purchase agreements with vaccine manufacturers, which casts doubt whether there will be enough vaccines to reach the developing countries.[60] Even though South Africa is part of this facility, it is an upper middle-income country as compared to other participants. [61]As a result, it had to pay $12 –$13 dollars per vaccines which is much more expensive than other cheaper alternatives, developed by Serum Institute of India (hereinafter, ‘SII’).[62] This further aggravates the issue of accessibly, since South Africa is facing fiscal crisis,[63] and with the lack of sufficient funds it may not be able to sign comparatively cheaper deals with future manufacturers. Apart from COVAX Facility, there are other collaborations such as IV-A for European Union states[64] that aim to follow the similar advance purchase agreements with manufacturers, further hindering COVAX in fulfilling its equitable goal.[65]

In order to side-line the waiver proposal, its opponents in a WTO meeting pushed the proponents to adopt the “product-by-product” compulsory licensing approach, where manufacturers can produced generic variations of a product without the consent of its patent holder.[66] However to opt for this facility under Article 31bis of the TRIPS mechanism every product under a compulsory license has to be of specific quantity, packaging, labelling, and colouring.[67]. However, this flexible mechanism can be restrictive during the pandemic due to lack of institutional capacity and skilled labour, and stringent national laws of developing countries.[68] Maintaining homogeneity in such trivial matters will delay the distribution process further. In the meeting, India stressed that following article 31bis mechanism to support countries that do not have sufficient manufacturing capacity has proved cumbersome even in normal times.[69] The mechanism focuses on elaborate procedural requirements on imports and exports, [70] and hence has only been used once, since its inception in 2006.[71] Compliance with such TRIPS flexibilities under compulsory licensing is a must to produce generic versions of patented products, [72] which is a major problem in developing nations like India where factories are heavily labour based, which does allow them to meet the production scale of the more capital intensive nations. Therefore, article 31 bis mechanism is not a legal requirement that can be met by developing nations such as India, South Africa etc.,  

However, out of the two countries primarily backing the waiver, India may be at an added advantage compared to its counterpart South Africa. South Africa’s Bivoc Institute is beginning to enter into the process of vaccine manufacturing, but its capabilities are quite limited to India,[73] such that it may not be able to develop enough vaccines for its entire population alone. On the other hand SII, the world’s largest vaccine manufacturer has obtained authorisation to use AstraZeneca in India and developed a vaccine as well.[74] India in extension of its ideas against vaccine nationalization has shared doses with neighbouring countries and other nations in need. The SII has already made over 80 million doses and is producing close to 50 million doses a month, a significant portion of which has been pledged to the World Health Organization to provide to poor nations.[75] Moreover, a few nations that the country has already supplied the vaccine to include Bhutan (1,50,000 doses), Bangladesh (2 million doses), Maldives (1,00,000 doses) etc., However, India and a few other countries singlehandedly sharing vaccines will not be enough to flatten the Coronavirus curve globally and the only way to satisfy the global demand is by sharing the vaccine technology.[76] The transfer of technologies is necessary to speed up production in remote corners of the world and ensure equitability in the fight against a global health crises.[77]

Conclusion

In light of these difficulties, all the member nations must come together and agree to the waiver proposal, which is the most viable situation in this international emergency, and is also a preferable solution over the compulsory licensing approach. This proposal will only come through if South Africa and India manage to convince member states that the TRIPS flexibilities are insufficient in itself and the COVAX facility may fall prey to vaccine hoarding by rich countries. It is imperative that universal vaccination is achieved worldwide swiftly to effectively tackle the COVID-19 crisis.

The authors, Simran Upadhyay and Sri Hari Mangalam, are currently law students at the West Bengal National University of Juridical Sciences (NUJS), Kolkata.

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[1] World Trade Organisation, Overview: The TRIPS Agreement, available at https://www.wto.org/english/tratop_e/trips_e/intel2_e.htm (Last visited on January 30, 2021).

[2] Id.

[3] The Agreement on Trade-Related Aspects of Intellectual Property Rights, 1995,  Article 7.

[4] World Trade Organisation, supra note 1.

[5] Amit Sen, World Trade Organisation may hold TRIPS meet early next year for further discussion on waiver proposal, The Hindu Business Line, available at https://www.thehindubusinessline.com/economy/wto-may-hold-trips-meet-early-next-year-for-further-discussion-on-waiver-proposal/article33326698.ece#:~:text=%E2%80%9CAs%20countries%20could%20not%20arrive,in%20January%20or%20early%20February. (Last visited on January 30, 2021).

[6] World Trade Organisation, Members to continue discussion on proposal for temporary IP waiver in response to COVID-19, available at

https://www.wto.org/english/news_e/news20_e/trip_10dec20_e.htm#:~:text=At%20the%20meeting%20of%20the,in%20response%20to%20COVID%2D19 (Last visited on January 30, 2021).

[7] Amit Sen, World Trade Organisation may hold TRIPS meet early next year for further discussion on waiver proposal, The Hindu Business Line, available at https://www.thehindubusinessline.com/economy/wto-may-hold-trips-meet-early-next-year-for-further-discussion-on-waiver-proposal/article33326698.ece#:~:text=%E2%80%9CAs%20countries%20could%20not%20arrive,in%20January%20or%20early%20February (Last visited on January 30, 2021) ; Human Rights Action, Urgently waive Intellectual Property Rules for Vaccines, available at https://www.hrw.org/news/2020/12/10/urgently-waive-intellectual-property-rules-vaccine (Last visited on January 30, 2021).

[8] Amit Sen, World Trade Organisation may hold TRIPS meet early next year for further discussion on waiver proposal, The Hindu Business Line, available at https://www.thehindubusinessline.com/economy/wto-may-hold-trips-meet-early-next-year-for-further-discussion-on-waiver-proposal/article33326698.ece#:~:text=%E2%80%9CAs%20countries%20could%20not%20arrive,in%20January%20or%20early%20February (Last visited on January 30, 2021) ; Rupali Mukherjee, No Consensus WTO yet on IP waiver on COVID-19 vaccines and drugs, available at https://timesofindia.indiatimes.com/business/india-business/no-consensus-at-wto-yet-on-ip-waiver-on-covid-19-vaccines-drugs/articleshow/80372808.cms (Last visited on January 30, 2021).

[9] Joe C Mathew, India, South Africa ask WTO to waive off patents, intellectual property protection for faster COVID-19 care access, Business Today, available at https://www.businesstoday.in/current/economy-politics/india-south-africa-ask-wto-to-waive-off-patents-intellectual-property-protection-for-faster-covid-19-care-access/story/417668.html (Last visited on January 30, 2021).

[10] Id.

[11] Id.

[12] Id.

[13] Prabhash Rajan, Suspend international IP, patent obligations on Covid-19 vaccines, The Hindustan Times, available at https://www.hindustantimes.com/analysis/suspend-international-ip-patent-obligations-on-covid-19-vaccines/story-C8KL9pTmRcvaxvMOXhZcYN.html (Last visited on January 30, 2021).

[14]UNCTAD, UN to boost Health Tech Production for Covid-19, available at https://unctad.org/news/un-boost-health-tech-production-covid-19(last visited on February 27, 2021).

[15] Anoo Bhuyan, Patent Battles could choke coronavirus drugs pipeline: Carlos Correa, The Business Standard, available at https://www.business-standard.com/article/current-affairs/patent-battles-could-choke-coronavirus-drugs-pipeline-carlos-correa-120112100194_1.html (Last visited on January 30, 2021).

[16] United Nations Human Rights, Statement by UN Human Rights Experts Universal access to vaccines is essential for prevention and containment of COVID-19 around the world, available at https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26484&LangID=E#_ftn18 (Last visited on January 30, 2021).

[17] World Trade Organisation, Part II – Standard concerning the availability, scope and use of Intellectural Property Rights, available at https://www.wto.org/english/docs_e/legal_e/27-trips_04c_e.htm (Last visited on January 30, 2021).

[18] World Trade Organisation, Waiver from Certain Provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19, available at https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W669.pdf&Open=True (Last visited on January 30, 2021).

[19]Abhishek De, Explained: Vaccine nationalism, and how it impacts the Covid-19 fight, The Indian Express, available at

  https://indianexpress.com/article/explained/what-is-vaccine-nationalism-how-does-it-impact-the-fight-against-covid-19-6561236/ (Last visited on January 30, 2021) ; Saeed Shah, In Race to Secure Covid-19 Vaccines, World’s Poorest Countries Lag Behind, available at https://www.wsj.com/articles/in-race-to-secure-covid-19-vaccines-worlds-poorest-countries-lag-behind-11598998776 (Last visited on January 30, 2021).

[20] Abhishek De, Explained: Vaccine nationalism, and how it impacts the Covid-19 fight, The Indian Express, available at https://indianexpress.com/article/explained/what-is-vaccine-nationalism-how-does-it-impact-the-fight-against-covid-19-6561236/ (Last visited on January 30, 2021) ; UN News, WHO Chief calls for solidarity in financing, ensuring equal access to future COVID-19 vaccine, available at https://news.un.org/en/story/2020/08/1070162 (Last visited on January 30, 2021).

[21] US Global Leadership Coalition, COVID-19 Brief: Impact on the Economies of Developing Countries, available at https://www.usglc.org/coronavirus/economies-of-developing-countries/ (Last visited on January 30, 2021).

[22]  World Health Organization, Global Survey on National Vaccine Deployment and Vaccination Plans for Pandemic A(H1N1) 2009 Vaccine, available at http://www.who.int/influenza_vaccines_plan/resources/deployment/en/ (Last visited on January 30, 2021).

[23] Mark Eccleston-Turner, Vaccine Procurement during an Influenza Pandemic and the Role of Advance Purchase Agreement: Lessons from 2009-H1N1, Global Public Health (2015).

[24] Jeffrey Partridge and Marie Paule Kieny, Global Production of seasonal and pandemic (H1N1) influenza vaccines in 2009-2010 comparison with previous estimates and global action plan targets, 28(30) Vaccine (2010). 

[25]  Turner, supra note 23.

[26] World Health Organization, Main Operational Lessons Learnt from the WHO Pandemic Influenza A (H1N1) Vaccine Deployment Initiative, available at https://apps.who.int/iris/handle/10665/44711 (Last visited on January 30, 2021).

[27] Id.

[28] World Health Organisation, COVID-19 as a public health emergence of International Concern under the IHR, available at https://extranet.who.int/sph/covid-19-public-health-emergency-international-concern-pheic-under-ihr (Last visited on January 30, 2021) ; Frederick Abbot, The TRIPS Agreement Article 73 Security Exceptions and the COVID-19 Pandemic, South Centre, available at https://www.southcentre.int/wp-content/uploads/2020/08/RP-116.pdf (Last visited on January 30, 2021).

[29] World Health Organization, The Right to Health, available at https://www.ohchr.org/documents/publications/factsheet31.pdf (Last visited on January 30, 2021).

[30] Brook Baker, South Africa and India’s Proposal to Waive Recognition and Enforcement of Intellectual Property Rights, available at https://healthgap.org/south-africa-and-indias-proposal-to-waive-recognition-and-enforcement-of-intellectual-property-rights-for-covid-19-medical-technologies-deserves-universal-support-but-countries-also-have-to/ (Last visited on January 30, 2021).

[31] Third World Network, Developing Countries continue to block TRIPS Waiver proposal, available at https://www.twn.my/title2/intellectual_property/info.service/2020/ip201108.htm (Last visited on January 30, 2021).

[32] World Trade Organisation, supra note 1.

[33] As explained in the preceding paragraphs.

[34]World Health Organization, Supra Note 30.

[35] United Nations General Assembly, U.N. Doc. A/RES 74/274 (April 21, 2020).

[36] World Health Organisation, WHO Director-General’s speech at the Paris Peace Forum Panel: ACT-A: Covid-19 Vaccines, Tests and Therapies, the Global public good Solution, available at

https://www.who.int/director-general/speeches/detail/who-director-general-s-speech-at-the-paris-peace-forum-panel-act-a-covid-19-vaccines-tests-and-therapies-the-global-public-good-solution—12-november-2020 (Last visited on January 30, 2021).

[37] Gavi, Are Vaccines a global public good? available at https://www.gavi.org/vaccineswork/are-vaccines-global-public-good (Last visited on January 30, 2021).

[38] US, EU, Canada, Australia, Japan.

[39] The Agreement on Trade-Related Aspects of Intellectual Property Rights, 1995, United Nations Committee on Economic, Social, and Cultural Rights, General Comment No. 14: The Right to the Highest Attainable Standard of Health, available at http://www.ohchr.org/Documents/Issues/Women/WRGS/Health/GC14.pdf (Last visited on January 30, 2021).

[40] UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 17: The Right of Everyone to Benefit from the Protection of the Moral and Material Interests Resulting from any Scientific, Literary or Artistic Production of Which He or She is the Author, available at https://www.refworld.org/docid/441543594.html (Last visited on January 30, 2021).

[41] Id.

[42] United Nations Committee on Economic, Social, and Cultural Rights, supra note 41.

[43] Saeed Ahmadiani, and Nikfar Shekoufeh, Challenges of access to medicine and the responsibility of pharmaceutical companies: a legal perspective, 24(1): 13 Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences  2016.

[44] World Health Organization, The Access to COVID-19 Tools (ACT) Accelerator, available at  http://www.who.int/initiatives/act-accelerator (Last visited on January 30, 2021).

[45] Gavi, What Is the COVAX Pillar, Why Do We Need It and How Will It Work?, available at  http://www.gavi.org/vaccineswork/gavi-ceo-dr-seth-berkley-explains-covax-pillar (Last visited on January 30, 2021).

[46] Institutions such as The Bill and Melinda Gates Foundation, CEPI, FIND, Gavi, The Global Fund, Unitaid, Wellcome, and the World Bank have either contributed or participated in this initiative.

[47]United Nations India, ACT Together to End COVID-19, available at https://www.un.org/en/coronavirus/act-accelerator (Last visited on January 30, 2021).

[48]Reuters, G-20 launches initiative for health tools needed to combat the coronavirus, April 26, 2020, available at https://www.reuters.com/article/health-coronavirus-g20/g20-launches-initiative-for-health-tools-needed-to-combat-the-coronavirus-idUKL5N2CD0LA (Last visited on February 27, 2021).

[49] Gavi, COVAX Facility, available at https://www.gavi.org/covax-facility (Last visited on January 30, 2021).

[50] Id.

[51]  Gavi, Gavi Launches Innovative Financing Mechanism for Access to COVID-19 Vaccines, available at

http://www.gavi.org/news/media-room/gavi-launches-innovative-financing-mechanism-access-covid-19-

vaccines (Last visited on January 30, 2021).

[52]  Gavi, supra note 49..

[53]Gavi, The Gavi Covax AMC Explained, available at https://www.gavi.org/vaccineswork/gavi-covax-amc-explained (Last visited on February 27, 2021).

[54] Express Healthcare, ACT Accelerator faces $35 billion current financing gap : WHO DG, available at  https://www.expresshealthcare.in/news/act-accelerator-faces-35-billion-current-financing-gap-who-dg/425007/ (Last visited on January 30, 2021) ; Jenny Lei Ravelo, The ACT- Accelerator needs $35 billion more funding. Here’s what’s at stake if it fails, Devex, available at https://www.devex.com/news/the-act-accelerator-needs-35b-more-funding-here-s-what-s-at-stake-if-it-fails-98189 (Last visited on January 30, 2021).

[55] Saeed Shah, Developing Nations Push for COVID-19 Vaccines without the Patents, The Wall Street Journal, available at https://www.wsj.com/articles/developing-nations-push-for-covid-vaccines-without-the-patents-11605614409 (Last visited on January 30, 2021).

[56] Euronews, Coronavirus vaccines: US, China and Russia absent from WHO’s equal access COVAX coalition, available at https://www.euronews.com/2020/09/22/coronavirus-vaccines-us-china-france-and-germany-absent-from-who-s-equal-access-covax-coal (Last visited on January 30, 2021).

[57] Helen Branswell, 64 High-Income Nations Join Effort to Expand Global Access to COVID-19 vaccines, but U.S. and China do not, Stat, available at https://www.statnews.com/2020/09/21/64-high-income-nations-join-effort-to-expand-global-access-to-covid-19-vaccines-but-u-s-and-china-do-not/ (Last visited on January 30, 2021) ; Kaitilin Mara, Decision on Intellectual Property Waiver Over COVID Technology on hold till 2021 : What are the Next Steps ? available at https://medicineslawandpolicy.org/2020/12/decision-on-intellectual-property-waiver-over-covid-technology-on-hold-till-2021-what-are-the-next-steps/ (Last visited on January 30, 2021)

[58] Shashank Bengali and Kate Linthicum, Rich Countries are hoaring COVI-19 vaccines, Elsewhere, the pandemic may keep killing for years, Los Angeles Times, available at https://www.latimes.com/world-nation/story/2020-12-22/rich-nations-snap-up-covid-19-vaccines-leaving-less-for-the-poor?utm_source=dlvr.it&utm_medium=twitter (Last visited on January 30, 2021)

[59] World Health Organization, supra note 29.

[60] DW, Fact-Check: Will Poor Countries Miss Out on COVID-19 vaccinations, available at https://www.dw.com/en/fact-check-will-poor-countries-miss-out-on-covid-19-vaccinations/a-55886334 (Last visited on January 30, 2021); Canada has purchased vaccines to vaccinate its population five times over.

[61] The Conversation, South Africa Failed to Get its Act Together on Vaccines: Here’s How, available at https://theconversation.com/south-africa-failed-to-get-its-act-together-on-vaccines-heres-how-153384 (Last visited on February 27, 2020).

[62] Id.

[63] Michael Sachs, Fiscal Dimensions of South Africa’s Crisis, Southern Centre for Inequality Studies, Working Paper 5 (forthcoming) (Last visited on February 27, 2020).

[64]Rueters, EU agrees first COVID-19 vaccine deal with AstraZeneca in WHO blow, available at https://www.reuters.com/article/us-health-coronavirus-eu-astrazeneca-idUSKCN25A1A7 (Last visited on January 30, 2021).

[65] Id.

[66] Weinian Hu, Compulsory Licensing and access to future Covid-19 Vaccines, CEPS Research  Report, available at https://www.ceps.eu/ceps-publications/compulsory-licensing-and-access-to-future-covid-19-vaccines/ (Last visited February 27,2020).

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[69] Third World Network, supra note 31.

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