India, a leading producer of generic drugs, and South Africa, which has been reportedly lagging in its vaccine rollout, lodged the proposal on Oct. 2, 2020 with the World Trade Organization (WTO).

The proposal “for the Prevention, Containment and Treatment of COVID-19” requests a waiver from several provisions in the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), “such as patents, industrial designs, copyright and protection of undisclosed information” so they “do not create barriers to the timely access to affordable medical products including vaccines [...] essential to combat COVID-19”.

India and South Africa argue in the proposal that developing and least developed countries had been “especially disproportionately impacted” by the pandemic, making particular note that Article 31 of the TRIPS Agreement created “institutional and legal difficulties” in importing and exporting pharmaceutical products “for countries with insufficient or no manufacturing capacity”.

Indonesia is among around 100 countries supporting the TRIPS waiver proposal, which also has the support of 53 cosponsors. The TRIPS council has held more than five meetings on the proposal with the latest on March 11, but it has yet to reach a consensus. The council’s members have agreed to consider additional meetings in April ahead of its scheduled meeting in June.

Read also: Indonesia rallies to keep COVID-19 vaccines, drugs affordable

But Agustaviano Sofjan, the Foreign Ministry’s director for trade, commodity and intellectual property, said he expected the proposal would be raised much later at a WTO ministerial meeting in November amid resistance from wealthy countries.

“We are expecting that it won’t be easy to have developed countries release their IP [intellectual property], so the President has always emphasized the need for collective global solidarity. We want something more concrete,” Agustaviano told The Jakarta Post on Sunday.

A paper published on March 5 in Science Direct states that “high-income countries comprising 16% of the world's population have placed orders amounting to more than 70% of the available doses in 2021 of five leading COVID-19 vaccine candidates”.

It also cites a separate article on global vaccine access in The Lancet with the sobering statement, “Uneven access to vaccines would not be unprecedented,” referring to the H1N1 influenza pandemic in 2009, when “rich countries bought up most of the global supply of pandemic influenza vaccines, leaving inadequate amounts for resource-poor countries, many of which were among the world's worst affected”.

Further, The Lancet report says that “some countries went as far as to block locally manufactured vaccine doses from being exported elsewhere”, and that the tactic is being considered among European Union states as regards the COVID-19 pandemic.

Read also: Indonesia receives first AstraZeneca vaccines under COVAX facility

Indonesia has cautioned against vaccine nationalism and reiterated that “no one is safe until everyone is safe” at international forums and other occasions.

Foreign Minister Retno Marsudi also cochairs the engagement group of the Gavi COVAX Advanced Market Commitment (COVAX AMC), the financing arm of the multilateral initiative on equitable vaccine access, which has a particular focus on poor countries. Indonesia expects to receive around 11 million total doses of the AstraZeneca vaccine through the COVAX Facility, and has received only around 1 million doses so far.

Health Minister Budi Gunadi Sadikin said the country needed a total of 426 million vaccine doses to meet its vaccination target of 181.5 million people to achieve herd immunity. But the government had confirmed deals on just 275 million doses, or 64.6 percent, including pricing and shipment schedules.

As the country proceeds with inoculating 38 million eligible recipients, including 21.5 million senior citizens, it is still awaiting the arrival of additional vaccine supplies to cover this second phase of the vaccine rollout. Less than 5 million recipients have received their first doses to date.

Read also: Indonesia cautions against ‘vaccine nationalism

Agustaviano said approval of the proposed TRIPS waiver would mean that both developed and developing countries could more easily produce, distribute and procure vaccines, drugs and medical equipment for tackling COVID-19.

In short, no country would be left behind or left out in this crisis of such an unseen scale, with the global COVID-19 death toll now more than double the 1.1 million lives lost during the 1957-1958 Asian flu, according to Gavi.

Nevertheless, Agustaviano noted the need for Indonesia to prepare its manufacturing capacity.

“We are considering how prepared we are [at present], and also in the future. People say to never waste a good crisis,” he said “Every country, including Indonesia, must improve its healthcare system.”

State-owned pharmaceutical company Bio Farma, the only vaccine manufacturer in the country, currently has the capacity to produce inactivated COVID-19 vaccines. It is now building its manufacturing capacity to produce recombinant vaccines in anticipation of Indonesia’s Merah Putih candidate vaccine.

The pharmaceutical giant still has no capacity to produce mRNA vaccines, like the Pfizer and Moderna vaccines developed in the United States.

Read also: Indonesia delays rollout of AstraZeneca vaccine

Bio Farma spokesman Bambang Heriyanto said the company possessed a manufacturing capacity for producing 250 million doses of China’s Sinovac vaccine per annum, and an initial capacity to produce 40 million doses of the Merah Putih vaccine when it had been approved for mass production.

Bambang added that a TRIPS waiver for COVID-19 would ease IP royalty and licensing costs for Indonesia’s pharmaceutical industry.

“It would definitely reduce prices and make the products more accessible for the people," he said.

Citta Widagdo, who is pursuing her doctoral research on public health ethics at the University of Birmingham in the United Kingdom, said a TRIPS waiver could tap global manufacturing capacity for COVID-19 vaccines and allow for faster distribution from diverse sources to developing countries like Indonesia.

G7 countries had attempted to upscale vaccine supplies in developing countries, but this involved distributing the surplus supply from rich countries, Citta said, calling it “immoral and irresponsible”.

“Historically speaking, using patent rights to block developing countries has occurred often, although at the domestic and regional [level],” she said on Monday, citing the legal challenges over the patent India granted to Pfizer’s pneumococcal vaccine and Pfizer’s IP lawsuit against South Korean pharmaceutical firm SK Bioscience for developing a pneumococcal conjugate vaccine.

With the US, the UK and EU member states having influence in the WTO, Citta said that developing countries would have to wait and see how any future meetings played out, including whether the proposed waiver gained the support of at least 123 of the 164 WTO member states it needed to be granted.

“COVAX is not enough. It is altruistic [but] it is highly dependent on donations and funding from developed countries” and was not legally binding. Even if the facility achieved its full funding target, “it is only a partial solution”, she said.