As India grapples with a devastating Covid wave that has overwhelmed its hospitals, offers of aid, including from Australia, have flooded in from around the world.

The help on offer has focussed on medical supplies such as ventilators, personal protective equipment and even oxygen from India’s traditional foe Pakistan. But the quantity of equipment on offer is dwarfed by the mammoth task of vaccinating the country’s 1.4 billion citizens and the ultimate effort to protect the country from future outbreaks.

And Australia, along with a handful of other wealthy nations, is not making that task any easier, so far refusing a plea made by India in October to help ramp up vaccine access for developing nations.

India is leading a push from lower and middle income nations at the World Trade Organization to suspend vaccine patents to allow cheaper versions to be manufactured and sold.

Human rights organisations, vaccine experts, trade unions and aid groups have called on the Australian government to change its position, citing ethical responsibilities and the risk that allowing the virus to mutate in developing nations poses to vaccine efficacy in developed nations.

Ahead of a key meeting at the WTO on Friday, here’s everything you need to know about India’s proposal and why Australia is yet to get on board.

What do developing nations want?

In October, India and South Africa submitted a proposal to the WTO to suspend Covid vaccine patents for successful jab formulas invented by pharmaceutical giants such as AstraZeneca and Pfizer for the duration of the pandemic so poorer countries could acquire more affordable doses faster.

A suspension is needed because the existing WTO rules require member nations to provide patent protection for at least 20 years.

The proposal, to waive patent protection only for the duration of the pandemic, has been supported by more than 100 countries, mostly lower and middle income nations, to be able to manufacture and sell cheaper generic copies of vaccines to help achieve a quicker end to the global pandemic.

More than 85 poor countries are not predicted to achieve widespread vaccination rollout before 2023, if at all, because of licensing rules and distribution limits that the World Health Organization director general, Dr Tedros Adhanom Ghebreyesus, has labelled a “catastrophic moral failure”.

Tedros, along with vaccine experts and human rights groups including Médecins Sans Frontières and Amnesty International, have also warned that the longer Covid-19 circulates in developing nations, the greater the chance more deadly and vaccine-resistant variants emerge that could stifle immunity in wealthy, well-vaccinated countries.

But the proposal has failed to win enough support.

Why hasn’t the waiver been agreed to?

There are a few reasons.

Despite more than 100 low and middle-income countries supporting the waiver, pharmaceutical companies and governments in the US, UK and Europe are strongly opposed to the waiver.

Pharmaceutical companies opposed to the waiver are understood to be lobbying governments against the proposal, especially in countries home to companies involved in Covid vaccine research and development.

The Swiss-based International Federation of Pharmaceutical Manufacturers and Associations has argued that cutting companies’ returns is a disincentive to innovation.

When the WTO’s Trade-Related Aspects of Intellectual Property Rights (Trips) last met to discuss the waiver in March, the proposal was ultimately brought down by Britain, Switzerland, EU nations and the US – because of the WTO’s consensus-based system, as opposed to a majority voting system.

Dr Patricia Ranald, convener of the Australian Fair Trade and Investment Network, said: “It is remarkable in a forum like this when we’re talking about medicines and vaccines that will save peoples’ lives that six or eight countries can block it for them.”

Why is Australia holding out?

While human rights and aid groups remain furious that Australia hasn’t supported the waiver proposal, it also hasn’t blocked it to the extent the US and UK and some other countries have.

At the most recent Trips meeting in March, Australia was part of a last-minute attempt, along with New Zealand and Canada and three other countries, which urged the WTO to help individual countries negotiate with pharmaceutical companies.

Australia’s position would still require poorer countries and those manufacturing the generic vaccines to pay for rights to formulas.

Ranald said: “The Australian proposal would still result in delays because current WTO flexibilities require each country to negotiate with each pharmaceutical company for access to each vaccine.”

“This puts the profits of pharmaceutical companies above the lives of billions in low-income countries. The temporary patent waiver is a quicker and fairer way of ensuring access to vaccines. That is why most low-income countries support it.”

Asked about the waiver, trader minister Dan Tehan in March said “we’ve got to make sure that there are some protections in place for the millions of dollars that has gone into the research to create these vaccines.”

A department of foreign affairs and trade spokesman, when asked if Australia’s position would change at the Trips meeting on Friday 30 April, insisted “Australia has not sought to block the proposed waiver of international IP rules”, but would not clarify if it would seek any compromises.

Will the waiver really make a difference?

In short, yes. But while vaccine experts believe it is an important step towards increasing the scale and speed of the world’s vaccine rollout, they note it is unlikely to be an instant fix for developing nations.

Ranald said the waiver would have helped countries like India with its current outbreak had it been accepted last October, noting that while India is manufacturing vaccine doses, the bulk of what it’s producing “is being taken up” by orders made by European countries “that could pay more” to get in earlier.

Ranald, and many aid groups, believe the waiver would provide for poorer countries on a scale that donations cannot achieve.

“There has to be change to open up the capability of developing countries to have quicker and broader access to vaccines. You need to have manufacturing in Africa, and more in India.

“We hope Australia will change their mind. But it’s pretty clear the current system isn’t working, and the efforts that Australia’s making to give so many vaccines to Papua New Guinea or offer help to India, the scale of those things is not adequate compared to what the patent waiver could achieve.”

While she noted Australia’s pharmaceutical lobby was vocal in opposing the waiver, she said, given Australia’s status as a high income and “quite influential middle sized power”, Australia supporting the waiver proposal could “have quite a lot of influence”.

Meanwhile, in the US, the Biden administration is also coming under pressure to support the proposal.

Regarding mutations, Robert Booy, a University of Sydney professor of vaccinology told the Guardian: “Covid is going to continue to evolve, and we remain concerned that the longer we let it evolve, a variant may arise that is poorly covered by any vaccine. That’s a real worry.”

Booy said the unfolding situation in India highlights how important spreading the vaccine quickly to stop “triple and even quadruple” mutations developing.

“It’s really important that Australia pushes the agenda to share, not block the vaccine.”

Labor wants to see the government do more at the WTO to ensure widespread access to vaccines.

Opposition trade spokeswoman Madeleine King told the Guardian that while the patent waiver was “one option”, the government should also explore article 31 of the Trips agreements, which could allow WTO member nations to issue licences for the production of vaccines to third parties without the express permission of the patent holder.

“Not only is it in Australia’s interests – it is the right thing to do.” King said.

This content first appear on the guardian

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