The normal rules of business that protect the profits of vaccine manufacturers will have to be set aside if that is what it takes to ensure everybody is immunised against the coronavirus, according to the director general of the World Health Organization. Writing in the Guardian, Dr Tedros Adhanom Ghebreyesus says the world needs to be “on a war footing”. Before a key meeting of the World Trade Organization next week on the anniversary of the declaration of the pandemic, he supports a patent waiver that would allow countries to make and sell cheap copies of vaccines that were invented elsewhere. “We are living through an exceptional moment in history and must rise to the challenge,” he says. “Flexibilities in trade regulations exist for emergencies, and surely a global pandemic which has forced many societies to shut down and caused so much harm to business – both large and small – qualifies. We need to be on a war footing and it’s important to be clear about what is needed.” The WTO meeting will discuss a proposal for a waiver of intellectual property rights – in this case, vaccine patents – put forward by South Africa and India and now supported by 100 countries. Member governments are split on the issue, broadly with low- and middle-income countries in support and rich countries opposed. In the Guardian article, Tedros argues that the manufacturers will still get some reimbursement. “Waiving patents temporarily won’t mean innovators miss out. Like during the HIV crisis or in a war, companies will be paid royalties for the products they manufacture,” he says. Pharmaceutical companies and governments in the US, UK and Europe are strongly opposed to the waiver, with or without compensation. They back the argument of the International Federation of Pharmaceutical Manufacturers and Associations, based in Switzerland, that cutting companies’ returns is a disincentive to innovation. Tedros says a range of measures must be considered. “Whether it’s dose sharing, tech transfer or voluntary licensing, as the WHO’s own Covid-19 Technology Access Pool [CTAP] initiative encourages, or waiving intellectual property rights, we need to pull out all the stops.” Campaigners say none of those things are happening. On CTAP, which is supposed to encourage companies to share their technology with low- and middle-income countries, “only civil society are shouting about it. Not one company has engaged,” said Dr Mohga Kamal-Yanni, an adviser to the People’s Vaccine Alliance. The great hope for vaccines for most countries is Covax, the UN-backed initiative that aims to deliver 2bn doses by the end of the year. Just over a week ago, Ghana became the first country to take delivery of Covax doses. Ivory Coast and Colombia have also received some vaccines, says Tedros, who calls it “a moment of celebration that the miracle of science is being shared – but one that was offset by the shame that many countries hit hard during the pandemic have still not received any vaccines.” Of the 225m vaccine doses administered so far, he says, “the vast majority have been in a handful of rich and vaccine-producing countries, while most low- and middle-income countries watch and wait. A me-first approach might serve short-term political interests, but it is self-defeating and will lead to a protracted recovery, with trade and travel continuing to suffer. Any opportunity to beat this virus should be grabbed with both hands.” New variants are appearing that are less susceptible to vaccines and more transmissible. “The threat is clear: as long as the virus is spreading anywhere, it has more opportunities to mutate and potentially undermine the efficacy of vaccines everywhere. We could end up back at square one,” Tedros says. He praises AstraZeneca for sharing its licences so that its vaccine can be manufactured around the world. However, campaigners say that even the AstraZeneca model is flawed. Under pressure to supply more doses to Europe, the company is shipping 10m doses to the UK from the Serum Institute of India, which is supposed to be the main supplier to low-income countries through Covax. Anna Marriott of Oxfam, which backs the patent waiver, said next week’s WTO meeting would be “a big moment”. She said rich countries must stop stalling. “It is untenable,” she said. “To be seen to publicly kick the can down the road when we have extreme vaccine apartheid right now is out of tune with what we need.”