 We now know that vaccination is the only sustainable route out of the panel. Yet, there is a cross-iniquity in vaccine distribution around the world. The WHO has recently warned that COVAX, its vaccine-sharing program, is running out of supplies. COVAX has delivered 90 million doses to 131 countries, but more than half of eligible countries do not have sufficient supplies and some have run out altogether. Africa's specialties are in a difficult situation as cases surge across the continent less than 2% of the population have been vaccinated. To quote the related general WHO, the number of doses administered globally so far would have been enough to cover all health workers and older people if they have been distributed equitably. We could have been in a much better situation. In this webinar, Jaitik Ghosh makes a provocative and important argument. By temporarily waiving intellectual property rights and promoting transfer of knowledge and technology to enable public production of the vaccine, the supply issue would have been alleviated. As it stands, the patent system may be delaying the end of the pandemic and protecting the profits of pharmaceutical companies. Jaitik Ghosh is professor of economics at the University of Massachusetts at Amherst, U.S. She has taught economics at Jihalan University in New Delhi for nearly 35 years. She has authored or edited 20 books, including the Making of a Catastrophe, COVID-19 in the Indian economy, which is forthcoming this year, published by Ellup Books. Never done and poorly paid women's work in globalizing India, women unlimited, in New Delhi in 2009. She has co-edited the Elgar Handbook of Alternate Theories Economic Development 2014. She's also published a book on the women's work, women workers in informal economy, which is also forthcoming published by Outledge, and nearly 200 scholarly articles. In 2021, Jaitik was appointed to the WHO's Council on the Economics of Health for All, chaired by Mariana Mazukat. Very pleased to have Jaitik providing the webinar today. He also is a commentator who is a leading scholar in the global and cross-national politics intellectual property. Ken Shadlin is a professor of studies in the Department of International Development at LSE. In fact, in his book, Coalitions and Compliance, the Political Economy of Pharmaceutical Patents in Latin America, can analyze this difference in how countries introduced pharmaceutical patents in the 1990s and subsequently revised its patents in 2000. So very relevant for the current discussion. Now to a few logistical issues. Please stop in your questions using the Q&A feature that you see on your screen. I will read out the question on your behalf. The webinar will be recorded and shared later on a YouTube channel afterwards. I would now like to invite Jaitik to present the webinar. Jaitik, over to you. Thanks. Thank you very much, Kunal. It's a pleasure to be here. And I'm not going to waste more time. Let's just go straight into the issue. As you can see, the topic is already mentioned. Let's just begin with some background on this pandemic. Of course, we've had endless discussions and analysis of it already. But I think there's one particular aspect that is not often noted so much, which is the background that in the first wave, the north was disproportionately affected. I think it's because this is unlike previous epidemics, previous recent epidemics, such as, you know, Ebola, the H1N1, the SARS, MERS virus and so on, which dominantly affected developing countries and Asia and Africa. By contrast, this one, although it began in China, it really affected Western Europe and the North America, much more dramatically. I would argue that the pattern of policy response is very significantly affected by that. The design, which is to say containment through lockdowns, through restriction of mobility and economic activity, through what is called social distancing, more correctly physical distancing of people, etc. These are really designed for developed economies. I would know and I'm sure many of the listeners would know in most developing countries, especially in highly congested urban slums and even in many rural parts. This is really not possible. You cannot do physical distancing because living and working conditions simply don't allow it. More than 70% of workers across the developing world are informal, that is without legal and social protection. And so imposing lockdowns that prevent them from earning their livelihood actually requires very dramatic increases in social protection, which is often physically impossible for them to do. So, this is really a strategy that is designed for developed countries. I would also like to mention the urgency of the global response with vaccine development. We had a dramatic stepping up, and I'll come back to that in a minute. We had a dramatic stepping up in terms of both public investment and public support for vaccine development, unlike anything we saw in the previous epidemics. And so therefore the nature of this global policy response reflects global inequality and power imbalances already. My friend, the economist as Subramanian from Mids has actually pointed out that this shows how some viruses are more equal than others. But what we do find therefore is that the pattern of response has reflected inequality, but it's also added to those. So, as a result of the fact that the first wave affected Northern Europe and North America very sharply, even today, that is rather yesterday, the cumulative deaths per population are the highest in these regions, and now Latin America is rapidly catching up. The number of deaths in India is widely known to be an undercount, the most recent estimates from Uttar Pradesh from detailed district level data suggest that the undercount is anywhere between 14 to 55 times the official count. So I think if we had the actual numbers for India we would find India also in the very dark spot in this map, but nonetheless you can see that, you know, the deaths per population still are relatively concentrated in the western hemisphere, and in Northern Europe. On the other hand, we also know that this pandemic operates in waves. And what we found therefore is that certain waves. The Indian wave is now rising and has just come down again Brazil is on, it appears to be the third wave. The United States had a major second wave that actually led to dramatic increases but we are now in a phase of apparent decline in some countries, largely because of vaccination I think this is the point that Kunal had already made Brazil it's still rising and India, we don't know everybody's anticipating a third wave but it, given the slow pace of vaccination it could well be India also. Now, why did this happen. Essentially, we know that the only way we will control this pandemic eventually is to vaccinate at least 70 maybe 75% of the population. And yet, we find that the way vaccines have been produced and distributed, it's become a major stock stock, it reminded of the nature of the inequality. There's a vaccine grab by rich countries. There's the protection of intellectual property rights of the farmer companies big farmer if you like by rich country governments. Vaccine distribution has reflected extreme nationalism, but also the use of soft power diplomatically I'll come to that. Now, all of this is rather bizarre because you know we realize now and surely the last year and a half should have made us realize even more that a pandemic will not be overcome unless it is overcome everywhere. And as long as there are people contracting this disease, we are not going to be safe, even with vaccination. It's also the problem that mutations of the virus are much more likely, especially with large unvaccinated populations, and they affect economic prospects in both the developed and the developing countries. We have the delta plus variant in India is the double mutant, and they have been recent concerns that this is actually not just more infectious and more fatal, but less likely to be impacted by vaccination. So we've just been lucky so far that the current vaccines including the mRNA vaccines are able to control the disease, despite the new mutants, but these are continuing to mutate we cannot be sure that this will occur in future. So here's the vaccine apartheid for you. The share of people who have received at least one dose of the COVID vaccine as a, as you can see, among the developing countries, it's really only Chile and China Mongolia that are, you know, reasonably up there in terms of the, the kind of vaccination that they have been able to do. And this reflects the kinds of inequality the forces that I had mentioned earlier. There are many parts of Africa where not even a single dose has been provided and as Kunal mentioned for the continent as a whole, only 2% less than 2% have been vaccinated at all this is just one dose this is not full protection. It's a very much it's a north-south divide, global north and global south, obviously, other than as I mentioned China and Chile, incidentally both countries have benefited from the Chinese vaccine Sinofarm and Sinovac. And look at the share of people that this gives you both the single and double dose. And the United Kingdom and Israel and Chile are at the top of the list in terms of the proportion of the population reaching levels of herd immunity supposedly except that in the United Kingdom we still find concerns about mutant variants and they're still in semi laptop for various reasons. But once again you will see that this is only the countries for which you can get the division between second and first dose. You can see that there's a combination of things going on. There is of course availability which is the major restriction for most of the developing world, but there's also vaccine hesitancy. And this is very strong in some countries you will see in Russia, where they produce their own vaccine, that they have been unable to persuade a large part of their population to actually go in for vaccination and we find vaccine hesitancy. Even in the United States where I'm based at the moment, where the vaccination program has just plateaued it's just stopped mainly because a very significant proportion of adults is unwilling to get themselves vaccinated. So, what are the constraints, what's the problem. Well, fundamentally the most basic problem globally is that there isn't enough. Okay, there's an inadequacy of supply because production is not sufficient. And then of course the distribution is skewed because of vaccine grabbing by retinations. The internal distribution is also messy and in many states incompetent. Even when they have vaccines they've not been able necessarily to distribute them either equally often it reflects internal inequalities and discrimination and power imbalances as well. And I have already mentioned the vaccine hesitancy. This wasn't supposed to happen as early as March 2020 there were discussions about how we can prevent this and the covax, which is the COVID-19 vaccines global access facility it's part of something called the act accelerator WHO, the World Health Organization created something called access to COVID-19 tools, which at covax is one of the elements of it that's the one that's supposed to distribute vaccines. There's another part of it which is supposed to share technology but we come to that. Now covax was created specifically to prevent hoarding by rich country governments and ensure accident vaccines to everybody, especially the world's poor. By mid 2021 that is now we have it has 190 countries. So, most of the world's population. The Trump administration has stayed out of covax Biden joined it in February. So pretty much all the major important countries had joined it. So what's the idea the idea is that the member countries all can access vaccines by the richer and middle income countries would pay for their doses and would contribute to a fund that fund would then enable the low income countries to receive free doses. And the idea was that there would be a sort of needs based distribution first 3% of the population that's essential health workers and extremely vulnerable. Then 20% which covers older age groups and the next more vulnerable, then focus on areas that are very vulnerable because the epidemic is spreading rapidly and people who are more likely, and then finally all of the country's population. The problem is that this covax is hugely underfunded. The estimate was about 24 billion would be required, at least in the first year and a half, only 5 billion has been raised. And, as I mentioned covax has not been able to purchase vaccines as required and so therefore it's, it's not just that it's underfunded but doesn't even able to buy vaccines. And why because there was a major design flaw in covax, which was that it did not prevent bilateral deals between vaccine companies and governments. Now, there is a problem that the covax pricing itself is not transparent. And this is the second design flaw is actually the biggest and most significant because what we found is that governments, especially in the developed world, basically sought out their big pharma, or other countries big pharma and did deals. So within a month of the regulatory approval for the Pfizer biotech and the modern and AstraZeneca vaccines which really happened in between early October and mid November. And there were a number of countries and countries that account for only 14% of the world's people had booked 85% of the production for this year. We had 44 bilateral deals in 2020 and other 20 that I know of already signed this year possibly there are more. We don't know because these are all opaque. And of course the greed was enormous it's like those, you know, those little bully boys at children's birthday parties are going to grab all the cake. So, Canada booked vaccines more than 10 times its population, the US more than four times its population. Now of course, as I mentioned, nonetheless, there's incompetent internal distribution, but we know that the pricing is much higher than for covax. Even though we don't have full details of all the deals. And that's really why these covax are one of the big reasons is that covax has not been able to buy even with money it's not been able to buy because the orders have already been the deals have been done. Massive variations in the price anywhere from $2.19 to $40 per dose. I think Israel paid one of the highest rates. There's a non estimate that some doses were even $72. But what is remarkable is that some developing countries are often paying more than developed countries the AstraZeneca vaccine which was supposed to be a completely nonprofit thing $5.25 in South Africa $3.50 in the European Union. So what we have now today, 75% of vaccines have gone to just 10 countries. And these same countries are now sitting on these large stockpiles of vaccines. The US has 80 million AstraZeneca which it's never going to use because it's really only using Pfizer Moderna and the Johnson and Johnson vaccines. And these may soon become unusable. In the last seven recent meeting for a lot of hopes, what did they pledge 870 million doses it's a joke. It's not, it's a tiny little drop in the ocean, and that to only half of that by the end of this year in the next six months. So it's nowhere near what we need. And of course the pace is too slow. So the dose is only in Africa with a population of 1001.36 billion. And what is really obscene is that some of the vaccines that were delivered as charity to African countries were close to expiration dates they had to be destroyed. So, if we want to get global herd immunity we're not going to get it till age 2024. Distribution is of course one sign of the inequality but the basic reason is that vaccine supply is limited. And that's because the vaccines that have been approved by WHO in particular have really all of them have got patent rights that give the pharma companies monopoly on production. That really means that they will produce only what their own capacity enables and the few production licenses that they choose to issue to others. Now remember patents are supposed to reward innovation, but already we have seen the big pharma in this case got massive government subsidies this is part of the policy response that I had mentioned earlier in the US $12 billion to just six companies, and possibly $12 billion and that more than covered the R&D costs. In addition, they did pre sales right so they already got very big profits. The MRNE vaccines use significant amounts of prior public research that it's only the last mile development that was done by these two companies. And that too, as I mentioned, was publicly funded. The AstraZeneca vaccine was developed 97% with public funds by in Oxford University in a public lab. It was originally intended to be open. They were going to put all the data everything up on the website. The Gates Foundation, which is a major funder of Oxford University moved in and persuaded them to shift entirely to a singular deal with AstraZeneca which now holds the patent. Now the other problem is that it's not even as a big pharma then uses the profits for R&D it doesn't. Currently spending is relatively low compared to other spending. The Pfizer for example which is estimated to get 24 billion according to its report to shareholders this year. Last few years it spent 139 billion on share buybacks and dividends and only 82 billion on R&D. So there are some ways in which we can get around this and one of the most basic requirements is a waiver on the TRIPS rules on patenting. So the WTO trade related intellectual property rights agreement or TRIPS is the one that is preventing governments from issuing like production licenses to more and more companies. So in October last year, India and South Africa requested a waiver. They said allow all the countries to not enforce patents and other IPRs on not just the vaccines but on drugs, diagnostics, the testing, all the things that we need to deal with this pandemic until we get global herd immunity. Now this is obvious it's been done before it's second World War is a period when patents were suspended many other emergencies and the TRIPS says explicitly that there are emergency conditions that are exceptional circumstances where these patent rights and other intellectual property should be suspended. So it's a very limited request. All it says is that we are not going to face cases in WTO if we give other producers compulsory licenses if we distribute the information if we actually allow enable other producers. It's a very limited request. This has been repeatedly blocked in the TRIPS cancer by the advanced countries. Surprising because this would also benefit their own populations that would make vaccines available globally much more quickly and larger supply would reduce the costs. So it would even make it cheaper for governments and taxpayers. Very recently last month the Biden administration agreed. It was one of the major opposers, and it has now agreed to stop blocking the TRIPS waiver. But if you look at the map of the countries, other than the US, it's really a once again a North South divide. Brazil is an outlier but then you know Bolsonaro. Well, okay. That explains the Brazil outlier, but largely is once again a North South divide in terms of the TRIPS waiver for medical tools. Some have argued that you don't need that request. A government can just issue a compulsory license. Now what's that that is when a government gives the authorization to produce to a third party. And it's supposed to happen because you want to prevent monopolistic behavior and during public health emergencies. There is actually a TRIPS agreement. The Doha declaration on TRIPS and public health. But it's also true that it's not just TRIPS there are some free trade agreements bilateral investment treaties, economic partnership agreements that also prevent compulsory licensing. But why is the TRIPS waiver important, because you know, many of these vaccines the production is not just that Oh, I'm going to produce the modern vaccine so I will take that license, because the process is very complicated. And there are many other patents that you have to get the approval for. It's estimated between 60 and 64 approvals required in the process. So it would be a nightmare for new producers, unless you had a waiver. But remember that this is just the legal condition. This is an enabling condition that says you're not going to face cases. The transfer of technology is not compulsory. And it's true that when you ask for a patient you have to provide a lot of data, but it's been argued that because some of these vaccines are quite complicated to produce the data provided during the approval process is not necessarily enough to enable other products. So what we really need. This is just the first step we really need the transfer of technology. It's urgent, and it has to happen. Now the point is there are existing producers in many countries. They have a state of art facilities and these are countries as far apart as you know Canada and Bangladesh. Some have been willing, some have even applied for licenses and been denied. The WHO has got a list of more than 200 companies that are willing and able to produce vaccines, including the mRNA vaccines. And you know there's a very harshly put it sort of currently colonial argument that has been made even by Bill Gates and others that, oh, you know, these poor countries they don't have the ability to produce the vaccine so we can't just let any old person produce it. It's under the right conditions. They're in mind that most of the vaccines in the world were actually produced in the developing world, until this particular pandemic. So, in fact, this technology can be shared governments can push the companies that have received significant public funding, which is let's say all of them to share the technology. The Biden government already did this for Johnson and Johnson it said share your technology with Merck, so that you have more production, and they did that. So if they can do that within the country they can also do that for the CTAP the COVID-19 technology access pool of the WHO, which is another part of the accelerator. It's essential to build up manufacturing capacity across the world there are systemic risks. You have to actually make sure that there is a basic supply of essential pharmaceuticals at the local levels. Now it's true these are global health comments this is a global pandemic, but unfortunately they're very nationalistic current experience, and it's been nationalistic at many levels. Countries have banned exports like India suddenly banning the exports when it realized the Modi government realized what a mess it had made of its own vaccine policy. But within Europe we've seen that I mean there are many countries are now forced to think regionally nationally locally. The point is that this is going to be critical even in future pandemics and health threats. We don't know in advance, which vaccines and treatments will be necessary. This is going to be more important to invest in a range of assets. Countries that are being tonight today are going to do their best to set up new technologies. Final aspect I just want to mention is the regulatory approval. Now because of the speed of this response. We've had the fastest approval ever for vaccines, the fastest development R&D and the fastest approval. Normally vaccines are approved after five, six years, because you'll take account of all of the possibilities. These all of them, every single one of them have got only emergency authorization. There are other vaccine candidates vaccines have developed to in China one sputnik five in Russia. The Cuban one is apparently very promising and is in stage three tiles, India has got its own vaccine. The WHO approval process is skewed in favor of companies based in the developed world. It has a list of stringent regulatory authorities and guess where they are in Europe, US, Canada, Australia, Japan. Every other country, the vaccine producers have to go through pre qualification, which is very complicated bureaucratic extended takes at least six months. So, Sinovac and Sinofarm applied before the well known Western vaccines sputnik applied before Sinofarm and Sinovac just got approved. Sputnik is not yet approved. The Pfizer bio and tech vaccine was approved within three weeks, because WHO worked with the European medical agency. So, these are also inequalities that need to be addressed. The WHO also needs to get it back together. Kunal mentioned that I'm on the WHO council for the economics for health for all. And we have made very recently we brought out a position paper, and on the use of technology and on basically on innovation medical innovation and how to govern it. And we have a number of key recommendations. The first most urgent is that the countries that are sitting on available doses should immediately redistribute. Everyone that has vaccinated more than 20% of their population should redistribute with a significant proportion of the doses going to go backs. That's still not the case even with the US even G seven those grandiose announcements amount to very little. We have to wave the IP hours, basically to get rid of the legal barriers. And that's essential because without that, that's, you know, there are too many complications and country governments can face all kinds of cases and investor state disputes from all farmer companies. We need technology transfer I've already talked about that. And we need supply chain resilience, there is also nationalism in terms of the raw materials and intermediate goods, the Biden government is still preventing the export of essential raw materials and intermediates required for vaccines and this is true across the world so we need much greater focus on supply chain resilience, but we also need to diversify manufacturing, we need to expand manufacturing to all regions to better respond and to sort of establish as end to end pandemic preparedness, because let's not get ourselves this is not the end. This may just be the beginning we have to be prepared. So I think that's it. Thank you so much. I mean the WHO Council recommendation to your member of provide really clear action steps steps that global company can take to do something right away isn't it and that's something we can come back to the Q&A. Now very well, very pleased to ask to invite Ken Shadlin to provide his comments and can of course working on forms of the patrons for a long time. Can go ahead, please. Okay, great. Thank you for such a nice presentation a real tour force. We covered so many important issues and different dimensions of the crisis is great it's an honor to be asked to discuss this. So thanks for that and also thank you canal and the UNU wider team for inviting me and giving me this chance. Let's start by underscoring a couple of Jayati's key points about the COVID response. And then I'm going to move to a few comments about the immediate situation we're in now, where I don't think there's very much water between us but there might be a little bit. And hopefully this will give us some material for a nice discussion and I'll do my best to finish by 140 within 10 minutes. Just to start I mean as Jayati said there's no question that the response in 2020 was urgent and impressive. But there's also no question that it lacked sufficient attention to global diffusion and access issues. One of the things specifically is that there was a, there was a heavy focus on diffusion within countries. So for example, in, you know, the US in the US vaccines are free drugs aren't usually free in the US. And there's massive campaigns to get the vaccines out into, you know, governments focusing on distribution in ways that they don't normally care about. And the focus in diffusion was a key part of the campaign within a lot of countries, but just not among countries as Jayati so nicely illustrated. And I think that this could have probably been done differently. If you think about sort of some of the, the funding mechanisms could have had as a condition for receiving the funding, the requirement to establish partnerships and global production networks. And sort of the advanced purchases which were there in some ways just to get in front of the queue, but presumably were there theoretically to sort of incentivize innovation and production they could have been a lot larger to make enough for the whole world. You know, kind of like what Biden announced last month where it was like the US is going to buy a lot of the Pfizer beyond tech vaccine for the world not just for the US, but this could have been done a lot earlier, and a lot bigger than the amount of doses that was announced. Generally, I think the national responses, particularly in the US and the UK with the two, which were the two countries that sort of led the national responses. I know less about what happened in Russia and China. These national responses totally swamped and overwhelmed the global responses. And so the same vaccines that the global supporters like sepi which wasn't part of the presentation because you don't think she had time to include it. The same vaccines that sepi were was supporting, which then should have had some access conditions attached to it. These were also supported by the US and by the UK with a lot more money. And so they impose their own conditions. And then there's the marginalization of covax as daddy explained. One quick point about covax before moving on to production. One is that, and this might sound like a small quibble but I think it's an important quibble. I think to say that covax allowed bilateral deals and to criticize covax for allowing bilateral deals. That strikes me as a strange and probably unfortunate way to put it. I think covax was initially designed very naively as if there wouldn't be bilateral deals. But there were, and covax couldn't prevent them. So in the summer of 2020 it was effectively redesigned sort of to accommodate bilateral deals as a fact. I have a lot of trouble imagining how covax could have possibly been designed to prevent bilateral deals. I know that they wish they would could have, but I don't see how that really could have happened. And so the result is, you know, we've seen a vicious cycle. Countries want to they're willing to pay more to get the vaccines faster. And so they procure doses directly to avoid depending on the supply from covax that looks like it might be unstable. And what that does is it creates unreliable, unstable supply from covax. And so if you're watching that what you do is you purchase doses directly. And what that does is it creates or reinforces the lack of reliable supply from covax. And then as you see that you say, oh, I better do that. And so there's more bilateral purchase and it just goes on and on and on and on. And of course the obvious point here is that not all countries can engage equally in these bilateral purchasing strategies for the reasons that we all understand. The second thing I want to point out, and this was sort of implicit I think in Johnny's comments but I wish it were a bit more explicit is that covax was never going to be about equal access to vaccines. It was about avoiding the worst instances of unequal access to vaccines, essentially where some countries had none. So covax aim was for roughly 20% of the populations in all countries to be vaccinated by the end of 2021. That was the aim. And relative to none of the populations being vaccinated by 2021 that's a really big aim. But that's all it was was 20% of the populations. The fact of the matter is that covax still might hit that target might even exceed that target I've read like oh they might get 25% in most countries. And if they do, it will be celebrated as a major success, but it's only success on very very limited terms, I mean, it's sort of an unprecedented success of a global instrument to purchase and distribute vaccines. But it's going to still leave us with intense distribution were problems as I had to explain is because 20% doesn't really solve the problem. So I think there are some important lessons here for students and scholars of international political economy about sort of international institutions and how they can be designed and how they respond to external dynamic power dynamics and the global economy, happy to come back to that. If you want in the Q&A, but let's let's talk about production because we all agree that the distribution problems would be much less acute were production less constrained. I do think we have to acknowledge the production increases I mean in a normal year in the area of five billion vaccines are produced for all conditions around the world. In 2021, we're probably going to have about 10 billion vaccine doses produced just for COVID those are rough figures, but that's pretty impressive. Now, remember that most of the vaccines for COVID are double dose. So 10 million billion doses means roughly five billion people, but still that's a huge ramping up of production in a very short period of time. And I think that basically it's not enough, but I think we have to ask yourself how that happened and question sort of how quickly we say that basically the companies aren't producing enough, and they're not licensing very much. We produced or producing a ton. It's just not enough. And so we need to be figuring out ways to increase production. And I think the world is paying attention to this now, belatedly, but I think the world is finally paying attention to this now. I'm not as convinced as Jayati is that the trips waiver is the key piece of the puzzle. And the reason why is implicit or explicit in the last part of Jayati's talk, it needs to be complemented by technology transfer in ways that the trips waiver itself seemed like unlikely to enable. So let me just say a sort of parenthetically, this is a very weird moment for me. I spent my career researching and worrying about trips and the effects of intellectual property and pharmaceuticals, what I and other people call sort of the globalization of pharmaceutical patenting since the 1980s and 90s, sort of worrying about these things. And at the start of the pandemic, when we were all talking about treatments because that's nobody thought vaccines would be available this fast. I was giving presentations about patent related problems. I mean, a year ago, we were all talking about remdesivir and the problem. Yeah. And for treatments, particularly sort of normal small molecule chemical drugs, removing the IP barriers works to increase production. We saw this with AIDS drugs, we saw this with hep C drugs, we see it with lots of drugs. And they're a good case can be made as well for doing it broadly via a trips waiver rather than country by country, product by product with reforms to compulsory licensing rules. We can come back to that as well. I'm less certain about what a trips waiver achieves for increasing the production of COVID vaccines on account of a specific set of challenges, some acknowledged by Jayati but I don't think all of them were. And the key things are the challenges of replication at scale and doing so without the active transfer of technology and know how. And we talk about transfer of technology and know how one of the things we're talking about is tacit knowledge. Not the stuff that's in the patents, not the stuff that's in the regulatory submissions, not, not the recipes as people like to call it, but the stuff that's in the brains of human beings. And that's a lot of what technology transfer entails. You don't just share your documents and your data with me, you send your people to my factory to teach my people how to do this at scale and efficiently and well. One of the things that I've been trying to study during the pandemic is the extent to which technology transfer entails through the sharing of codified knowledge and information documents and data, versus the sharing of non codified tacit knowledge. And a lot, a lot is riding on that question, because the former can be transferred via compulsion. It's much harder, if not impossible, frankly, to compel transfer of the left. The bottom line for me is that we agree that increasing production is the key tasks. And we agree that there's probably a lot more production capability out there. It's not currently being mobilized and tapped into we can talk about that more. We agree that getting more production with more producers requires more than relaxing and removing IP, but also technology transfer. In other words, we agree that the trips waiver is not sufficient. Where I think we probably part ways as I also I actually wonder if the trips waiver is not only not sufficient, but even necessary for the reasons that I just mentioned. If we can't force the sort of technology transfer that's required, but I'm not really sure what the role of the trips waiver even is here. If the waiver is not enough on its own, if we also need technology transfer from the originators to producers in the global south, we need their active engagement, we need them to send their people. Then I'd like us to think about how to increase technology transfer, and specifically how the trips waiver is going to do that. Again, I should be the easiest person in the world to convince, given all of my priors on this topic. But I haven't seen an explanation of how the trips waiver is going to enable these other things to happen. The things that we all admit need to happen to complement the waiver. So how's it going to do it. But I often see as an acknowledgement that technology transfer is important. I mark an entry won't just happen without removing the IP and a call for funders to compel it sort of. Hey, look, Farmer, you've had a chance to do it your way. But if you're not going to do it, you know, if it's not going to happen in your way, then governments need to make it happen. And the trips waiver is somehow going to accomplish that. But it's those final two steps that I just haven't seen explained yet. And I want to be discussed more how the governments can make technology transfer of this sort happen and what role the trips waiver plays in it. Let me just end by saying there is a broader political point about the trips waiver that I think is worth noting too. And that is essentially using this as an opportunity to rebalance the global rules on intellectual property to challenge the institutional arrangements that essentially underpin the transnational pharmaceutical sectors power. After all, never has this topic gotten so much attention. I spent my year, my career basically toiling in the corner, you know, intellectual community of three because nobody really cares about this stuff. Now suddenly everybody cares about this stuff. And hey, if we don't seize this moment and topple the system now, then when will we ever seize the moment and topple the system. It's hard not to find that appealing politically. It's certainly hard to oppose this campaign. When you look at the map of countries for example that Jayati puts up, but I'm just not sure that's really where our priorities should be right now. I think our priority should be to ending the vaccine apartheid by scaling up production something like a call it operation warp speed for the world, and a much greater sharing of doses. And where the trips waiver fits into this for me is something I'm still unconvinced stuff. So I'll leave it there. And again, thank you for the presentation. And thank you. Can all for giving me the chance to speak. Thanks so much, Ken. So I think you know the point here that can that you raise is that we all agree that we need to have increased supplies. And of course, and we also agree that global production in the south global south has to, has to, has to increase. We cannot depend on only US pharmaceutical companies or supply to be to be supplied to supply needs. And whether the trip waiver is either a necessary condition or sufficient condition to get to that objective is the real question here. So let me see some really nice questions in the Q&A and the first question I see the one I was going to ask actually anyway. So let me get those questions in, and then maybe Jayati you can respond to Ken's comments, and then we can have a more of our interactive discussion. So let me make the, I can, I can allow the first, the question from the audience to the answer to be asked live. So let me see that's Anna Robble and I'm going to try and see if I can allow you to speak, because I think we've got a really interesting question there. So, let me just try to do that first. Anna, can you go ahead. I think I've unmuted you. Yes, thank you. Thank you for a very interesting presentation I have a question about the trips compulsory licensing. Why existing trips regulation on compulsory licensing are not are insufficient to ensure greater vaccine availability. You have talked a lot of a lot of about the India's proposal on waiver on intellectual property that we have this regulation on compulsory licensing why we do not should use them to, to make vaccines more available. Thank you. And that's a question from Arindam Laha. Arindam do you want to go ahead. Yes, sir. In the context of vaccine, in the context of vaccine access, we have implemented one project like vaccine mode three. And in the, and there is a socio economic and political cost of vaccine diplomacy adopted by the Indian government. We move towards benefiting the humanity by making the vaccine available to the neighbor, and our countries become under civil serious criticism actually we have a severe criticism from all the corners within the country. So although India is considering to be a largest producer of the vaccine in the world, it is literally struggling up to cope with the huge domestic demand coupled with additional demand on the ground of vaccine diplomacy. So what can be the alternative policy, how can prioritize our domestic needs without compromising the need of the other countries. Thanks so much Arindam and Sanjay ready is also going to question Sanjay I think about a good video on YouTube. You want to go ahead. Kunal, I wanted to ask Ken about a proposal which are now by Charlie and I made an article in foreign policy we wrote which I would think would fully address your concerns, which is that a pharmaceutical company could be paid to actively provide its technology to engage in consultancy services to ensure that the technology was applied in an effective manner on site wherever it was. It was actually implemented. And by being provided a sufficient incentive to do so it would presumably do so. And we have argued that it would be sufficient to have one company do this one doesn't have to have every company do a single company which has a viable vaccine or indeed a single country, which has produced such a vaccine. This would provide a global public option which would not only increase supply but also force a lowering of prices in the market as a whole. Why would this not fully address your concerns I'm not sure that I understand. Well, thanks so much, Sanjay. All right, let's go back to Jaiti and Ken. Jaiti, first to you perhaps maybe also to respond to some of Ken's comments but also the questions from the audience. Thank you so much. So, you know, I think let me first clarify a few issues. I mean, Ken, honestly, I think you're setting up a straw man. Everybody is agreeing that trips waiver is not sufficient. It is necessary. Why is it necessary, because as I mentioned of the multiplicity of patients, because every compulsory person has to be granted company to company item by item. And now given the complexity of vaccine production that means that there are huge numbers of approvals required even for one vaccine. And it's in each of these could then be contested. There is a history of contestation which you know better than me in the WTO, when companies have issued compulsory licenses they have often had to face cases or largely brought by the governments and Switzerland and bunch of other countries. So, in fact, it's not the case that you know you can just transfer some technology and get away with it because both are required. In other words, certainly this is not sufficient and nobody is saying it's sufficient, but it is necessary. It's necessary to overcome the legal hurdles for expanding production. The other point, you know, yes, the world is going to meet 25% of population, including in developing countries why because of China. What we haven't mentioned so far and I should have is that China today accounts for more than 50% of the global distribution of vaccines, and it's not just within China. There are many countries in the developing world who are getting vaccines only from China. In fact, if I was cynical and I am a bit, I would argue that G7 is even responding in the limited, rather pathetic manner that it is, because they're worried that China is extending its influence by providing vaccines. The failure of India to meet its own obligations is one part of that. And the whole attempt of the court to set India up as the producer of vaccines for the developing world. These are the China because China has doubled its vaccine production capacity in the last few months. And pretty soon Chinese vaccines are now that both of them have got regulatory approval from the WHO. Pretty soon Chinese vaccines are going to take over a large part of the developing world. I think that's a great thing. I think that's wonderful, especially because a lot of it is free. And once the Cuban vaccine actually emerges and some countries have declared they will take it even without regulatory approval, if they can get some other medical agency to actually approve it. So we are definitely going to see a ramping up. This is despite the control of IPR really because so many countries invested in vaccine development in R&D for the vaccines. Why would the trips waiver be important nonetheless, even if we're going to get more and more vaccines from China should we say no let's just forget it. No, because this is just the beginning. And I think the final point I made and it's part of our proposals in the WHO Council is that this is just one pandemic. We don't know whether this one will persist through mutations or whether we will get new threats, but we do know that the current global system is completely inadequate to actually meet any of these emergency needs. So we have to have a system that will enable us to very quickly respond to this, including by getting rid of the legal impediments, as well as the knowledge impediments. Anna had a question about the compulsory licensing. I have already partly answered that that it is you know it's really company to company, each company you have to give the particular transfer from that company to this company for this item and so it's incredibly complicated. And of course, it's not enough because you don't get the transfer of technology. Once you have a generalized trips waiver. The argument against that is that it will prevent further innovation, to which I would respond that we know that the vaccines that are being developed today were not because you know they said oh there's a pandemic let's quickly go into R&D to get vaccines or drugs or anything. And this is because there was major public intervention, direct support, prior public research, massive public subsidies, advanced purchases. And that's why we got these vaccines so quickly. So I think there is a, there is an issue about tacit knowledge I think that's a very important point you raised. It's not just you know I mean Sanjay is absolutely right you can pay but you know let's remember compulsory licensing doesn't mean that the company that holds the patient doesn't get any return. The license is the grant of inability to produce with a reasonable royalty. And so, along with that you can say we, we funded your technology, we have handed I mean, AstraZeneca in fact it's really even more obscene they didn't even do anything. They were just brought in when the thing had been developed, and they took over the patient. So, we have given you this technology you share it. And that enough, we will give you a reasonable return reasonable, but we will make sure you share it and I don't think that big pharma, I mean of course they can lobby and backdoor channels and all that, but I don't think that big pharma was necessarily go completely against governments on regulatory approval and continued subsidies they are hugely reliant, or in them, the vaccine might be. You know, let's admit that the Indian vaccine policy is not just a mess, it is an appalling undoing of a very successful universal immunization program that existed in the country for 70 years. It is an undoing of huge existing public sector infrastructure in drug and vaccine production. There are eight public sector companies that could have produced the vaccine. The Indian government stands let's admit it is hypocritical in the WTO, because it is demanding a trip so even in the WTO but it has not issued compulsory licenses, even for the co vaccine which is domestically produced, and was produced with ICMR with the Indian Council of Medical Research. So the Indian government could have issued compulsory licenses. Well, as soon as co vaccine was approved by the Indian authorities. It could have then assured that the eight public sector companies that exist and are willing and do have the facilities could be actually mobilized to produce it. They have doubled the co vaccine production easily. In fact, probably quadrupled quintuple depending on, you know how much you actually ensure that these producers do. The fact that it hasn't done so is really I would suggest an indication that of some kind of crony capitalism at work and attempt to protect one particular private producer. So I'm not holding any candle for the Indian governments approach. I think the Indian government's approach of vaccine my three was definitely good in theory that the fact that it messed up its own domestic distribution and then reneged on its commitments on its own aid commitments as well as on the commitments that the serum Institute of India had made with AstraZeneca and go backs that it forced them to renege. This is all. I mean it was all entirely avoidable and it is unfortunate that the Indian governments peculiar approach which is on the one hand trying to you know drum beat India's status as global vaccine producer which we have now completely and on the other hand not even making orders for vaccines domestically and then putting in extraordinary conditions first getting state governments to try and buy them separately from across the world. Then make making individuals pay for vaccines which no other country is doing all of these, I would say obscenities of the Indian vaccine policy are extremely unfortunate. Let's just hope that they are all reversed very quickly. And I think can do you want to address the latest first question. Yeah, but I just want to say that I think that I have been totally misunderstood it's not come. It's never come to be to be told that you're arguing into strong man when the argument is not what we may. My point is simple you can't compel the transfer of passive knowledge. And if tacit knowledge is important and you need to figure out a better way to get it from one actor to another. That if you want to give the tacit knowledge is important and the way you transfer it has to be with the active and willing engagement of the people who have that knowledge. Then the IP problems go away because they're already actively engaging, so you don't need to get rid of any other IP because the IP is no look, then the IP is no longer an obstacle. And so, from you need to get the firms to do that. A lot of firms are doing that they're just not doing enough of it. I agree that they're not doing enough of it and I want to understand how we could get them to do more of it. But if they do that they do it all the time, they transfer tacit knowledge, and in the course of transferring tacit knowledge, the IP issues go away. Sanjay's proposal I think is really interesting. I'm skeptical that you could do this through a third party sort of technology transfer facilitator of this sort, because I actually think that you need AZ to do it you need Pfizer to do it and so on. And so I actually think it needs to be done more on a firm to firm basis that on a, then sort of subcontracting it out to a third party one, but certainly is worth trying. And it would probably have a probably make some improvement in the situation so if I don't think it would fully address capitalize the concerns that I've raised I do think it would basically go a long way towards addressing at least some of them, and actually more constructively wait for discussing some of them. I mean I think that so I do I'm sort of, I'm kind of on board with you I'm on your train I just don't think it makes the problem go away, go away completely. Thanks again, there's one last question I can take the audience very quick question, what should we do. I think you can speak. I want me to do. Hello. Yes, go ahead. Many thanks for the insightful discussion. My question is, like, on the usage of your views on the usage of usage and approval of viral vector vaccines, these are we are in your vaccines. And also, how cost effective and useful do you think it's to conduct large scale serological surveys. Firstly to trace the variance. Like, we have the delta delta plus, we don't know what next, and subsequently device vaccination strategy that we use. Thank you. Thank you so much. Thank you. So in fact, you know, actually, I was going to ask this question, because the mRNA vaccines, the protein based vaccines have a very different supply chain issue than the virus based vaccines right older vaccines. And there is a complication that, you know, Pfizer needs 280 ingredients. I mean, that's incredible they are ingredients coming from often from other parts of the world. And that specific pro challenge with the mRNA vaccine now they might not be that much useful in the special Pfizer, for example, in, in, in Africa in Asia, but how do you address this question that this kind of vaccines with the even with the IPI waiver is very complicated because of the complex supply chains that that we have with this vaccines, as you already seen already in the case in the US, where we have as you mentioned, learning gradients have been not allowed to be exported to other countries. Quickly, we got one minute. Sure. No, thank you very much for this, you know, I am not really qualified. I'm not a scientist. However, we do have scientists in the WHO Council, and we are informed that there is ongoing research with the mRNA vaccines and it's not just the companies but it's also public research, which is identifying the process and requiring lower kinds of refrigeration, not the extreme cold chain, but more like you know, minus 10% 15% and that this is actually very promising so that's one. Apparently, the, the advantage of mRNA vaccines is not only that they have been proved to be much more effective, but also that they are hugely reproducible once you have technologies in other words, the scaling up once you have the processes is much much easier than it is even for Johnson and Johnson or AstraZeneca and some of the other adenoviral things, which apparently and like co vaccine which requires a much more complicated in lab process now as I said I'm not a scientist so I don't really know, but I, you know, the research on this is ongoing, and I repeat, most of this is now being done in labs. I do believe that by 2022 early 2022 we're going to have a new generation of vaccines, and that these will probably be much more easily reproducible, including the mRNA ones. But, as I said, that I'm just talk I'm repeating what I have been told by people who are actually experts in this field I myself have no expertise. Thanks, Jethi. Just to, and very quickly the one thing that you know that I feel is very important and this is not just about the IPR waiver issue is the point that you made about the fact that how much public subsidies and said funding made a difference with in this case right. I mean, prior to this pandemic. Global R&D was spaint on the diseases affected 90% of the global population, malaria, tuberculosis, AIDS, and so on. Right. Now we see this huge supply response to a large extent as you said because of the very important funding that's happened from from western governments. And I think the overall message is that how important that is, not only for this particular case, but for the future, because you often forget that and I think it's an important lesson in developing studies that how states can make a difference in this in this kind of case because previously that wasn't what we saw with previous diseases that are particularly affecting operation global south. So that's an important one. I think I just think that was very interesting is the question of the politics of vaccine distribution. The point you made about perhaps the GCM response could be because of the way Chinese vaccines are going around in the global south. I think it's really interesting we're going to see how that plays out. And that tells us that you know this mode to be said about the story which I think perhaps this is own separate webinar perhaps, because it's really interesting how the G7 responded to this particular issue. And I think that's something I think agree with you that could be in response to what we're seeing happening in the Chinese distribution of their own vaccines in Africa, Asian and Latin America. So that's sort of a very interesting observation. Let me conclude you by thanking both Jayati and Ken for really interesting discussion very important issues. I'm so glad that both of you agree to participate in this webinar because some excellent questions to thank you so much and hope to see you again and another wider event. And thanks to all to the audience. Thanks. Thank you.