Pressure is mounting for world leaders to waive intellectual property protections on Covid-19 vaccines in a bid to increase global production.
On Friday the World Trade Organization debated a proposal that would temporarily waive protections on patents, copyrights, and industrial designs for products to fight Covid-19, which was first put before the body by South Africa and India in October.
The discussions come as many countries are still scrambling to get hold of vaccines and with India's Covid-19 surge hitting supplies to the world's poorest countries.
Supporters say the measure would help manufacturers to begin making doses and exporting them to where they are most needed, but critics question whether this is the best way to expand supply.
"Around the world people are dying because they're not vaccinated, they're not tested and they're not treated," World Health Organization chief Tedros Adhanom Ghebreyesus, who has thrown the weight of the global health body behind the proposed waiver, said last week.
"The solution is straightforward; we need countries and companies that control the resources that could save lives to share."
The cosponsors of the WTO proposal said on Friday they would make revisions in a bid to find common ground.
Dagfinn Sørli, the Norwegian ambassador to the WTO who chairs the council of Trade-Related Aspects of Intellectual Property Rights, which will discuss the revisions next month, said there was reason for some "careful optimism" after the latest exchanges.
There are signs that the United States, historically a staunch defender of intellectual property rights, is seriously considering the proposal
US trade representative Katherine Tai last week discussed the possible waiver in meetings with executives from Pfizer and AstraZeneca and Bill Gates.
Gates, co-chair of the Bill & Melinda Gates Foundation and a major backer of the WHO's global Covid-19 vaccine distribution programme, known as Covax Facility, had previously said "free IP" would not improve access.
White House spokesperson Jen Psaki on Tuesday confirmed the waiver was "one of the ways" to increase vaccine supply being reviewed by the White House.
A change in position from the US could cause "the dynamics (at the WTO) to shift markedly", said Deborah Gleeson, associate professor of public health at Australia's La Trobe University.
Over 100 mainly developing countries support the proposal, while a handful of wealthy nations including the European Union, Britain, Switzerland and the United States have argued that IP rights need to be respected to incentivise pharmaceutical companies to invest in research and development. Some also question whether the move would boost global capacity.
A number of nations, including China, remain open to discussions on the text.
But as vaccine shortages loom and the pandemic accelerates, pressure is mounting for world leaders to support the measures.
More than 170 former heads of state and Nobel Prize winners earlier this month called on US President Joe Biden to support the waiver.
In Australia, over 700 health professionals and academics last week urged Prime Minister Scott Morrison to do the same, while 400 members of the European Parliament and EU national parliaments signed a joint appeal supporting the measure.
Prabhash Ranjan, senior assistant professor of law at the South Asian University in New Delhi, said in addition to building pressure on developed nations, "the urgency in India might create more pressure on the handful of developed countries who are blocking the waiver to relent".
The crisis-level surge in new Indian cases has prompted controls of exports from the country, a major supplier of Covax Facility.
Over the past two months 90 million doses of an AstraZeneca vaccine made by the Serum Institute of India that were meant to have been distributed via Covax have been delayed.
Some opponents of IP waivers would prefer vaccine production to be expanded via such licensing agreements between vaccine developers and manufacturers.
Ugur Sahin, chief executive of German vaccine maker BioNTech, voiced support for this method this week, saying waivers were "not a solution" to the problem.
But critics say not enough drugs are being produced under this arrangement and there needs to be a broader manufacturing base to stop the pandemic sooner.
"It's blindingly obvious now that governments need to take action to force vaccine producers to share their knowledge and technology," said Gleeson, who was one of the original signatories of the Australian appeal.
Despite growing pressure, the waiver proposal will still face an uphill battle to win the unanimous support it needs to pass, according to Enrico Bonadio, a reader in intellectual property law at the City University of London.
However, the continued discussions could push companies and governments to find other ways to expand production.
"In these scenarios, pressure is really useful," he said.
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