Free The Vaccine

“Craftivists” from Free the Vaccine decorated Columbia’s campus in May to advocate for an accessible SARS-CoV-2 vaccine. Photo provided by the author.

It's been over three months since the World Health Organization declared the coronavirus outbreak a global pandemic. It’s been almost as long since New York Governor Andrew Cuomo put the state on PAUSE and Columbia University shut down on-campus operations for the remainder of the spring semester. While the state is slowly hitting the go button, it's still unclear what the fall will look like at Columbia, in New York, and around the world.

The most secure way to be back on campus sometime in the 2020-21 academic year will be through the development of a coronavirus vaccine. Currently, over 100 vaccines are being explored, and a handful are even in trial phases, bringing reason for hope in an often hopeless time. However, a major question underlies all of this research and development: when there is a vaccine, will everyone be able to get it?

Since the start of spending time apart, two groups have come together to respond to this critical health access and equity issue: Universities Allied for Essential Medicine and the Center for Artistic Activism. They formed Free the Vaccine, a global movement to ensure that any COVID-19 vaccine, as well as diagnostic tools and treatment, will be available to all, and sustainably priced and free at the point of delivery. 

Universities Allied for Essential Medicine (UAEM) works at universities around the world to make medicines accessible to all. UAEM began in 2001 when a group of students at Yale convinced the university and pharmaceutical company Bristol Myers-Squibb to allow an HIV/AIDS drug that had been discovered at Yale to be produced as a generic in sub-Saharan Africa. This enabled an immense—and therefore life-saving—reduction in that drug's cost. The Center for Artistic Activism (C4AA) “helps people use their creativity and culture to effect power.” C4AA has helped create and implement thousands of successful advocacy campaigns around the world, including supporting sex workers in South Africa and expanding healthcare access for marginalized communities in Eastern Europe and East Africa.

With their experience in pandemics and public health advocacy, UAEM and C4AA came together to make sure the coming COVID-19 vaccine will be freely accessible. They recognized that, due to the specific limitations and dangers caused by the virus itself, novel methods of advocacy would need to be developed. They formed Free the Vaccine as an “Advocacy Innovation Lab,” centered around weekly meetings focused on discovering and implementing new access to medicine advocacy actions.  

Free the Vaccine quickly attracted over 300 volunteers from 29 countries. The volunteers were divided into smaller subgroups based on region. These subgroups are called Salk Squads, named for Jonas Salk, the medical researcher who discovered the vaccine for polio over sixty years ago. When asked who owned the patent on his polio vaccine, Salk famously replied, “The people, I would say. There is no patent. Could you patent the sun?”

Salk's reply is especially striking when considering the typical ways vaccines and medicines in general are researched and developed today. Taxpayer dollars go towards funding the National Institutes for Health (NIH), which invests almost $42 billion a year in medical research “for the American people.” The importance of NIH's investment cannot be overstated. A study that looked at all of the drugs the FDA approved between 2010 and 2016 found that NIH funding contributed to research published in association with each and every one of them.

Yet, once these drugs are developed with public investment, if the public wants to use them, they still have to pay for them—if they can afford to do so. The extremely high price for pharmaceuticals in the United States has been well documented. Take, for example, that 34 million Americans lost a family member or friend in the last 5 years because that person could not afford the cost of medical treatment. The high price of drugs has come under new scrutiny during the current pandemic. Representatives Jan Schakowsky (IL-9) and Francis Rooney (FL-19) recently wrote in Newsweek about how most medicines brought to market in the past decade were paid for by “a hefty investment from taxpayer dollars,” and yet this “accountability for public funding has not prevented pharmaceutical corporations from hiking up prices.” Further, the profits pharmaceutical corporations earn from the high costs are not always used to recoup their investment in research and development (R&D), as they often claim. A study released last year by the Roosevelt Institute found that from 2006 to 2015, the eighteen largest drug corporations in the U.S. spent $465 billion on R&D—but $516 billion on stock buybacks and dividends. 

Pharmaceutical companies earn hundreds of billions of dollars in part because of the ways drug companies use the U.S. patent system. As lawyer and health justice advocate Priti Krishtel explains in her TED talk, the patent system was designed to encourage invention and then to reward inventors with a monopoly for a limited time. But the system has been manipulated, with companies working both to extend patents and to file as many patents as possible. The latter builds a high “patent wall” on a drug, and the former allows them to operate behind this wall for a very long time—not a limited one. With this fortified monopoly, they can set whatever prices they want and prohibit the production of generics that would lower costs not only in the U.S., but also in much poorer nations. Nobel Prize-winning economist and Columbia professor Joseph Stiglitz recently lamented this manipulation, writing that “commercial pharmaceutical companies have for decades been privatizing and locking up the knowledge commons by extending control over life-saving drugs through unwarranted, frivolous, or secondary patents.” As Stiglitz points out, it's not just vaccines that become inaccessible because of patents, but also research and know-how more broadly. The magazine The New Republic recently called the intellectual property claims in the pharmaceutical industry “a progress-obstructing asteroid field for nonprofit research efforts geared toward public health.” 

There are many ways the current system could better respond to public need. In 2016, UAEM published a report that mapped out 81 alternative R&D models. Specifically in regard to COVID-19, UAEM, C4AA, and Free the Vaccine are pushing subjects to sign the Open Covid Pledge. The pledge states that signers will make their intellectual property available for free for work ending the pandemic and minimizing its impact. The pledge has been recognized by the WHO and been signed by the biggest companies in the world—Facebook, Amazon, and Microsoft—and many others.

Yet even more companies and universities have not, and while there has been atypical collaboration in the race to find treatments and a vaccine, there have also been the typical manipulations as outlined above. For instance, one of the most promising COVID-19 treatments, remdesivir, was developed with at least $70 million in taxpayer funding. Yet pharmaceutical company Gilead used a loophole to extend its patent on remdesivir (it reversed course after extreme backlash) and, after donating doses initially, has since set the cost for patients in the U.S. at several thousand dollars. 

Free the Vaccine’s redecoration of the statue of Alexander Hamilton outside of Hamilton Hall. Photo provided by the author.

Supply is another huge concern. The Department of Health and Human Services considers remdesivir a “scarce resource,” and the demand for a vaccine will be exponentially greater. Vaccinating everyone would mean vaccinating almost 8 billion people, requiring at least 8 billion doses and the mechanisms to distribute them—and potentially more, should the vaccine require more than one dose. Questions of who will get the vaccine first are already arising—just as questions of who could get coronavirus tests plagued the early days of the pandemic and caused death. Doctor and best-selling author Sandeep Jauhar worries that disadvantaged communities—who have already disproportionately fallen victim to COVID-19, especially in our city of New York—will continue to be marginalized in a vaccine roll-out.

Understanding all of this, Free the Vaccine is targeting power players in the field—especially universities. Institutes of higher education play a huge role in drug development. About one-third of new drugs and medical technologies originate in university labs, and these labs get staggering amounts of public funding. Columbia University is no exception, currently working on many projects concerning COVID-19. UAEM has tracked public funding for COVID-related R&D; according to its map, Columbia has received over half a million dollars from the NIH for diagnostic R&D, as well as additional public funding for therapeutic R&D.  

What will be done with this research? The answer appears to be: we don't know. Several of Columbia's peer institutions have agreed to “humanitarian licensing” guidelines written by AUTM, the Association of University Technology Managers. As they are just guidelines, the agreement is much weaker and vaguer than the Open Covid Pledge, but signatories at least demonstrate a public openness to rethinking the typical patent and profit model outlined above. Signatories include Cornell, Harvard, and Yale—but not Columbia.  

This is, perhaps, a pattern. Over a decade ago, the same peer institutions and eight other prominent universities convened to compile “In the Public Interest: Nine Points to Consider in Licensing University Technology.” These points recommended best practices so that university technology transfer would benefit the general public. Columbia, again, is not listed in the document.

In early May, a group of New Yorkers within Free the Vaccine formed a Salk Squad to focus on changing this and getting Columbia to sign the Open Covid Pledge. The group included a mix of current students, past students, adjunct professors, and those living in the surrounding community. The members decided to use the upcoming event of graduation to spread the word about Free the Vaccine and its crucial mission. 

The squad took inspiration from their artistic activism lessons within Free the Vaccine, which emphasize the effectiveness of narrative, surprise, and creativity in achieving social and policy change. One thread of creativity and surprise that the squad latched onto stems from the ideas of craftivism as explained by Sarah Corbett. As Corbett practices it, craftivism is a form of “gentle protest” that centers compassion and care. Often the protest takes the form of her and her Craftivist Collective making gifts for people they disagree with. 

The members of the Columbia squad knew, from being students and hearing from students, that the graduating class and everyone at Columbia and in the neighboring community could certainly benefit from some compassion, their worlds having been turned upside down. Taking further inspiration from craftivism, the idea arose to give graduates and the community at large some kind of gift. The Salk Squad selected the iconic statue of Alma Mater, the “nurturing mother” of Columbia, to be the mouthpiece for the gift. And what better gift could Alma bring than a free coronavirus vaccine?

Alma Mater was also redecorated by Free the Vaccine on Columbia’s campus in May to advocate for an accessible SARS-CoV-2 vaccine. Photo provided by the author.

Whereas Alma is typically the center of University Commencement, this year, with the ceremony online, she would be far from her community. With this in mind, the group designed an oversized Columbia-blue surgical mask, sash, and vaccine bottle for Alma and adorned her the weekend before commencement. The sash bore a simple message from Alma to the public: “Be Well.” Her open hand held the free vial of the coronavirus vaccine—the mechanism by which the community, the city, and the world could finally be.

The action sparked extensive interest from those who saw it—and though Columbia's campus is closed, many graduating students were nearby to get their pictures taken in cap and gown. Members of the squad were present to share the importance of Free the Vaccine's work. To further spread the message, they also adorned some of “Alma's friends”—other iconic statues on campus, including the Columbia lion—with a sign that sported the message, “Be Well, Students and Neighbors,” to highlight the impact the coronavirus has had not just on campus but throughout the city.

Columbia University in the City of New York states in its mission that it is “one of the world’s most important centers of research,” and it commits to linking its research and resources to the city and advancement around the globe. Columbia could no better link its research to worldwide advancement than by doing everything in its power to ensure that COVID-19 testing, treatments, and vaccines are freely available and accessible to everyone on the planet. Signing the Open Covid Pledge would be a critical step in ensuring this universal access. 

If you, like the members of Free the Vaccine, want Columbia to share its research to help stop the pandemic in its tracks, you can sign the Open Covid Pledge here.

Rachel Karp graduated from Columbia College in 2010 and majored in Drama and Theatre Arts. She creates and directs performances about politics and public policy.

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