A vaccine against COVID-19 is humanity’s best shot at ending this painful pandemic. But how can we ensure that a vaccine is available to all people, all countries, free of charge? As we continue our #InequalityVirus miniseries, we talk about the need for a #PeoplesVaccine, what to do about the big pharma profits and vaccine nationalism that stands in the way and what we can learn from iconic struggles to fight for access to medicines like the victories by HIV/AIDS activists.

Nabil and Max speak to two amazing activist-advocates with a fascinating and powerful track record in the fight for access to medicines, Achal Prabhala (fellow at the Shuttleworth Foundation and Coordinator of the Accessibsa project) and Dr Mohga Kamal-Yanni.

We kick off with Achal Prabhala, who has been involved in the fight for access to medicines for the past 18 years. He supports the push for a #PeoplesVaccine and welcome the attention that the fight is finally getting.

Getting right into it, we want to know if we can really trust big pharma to make the vaccine available to all, free of charge. Achal responds, “…There is absolutely nothing we have that will allow for that unless we change the structures we have, the laws we have and the manner in which we have thought about access to medicines. … And then I think there is the connected idea that national solutions in the sense we could have thought about them in the past won’t work for the pandemic. So, it actually won’t matter to the United Kingdom or to the United States if they can strongarm a miracle cure or vaccine for their citizens because the problem won’t go away unless it goes away in the entire world… (because) when COVID-19 exists anywhere in the world, it’s a threat even to places where it doesn’t necessarily exist.”

Intellectual Property rights are described as barrier to supply of medicines. Max asks why this is and Achal explains, “…AIDS drugs were developed in 1996… The distance, between New York City and Johannesburg, which takes 16 hours to fly between these two cities, …took 8 years to bridge in terms of AIDS medicines reaching Johannesburg. The only reason it took 8 years for those drugs to reach Johannesburg was intellectual property, which is a fancy way of saying, monopoly. … It meant that one company could decide what price these drugs would be sold at. … It was completely unaffordable not just to individuals but to Governments in Sub-Saharan Africa or in South Asia or East Asia where the entire epidemic of AIDS had moved. … One of the best recent examples…is the pneumonia vaccine…which was developed in 2013 and is the monopoly property of a giant pharmaceutical company, Pfizer. …The price that it costs the Indian government to buy it at, even after subsidies, is so high that they cannot afford to buy as many as they need for the 13 million babies born every year in India and as a result, today in 2020, there are 127,000 infant deaths due to Pneumonia recorded every single year in India, 40 years after pneumonia became a preventable condition and 7 years after the latest version of a foolproof vaccine was brought to market!”

Nabil wears his neoliberal hat to challenge Achal, noting that patents are incentives for the creation of new treatments that the world needs. Achal pushes back strongly, “…It both works in the worst ways and fails in the worst ways. One of the most glaring ways in which it fails is that it fails to provide any kind of new treatment for diseases that are primarily experienced by poor people. …The important thing to remember is that most of the investment that comes into the pharmaceutical industry …is taxpayer money. When we say Government money, I think sometimes we obscure where that money comes from. This is taxpayer money and Bernie Sanders had a very eloquent way of putting it a couple of months ago. He said, ‘why are American customers paying for medicines twice? First, they are paying for the development of these medicines through their tax contributions and then buying them back at a market price that a monopolist decides.’”

Nabil then asks what conditions Governments are putting to these investments. Achal answers, “… That’s not what’s happening here… So what they’re hoping for is that the model we had before the corona virus pandemic, which took 8 years to get AIDS medicines to South Africa; which has taken like 40 years and counting to get the pneumonia vaccine to India, is going to be the same one that will solve the pandemic in under a year, right? It’s just absurd, but there’s a more important thing. … We need supply but there is an unprecedented number of doses and vials of treatments and vaccines that we’re going to need to get out of these. And none of these companies is capable of supplying that even to one country.”

What about the gestures we have seen from big pharma, such as Astra Zeneca promising to sell the vaccine at cost price: are they genuine? According to Achal, “…Any statement that doesn’t come with specific commitment and details should be treated with enormous suspicion. I think pharmaceutical companies are fully aware of their reputation in the world prior to the pandemic and now are aware of the massively increased scrutiny on them. So of course (they) have to mouth off any number of platitudes about access.”

We ask him what he would differently if he was in-charge and he says, “The truth is there is only one way to get treatments and vaccines to everyone everywhere, which is to strip (them) of any monopoly power whatsoever so that anyone, anywhere can manufacture them. There is a second solution however, which I think is a very viable alternative … if rich countries commit to it. This is the COVID-19 technology pool. … We need cooperation in creating a vaccine. And then we need competition in terms of supplying the vaccines. … We are doing it exactly the wrong way around. And this very frustrating because it is entirely in the control of the richest Governments on earth to fix.”

So, where does he find hope? He says, “I think that if there is anything to be hopeful about in this corona virus pandemic, it is that we all are affected in ways that possibly hasn’t been true in a century since the last great flu pandemic. I think there is hope that we will find a more humane and cooperative way to exit the coronavirus pandemic given the scale of attention, number of people who have been infected (and) unfortunately, given that rich white people in rich white capitals have been affected by it. What I would really like to have come out of this, is some substantial difference in the structure that we have to produce medicine for us…not just for this pandemic, but for all time.”

After that truly educative interview, we speak to Dr. Mohga Kamal-Yanni, who is like a Yoda figure in the access to medicines world. We talk about how past victories in the fight to access to medicine took place and what she thinks we can do in this fight for a #PeoplesVaccine.

We start with what keeps her going. In a wave of emotion, she says, “…How unequal the world is, that what decides whether you have access to medicine or not is not you as a patient or your needs, or your doctor, but actually how much is in your pocket and how much … the medicine is. And that is just not fair. I remember in 2001 I was in the UN big building in New York and I faced this HUGE picture of an African woman, maybe 40 years old or something like that. She was like lying down on her death bed and somebody next to her holding her hand. And under the picture, there was this text: you shouldn’t die alone. And I just cried, because at that time, there were medicines available. And I just wanted to scream at the top of voice and say, YOU SHOULDN’T DIE, FULLSTOP. Because she shouldn’t die. She should have the medicine and not die. I will never forget that picture and ill never forget that moment. I’m talking to you now and I feel like I want to cry, because it just really grips the heart that some people can have the medicine that keeps them alive but they actually don’t because of the system we have for charging the medicine and charging healthcare.”

We ask what we can learn from past victories and she says, : “To be honest, as I’m involved in this COVID-19 work, there is lots of déjà vu in the story and lots of things that are similar to HIV even beyond medicine. The misinformation, the inequality, the gender issues. … HIV was one of the biggest victories I think in access to medicine. It was a death sentence and these people who got together (from across the world) really just wouldn’t accept that. We wouldn’t accept the injustice in the global system…and I think that was one of the reasons that that movement was successful. The other thing was that we listened. We learned about it (all). … So, we started following what pharma does and basically naming and shaming. I must say, pharma did something ridiculous. … 39 companies took the late Nelson Mandela to court…over a law that would allow the medicines to be available at some affordable price. At that time, South Africa was like the hardest hit with HIV. The movement over the world really hammered pharma really hard and the good media followed and at the end they had to withdraw the case. That case has become like a landmark case in pharmaceutical companies’ history and they learned a lot! But come to COVID-19, if any company goes crazy on price or monopoly, they will have a hard time. So, I think we should … have this COVID-19 pool so that the vaccines can be produced by companies and be available at low price to everybody who needs it.”

Does she have hope that access to medicine can fundamentally change as a result of the pandemic? Vehemently, she says, “Yes! It’s a big opportunity. If it doesn’t change for a pandemic, how can the system change in ‘normal’ life?”

Do listen to the full episode and do share with friends and family. If you would like to know more about the #PeoplesVaccine, please visit www.peoplesvaccine.org . Send us any questions or comments to equals@oxfam.org or on Twitter @EQUALSHope .