The domination of global medicine by major pharmaceutical companies needs to be confronted to provide fairer access to vaccines, a leading South African official has said. The scramble over Covid vaccines should alert rich countries to the power of profit-driven companies that control production of crucial medicines, said Mustaqeem De Gama, South Africa’s delegate at the World Trade Organization (WTO) on intellectual property rights. “While Rome is burning, we are fiddling around [waiting],” said De Gama, who called on nations where many of these pharmaceutical firms are based to stop blocking a patent waiver proposed at the WTO. Backed by dozens of developing countries, the proposal, introduced by South Africa and India, argued that bypassing intellectual property rights would allow more of the world’s population to be quickly vaccinated by boosting production. “The first effective vaccines were ready four or five months ago. Do you think it would have made a difference if we had the capacity to manufacture? I certainly think so.” Supplies are low after rich countries bought more vaccines than they needed to, leading to predictions that many low-income countries may not be able to reach mass immunisation until 2024. Some vaccines are being provided to low- and middle-income countries through donations, largely through the Covax initiative led by Gavi, the Vaccine Alliance – a public-private global health partnership. But many argue the donations are too few and rely on stock unused by rich countries. De Gama said more structural change was needed to enable countries to make their own vaccines instead of relying on terms set by donors or profit-driven companies. “The infrastructure right now is providing a minimum and leaving the rest to the private sector,” said De Gama. “I don’t think governments should be outsourcing their responsibility for public health to private companies who are responsible to shareholders only.” He said the recent sale of AstraZeneca vaccines to South Africa at double the price paid by European countries was evidence of the need for more transparency in how decisions on supplies and pricing are made. Médecins Sans Frontières (MSF) on Thursday called for urgent delivery of vaccines to lower-income countries in order to avoid further mutations of the coronavirus, such as the 501Y.V2 variant that has spread throughout southern Africa since being identified in December. Prominent South African businesswoman Yamkela Makupula said many were angered at not being able to access vaccines while hospitals and the economy were suffering, hit by the wave of Covid-19 linked to the new variant. “Most countries across the world are facing recession while having to deal with the effects of the pandemic. So to only vaccinate a portion of the world and leave the rest to fend for themselves with limited resources is a very flawed strategy,” she said. “There is no amount of economic recovery strategies that can save South Africa where it is right now. What is imperative is to get our people vaccinated in order to not only rebuild the economy but to save people’s lives.” Shehnaaz Peer, a GP in Eastern Cape province, said the vaccine “really translates into hope” after seeing a rise in cases, more patients with prolonged Covid symptoms and increasing mental health challenges, especially among young people. Roz Scourse, a policy adviser for MSF Access, said the EU had been “hypocritical” in its recent outrage over undelivered AstraZeneca vaccines while blocking the proposed patent waiver, alongside other countries that host big pharmaceutical companies, including the UK. “This is really showing the EU and other rich countries what happens when you hand over all the rights and control of the manufacture and distribution of Covid vaccines in the time of a pandemic to huge multinational corporations,” said Scourse. Zain Rizvi, who works on access to medicine at US-based advocacy group Public Citizen, said governments should have demanded more open access from pharmaceutical companies because much of the funding for the initial research and development came from public funding. “Rich countries had tremendous leverage when they were giving funding to these organisations,” he said. “I can’t emphasise enough how outrageous it is that there are vaccine shortages when there is capacity just sitting there. It’s morally bankrupt.”