When Marxists say that under the capitalist mode of production, humanity faces the question of “socialism or barbarism”, it is not an exaggeration or a simple turn of phrase, but rather a direct analysis of the dynamics of society.

By: Daniel Sugasti, translated to English by Carlos Jara

It is a fact that barbarism is a daily reality for a significant portion of the Earth. The hundreds of bodies floating in the Ganges river due to the collapse of India’s healthcare system, where thousands are dying daily in their homes without receiving any medical aid, only to be tossed into the river by families that do not have enough money to afford proper burials are a tragedy of barbaric proportions. The thousands of Morroccan immigrants who just a few weeks ago swam to the shores of Ceuta to escape the economic and healthcare collapse in their home country is just one example of how the horrors underway in semicolonial countries reach the doorstep of imperialism.

The COVID-19 pandemic, caused by the devastation of the environment by the capitalists, is a perfect example of the capitalist system’s decay.

Latest counts state that 3.7million people have died of COVID-19. Based on this data, it is predicted that by September, the world will have suffered more than 9 million deaths.[1] But the real numbers are even worse. The WHO has acknowledged a reality that everyone suspected: the death toll of COVID-19 is two to three times higher than the officially reported statistics.[2] According to the WHO’s projections, the current death toll is between 6 and 8 million.

If we add to the number of dead the millions of people who recovered, but with further health problems, and the enormous number of people who are left without work, without income, newly impoverished or homeless, the outlook becomes even more grim. This suffering has largely fallen on the shoulders of the most exploited and oppressed sectors of the working class: Black people, women, immigrants, etc. The majority of infections and deaths occur among the population that is forced to expose themselves to the virus in order to work and make a living. We can note one statistic that illustrates this phenomenon, among others: 76.7% of the over 111,000 COVID-19 people who died of COVID-19 in Sao Paulo, Latin America’s most heavily populated city, never finished elementary school[3].

What we are witnessing is a genocide. This is not a deadly accident, but rather a deliberate and systemic culling. The governments of the world know perfectly well that they could put into place measures that would save lives and bring the pandemic to a quicker resolution. They know that failure to implement safety measures such as social distancing and universal vaccination will cause millions of deaths. They also know that the pandemic is hitting the most marginalized the hardest. But, these governments have chosen to prioritize the profits of the bourgeoisie, deny science, and continue business as usual, no matter how many die. There is no time to mince words: this is a conscious act of extermination.

The terrible state of public health, particularly in the peripheral countries of the world, predates the pandemic and significantly increases its death toll. This situation is the product of years of systemic attacks on the quality and degree of coverage of public health systems in favor of privatization of these systems. Because of this, when the pandemic arrived there were fatal shortages of intensive care units, healthcare professionals, medications, and even personal protective equipment for healthcare workers, resulting in a situation a thousand times more uncontrollable and deadly. Even in the face of this catastrophe, the national bourgeoisies of the world declined to invest in their country’s health infrastructure, let alone impose strict lockdowns with living stipends and proper labor protections in order to protect people from the disease. The arrival of vaccines, at least for as long as herd immunity is not accomplished on a global scale, does not remove the need to impose social distancing and to have properly equipped medical facilities. Nevertheless, no significant actions were taken to halt the pandemic. The order of the day was that the economy cannot stop, and whoever has to die will die.

The same logic has been applied to vaccination, which has been available since the end of 2020. The neglect in this regard is in some ways even worse, because the only way to end the pandemic decisively is to vaccinate more than 75% of the world population. Until that is accomplished, even the strictest anti-pandemic measures will be insufficient.

In order to reach the level of vaccination that would be necessary for herd immunity, it will be necessary to produce nearly 15 billion doses of vaccines. Up until now, only 2 billion have been administered.[4] Out of this number, 85% of the doses have been administered to people living in the richest countries, and only 0.3% have gone to the poorest. The WHO has stated that 75% of the vaccinations have been concentrated in 10 countries. Meanwhile, the imperialist countries have hoarded enough vaccine doses to vaccinate their populations ten times over.[5] It is expected that 90% of the people living in countries on the global periphery will remain unvaccinated at the end of 2021.

The establishment of a healthcare apartheid is first and foremost a product of global imperialism. A handful of rich countries are strangling the rest of the planet. It is in this context that vaccines and medical supplies are commodified, resulting in the commodification of health itself.

The production of vaccines under capitalism is not connected to the actual present need to end the pandemic, and instead is dominated by the laws of the market. They are not treated as a public good, but as a commodity. Consequently, there is an intentional, artificial scarcity of vaccines. If they were production was scaled to meet the global need for the vaccine, the price would fall. In other words, the vaccine shortage increases profits for the pharmaceutical industry, and consequently the scarcity is maintained and protected by the imperialist states.

Humanity is facing a structural problem. Reality is showing us first hand that for as long as public health remains under the control of the capitalist market, we will not have equitable vaccination nor will we be safe from future pandemics.

The patent dispute at the WTO

The health crisis’s extreme proportions have forced a discussion about intellectual property rights for vaccines and other medical technologies. And not a moment too soon. Only 26% of the world’s population has been vaccinated; meanwhile, five companies own the rights to the vaccine patents, and directly control the production and distribution of 90% of the available vaccine supply.

In October 2020, the governments of India and South Africa made a proposal at the WTO to suspend patents on vaccines, medications, personal protective gear, diagnostic tests. In short, it would affect all of the medical technologies that can be deployed to help fight the pandemic. This proposal would be a big step forward to breaking the Big Pharma monopoly, and would allow for the use of currently-unused factory facilities to produce more supplies around the world.

The proposal is currently co-sponsored by 62 countries, and has received support from over 100 countries, including China and Russia. When first proposed, the richest countries of the world: the US, EU, UK, Japan, Switzerland, etc. all rejected the proposal out of hand.

Recently, the group of countries in favor of suspending patents made a new proposal, which would be smaller in scope and duration, and which will be discussed by the WTO on the 8th and 9th of June. The main difference is that while the original proposal mandated a suspension until global herd immunity was reached, the new proposal has only a three-year term.

This new proposal got a major boost on May 5th, when, following a few weeks of acknowledging the situation, the Biden administration announced that they would support the temporary suspension of patents at the WTO. This change of position drew praise from the WHO and non-profit organizations like Doctors Without Borders. The move, which surprised the world and which was presented as a historic achievement, deserves additional analysis.

To start off, this posture change is not motivated by humanitarian sentiments, nor does it represent a break with “vaccine nationalism”. This announcement came only after more than half of the adult population of the US had been vaccinated. Moreover, whether or not patents are suspended, the US continues to restrict not only vaccine exports, but also the exportation of materials and equipment that could be used to create vaccines. Meanwhile, China is exporting on average 49% of its vaccine production. This is “America First”, Democrat style.

The vaccination progress within its own borders allows the White House to make token concessions to the global situation. Whether it is a breaking of the patents, or the donation of 80 million vaccine doses (a plan that will likely be approved on the 4th of July and announced with much fanfare and fireworks), these actions are drops in the ocean compared to the actual degree of the shortages faced by the world, and are being announced primarily to engage in “vaccine diplomacy” and catch up to China and Russia.

On a different front, the collapse of India’s healthcare system has raised alarm bells regarding the extremely precarious road back to “normal”, even after a broad domestic vaccination campaign. From an epidemiological perspective, for as long as we fail to reach collective global immunity, the virus will continue to circulate and mutate, creating the possibility for the spread of vaccine-resistant strains of the virus. The Indian strain (B.1.617), which is much more contagious than previous strains, has spread to at least 53 countries and threatens to derail reopening plans in the US and Europe. From a political perspective, a social upheaval in response to the situation in India could lead to major consequences both in the region and the rest of the world.

On another level, it is important to consider the domestic political pressures in the US. Donald Trump’s last year in office was marked by an uptick in popular resistance, especially by the anti-racist movement, which reached its peak in the protests following the murder of George Floyd. Last year was marked by a sharpening of social polarization. The root of this development was, obviously, the pandemic––and the US continues to be the country with the highest death toll––as well as a deepening crisis of the global economy. We cannot lose sight of the fact that Biden was elected in a tumultuous moment, and he is governing in the midst of multiple crises that remain unresolved, and which could motivate people to take to the streets once more. A heavy focus on vaccination is at least in part an attempt to set his administration apart from that of Trump. The pressure of more than 100 countries, as well as important public figures, scientists and organizations, has made even the Democratic Party take up the question of loosening patents.

But the key to understanding Biden’s new posture is the need to revitalize the global economy, even if it means interfering with the short-term interests of the pharmaceutical industry. Of course, this is all happening after said companies have signed the main contracts for vaccine production for 2021, in a sense locking in their profits. In other words, the US allowed the price of vaccines to artificially inflate for a whole year based on supply and demand. The high demand pushed prices up, to a current average price that ranges between $1 and $40 according to UNICEF.[6]. Airfinity estimates that the Sinovac and Sinopharm vaccines cost between $12 and $23 per dose; AstraZeneca varies between $3.5 and $5.25; Pfizer varies between $12 and 14.5; Modern costs between $18 and $32.[7]

These estimates, however, need to be taken with a grain of salt, as vaccine sales were negotiated behind closed doors. We do know, however, that the companies negotiated separate prices with each country, and favored countries that offered higher bids. For Pfizer, sale prices varied from $14.7/dose (as paid by the EU) to $47/dose (as paid by Israel), which explains the inequitable distribution of vaccines globally.[8]

Imperialism can no longer ignore the vaccine problem because it is aware that there is no such thing as “capitalism in one country”. The prolongment of the pandemic blocks the free flow of commodities and workers, necessary elements for the global bourgeoisie to keep up their profits. When push comes to shove, any long-term analysis will show that it matters little if the US is fully vaccinated if large swathes of the globe––India, Brazil, Colombia, and the rest of the periphery––continue to be paralyzed or destabilized by successive waves of the pandemic and the mass rebellions and heightening of the class struggle that such a catastrophe will likely inspire.

A large gap between rhetoric and practice

Nonetheless, there are significant obstacles between the US’s about-face and the actual suspension of the patents. The WTO’s decisions are made on a consensus basis. The EU, primarily Germany and France, remain opposed, as does the UK.

Nothing much was accomplished at the first meeting since the US’s change of posture, which was hosted on May 31st and consisted of an informal meeting of the TRIPS Council (which is the international body directly concerned with intellectual property in commerce). The US indicated that it is in favor of discussion of “any proposal that can meet the immediate needs of the moment to increase the production and distribution of vaccines”. They insisted that this process needs to move forward on the basis of “a document”, i.e. not necessarily the actual existing proposal put forward by India and South Africa.[9] According to a source published by Forbes, “there is an ocean between the existing proposal and what the US is suggesting”.[10] Regardless, discussion met a standstill as a group of countries (the EU, UK, Australia, Japan, Singapore, Taiwan, Brazil, South Korea, Noway, and Switzerland) requested additional time to study the proposal.[11]

The US does not agree with the proposal put forth by India and South Africa, even in its new and more limited form, which calls for a suspension of patents for medical supplies other than just vaccines. Washington, meanwhile, has only expressed support for suspending patents on vaccines alone. They also are anticipating some form of compensation for the pharmaceutical companies in the event that a suspension proposal is approved. Last but not least, the White House has sad nothing regarding the indispensable need to transfer technology and know-how in addition to the suspension of the patents. It is hardly useful to reveal the recipe for the vaccines if people will not also have access to the technology and trained personnel needed to actually manufacture them.

In this context, a counter-proposal has emerged, largely promoted by the EU and the pharmaceutical industry. In addition to the same old argument that suspending patents will disincentivize scientific research and impede our ability to confront future pandemics, the pharmaceutical companies are now promising that they themselves have the capacity to increase the production of vaccines. They propose further collaboration between companies, and a call to voluntarily relinquish their production licenses.

But bilateral agreements between companies are no alternative. It is estimated that over 300 such agreements exist, and despite that, vaccine production in 2021 is between 9.5 and 12 billion doses (and this figure assumes that all vaccines currently in development are approved in clinical trials). This is insufficient. Even less so if it COVID-19 turns into a perennial illness like the flu which would require yearly vacinations, as some sections of the scientific community are worried may happen.

The problem with voluntary relinquishment of production licenses is that this leaves the production and distribution of vaccines under the control of a small handful of companies. AstraZeneca, for instance, granted permission to the Serum Institute in India in order to supply the vaccine to 92 countries covered by the Covax initiative. These countries total nearly 4 billion people combined. In other words, the fate of half of humanity is left relying on a single company.

 

The fact is that these bilateral agreements leave the companies in control of the patents, as well as the relevant technology and know-how. The contracts limit the degree of involvement by other companies involved with other phases in the production of the vaccines, or else place geographical restrictions (e.g. the company is not allowed to produce vaccines destined for certain countries). Practical know-how is a key element of production that no patent holder is willing to give up.

The WHO, for instance, has created the Covid-19-Technology Access Pool (C-TAP), which is a tool that allows pharmaceutical companies to provide others with data, experimental results, insights and voluntary relinquishment of licenses. Despite that, this plan was rejected by the pharmaceutical companies, which prefer bilateral agreements, whose details are often confidential, and which allow the companies to only share as little information as needed to outsource steps of production.

In this way, while millions die from a disease for which multiple effective vaccines exist, the bosses in charge of production are wasting the unused productive potential throughout Asia, Latin America, and Africa. Countries like Bangladesh and Vietnam could begin to help with production, and countries that are already involved, such as Brazil, Argentina, Mexico, India, etc. could significantly increase their output.Regarding the question of production quality, which the pharmaceutical industry alleges could be an issue, the bilateral agreements made thus far demonstrate that with the proper transfer of technology and know-how, companies can be ready to produce quality outputs in as little as six months.

Some of the vaccines require more than 9,000 different ingredients, which are produced by 300 providers spread across more than 30 countries.[12] In addition to the fight over patent law, the health crisis is demonstrating the pitfalls of a global economy organized to maximize the profits of the few, versus a planned economy organized democratically by the working class for the benefit of all of humanity and the planet Earth.

Capitalism presents an inherent contradiction: production is social and international, but profit collection is privatized. The pandemic has only made this dynamic more obvious.

Despite having received billions of dollars from public funds for research and development (AstraZeneca, for example, developed its vaccine on a budget that was 97% public funds[13]), the companies that hold the patents capture all of the profit. Pfizer announced that its vaccine provided them with more than 3.5 billion dollars in the first quarter of 2021, one fourth of the company’s entire budget for this period. They have announced to their investors that their profit margins on the vaccine are in excess of 20%, which equals nearly $900 million in profit for the vaccine during that quarter. The vaccine has become Pfizer’s most profitable product, and they have increased their earnings estimates for the vaccine to be $26 billion for this year.[14] BioNtech, a biotech firm associated with Pfizer, received liquid profits of nearly $1.4 billion in the first quarter of 2021, 75 times more than they earned during the same period in 2020. Ugur Sahin, the company’s president, announced that they expect to earn 12.4 billion euros from their COVID vaccine sales.[15]

Moderna reported that their vaccine has earned nearly $1.7 billion in the first quarter of 2021; the company expects to earn $19 billion by the end of the year.[17]

According to data collected by Airfinity and published by Bloomberg, if prices hold steady and production continues according to plan, the annual turnover for vaccine sales the nine companies controlling production could be as high as $190 billion. With setbacks, the estimate is $97 billion. Pfizer, Moderna, Sinovac and Sinopharm together could earn $124 billion, 65% of the prior projection. The two Chinese companies’ earnings would comprise 25% of that figure, nothing to sneer at.[18]

Those opposed to the freeing of the patents swear that such an act would not resolve the short term shortage of vaccines. Obviously, breaking the patents is not a magical solution, but the pharmaceutical industry’s argument comes off as cynical when you consider that they said the exact same thing a year ago. A similar hypocrisy is on display in Biden’s position, waiting nearly a year before supporting the suspension of patents, and promising to donate 80 million doses to Covax while upholding a ban on exporting vaccine ingredients and obstructing technology transfer.

Furthermore, it is worth highlighting that governments and pharmaceutical companies have leapt to philanthropic gestures of donating doses to poor countries, in addition to announcing a projected increase of production to sway critics of the obvious vaccine shortage. At the recent G20 summit, for example, the EU promised to donate at least 100 million doses in 2021. They will also commit more than 100 million euros to Covax. At the same meeting, Pfizer/BioNTech, Moderna, and Johnson & Johnson promised to allocate 3.5 billion doses (1.3 billion in 2021 and the rest in 2022) to be sold at production cost or with special discounts for poor countries.

The closing statements at G20 do not support a potential suspension of the patents. They counterpose this initiative with what they call a “voluntary exchange of licenses”, and the lifting of barriers to the export of basic production materials, in essence the same plan promoted by Big Pharma.

Additionally, at the same meeting the International Monetary Fund (IMF) presented a plan to put an end to the pandemic, with an estimated price tag of $50 billion. The IMF proposes that 40% of the world population will be vaccinated by the end of 2021, and the remaining 60% in 2022.

The IMF, clearly, is preoccupied with restarting the global economy: “the economic crisis will not be truly over until the health crisis has been resolved. Thus, policies against the pandemic are economic policy,” said a spokesperson.

Concretely, they plan to donate $4 billion dollars, as well as the surplus of vaccines in rich countries, numbering 1 billion doses. These materials, according to the IMF, will be provided by donations and subsidies, particularly from the G20 group, which is expected to provide $22 billion. A further $13 billion would be obtained from additional donations. The rest of the plan’s cost, comprising $15 billion, would be covered by multilateral banks.

To spice up their proposal, the IMF is promising major financial incentives: they expect to inject $9 billion per year into the global economy until 2025.[19]

The IMF has conceded that the lion’s share of the funding for their plan will fall on the rich countries. But its director general, Kristalina Georgieva, reassured that this seeming bid for altruism will not be uncompensated, as these self-same rich countries will “probably see the best return on public interest in modern history, capturing 40% of the increase to GDP and nearly $1 billion of additional income.

In conclusion, in response to the proposal to break the patents, countries and megacorporations have proposed to do more of the same: bilateral agreements between companies (i.e., deals amongst themselves), donations of leftover vaccines and money to Covax, a mechanism that has already proven insufficient to meet the vaccine demand. As of this publication, it has successfully distributed almost 50 million vaccines across 120 countries, far short of the planned distribution of 2 billion doses that was its 2021 goal.

Meanwhile, the IMF is asking for more donations, with the promise that rich countries will reap the economic rewards if the pandemic is cut short. A little over a year since the beginning of the worst health crisis of the century, the IMF estimates that the price tag on beating the pandemic will be $50 billion. In other words, the pandemic could be resolved using merely a quarter of what Big Pharma is expected to earn by selling the vaccines. It is also roughly equivalent to a quarter of the wealth of Bernard Arnault, recently named the richest man in the world. And all while the world’s multimillionaires have grown their fortunes by $13 billion over the past year, according to Forbes.[20] What a scandal!

A socialist program to beat the pandemic

If we reconsider the opening arguments of this article, the pandemic has been nothing more than a painful example of how the working class and its allies do not bring an end to capitalism, humanity will march straight on into barbarism. There will be no effective solutions for as long as technology and the production of necessary goods for human survival are subordinated to the laws of capitalist profit accumulation.

Humanity is threatened not only by wars and the inherent crises of imperialism and capitalism, but also by a series of pandemics. The scientific community has eloquently alerted the world to the dangers of the incompatibility of the world’s hegemonic mode of production, unrestrained exploitation, and the world’s limited natural resources.

As far as the immediate struggle against the pandemic, it would be wonderful if the WTO could provide a human-centered solution to the problems of medical shortages. It is highly unlikely that a suspension of the patents will be approved, as that would require a consensus of the 164 member countries of the organization.

What is more likely is that a compromise will be proposed, a “third way” that preserves the pharmaceutical megacorporations’ property rights. In fact, Biden’s change of posture, which has yet to produce any concrete results, is likely a ploy to pressure the companies to speed up their internal negotiations and find additional partners for technology transfer, rather than an earnest intent to suspend the patents, an act which, while technically possible, would set an uncomfortable political precedent for the bourgeoisie as far as companies’ future property rights are concerned.

We can’t wait on the WTO to provide a solution to the urgent need to innoculate 75% of the global population. This reveals an enormous contradiction, because in terms of technological and logistical capacity, this level of immunization would be attainable in only a few months. But, thanks to the logic of capitalist organization, even a simple vaccination campaign is apparently inconceivable.

The workers’ movement and the masses need to fight to not only “suspend” patents but to get rid of them once and for all. No one has the right to monopolize the product of a collective research and production process. Thus, even if the patents are ultimately lifted, it would be vital to reject any attempts to pay royalties or otherwise compensate the pharmaceutical companies holding the patents.

At its core, the rejection of the patents is grounded in an opposition to the commodification of health and other fundamental human rights under capitalism’s domain. For this reason, we need to raise the slogan of “End the patents, without any compensation”, and we need to take it into the streets to pressure each and every one of the governments and bourgeois institutions involved in the privatization of the right to life itself. Secondly, we need to consider this as a first step towards the expropriation of the pharmaceutical and biotech sectors in favor of control by the democratic organizations of the working class, to be carried out without compensation to the owners. This is the only truly effective way to plan and socialize production and distribution, to transfer technology and know-how and to put them to work in service of the greater human good, instead of merely working for the benefit of a handful of multibillionaires and their governments.Thus, the fight against the pandemic becomes a fight for a planned, socialist, workers’ economy. This is the only way to put an end to the anarchy of capitalist production, which has failed to guarantee even the basic necessities for human survival and which is now the engine of a genocide against the poorest of the world.

For these reasons, the fight to stop the current and future capitalist genocides is one and the same as the historical need to destroy the capitalist system. A revolutionary perspective needs to bring in the most urgent demands of the people that can motivate mass mobilizations and open rebellion, such as what we have seen in Paraguay and now Colombia, while simultaneously, unequivocally insisting that unless we take power away from the capitalists and imperialists, the miseries of our class will never end.

The choice of socialism or barbarism thus means at its most basic level that only a global socialist revolution is capable of defeating imperialism and reversing the destructive path that humanity is currently marching down, a path inherent to capitalism and bourgeois society.

The original Spanish version of this article can be found here

Footnotes:

[1] See: <https://covid19.healthdata.org/global?view=cumulative-deaths&tab=trend>. Data from 06/03/2021.

[2] See: <https://www.lavanguardia.com/vida/20210521/7471738/cvirus-oms-estima-cifras-reales-muertos-covid-19-son-2-3-veces-mayores-oficiales.html> .

[3] The industrial sector represents 8.% of deaths. Seer:<https://polis.org.br/estudos/trabalho-territorio-e-covid-no-msp/ >.

[4] See: <https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html?>. Data from 06/03/2021.

[5] The US obtained enough doses to vaccinate their population three times over, and Canada obtained enough to vaccinate their population 10 times over.

[6] See: <https://www.unicef.org/supply/covid-19-vaccine-market-dashboard>.

[7] See: <https://www.bloomberg.com/news/articles/2021-05-26/covid-shot-makers-to-share-in-up-to-190-billion-sales-bonanza?sref=vetpZg4P>.

[8] See: <https://www.timesofisrael.com/israel-said-to-be-paying-average-of-47-per-person-for-pfizer-moderna-vaccines/>. Según esta fuente, EEUU pagó 19,5 dólares por dosis a Pfizer/BioNtech.

[9] See: <https://www.eldiario.es/internacional/pese-cambio-eeuu-mayoria-paises-ricos-resiste-suspension-patentes-vacunas_1_7989577.html>.

[10] See: <https://www.forbes.com.mx/acuerdo-de-exencion-de-patentes-por-covid-19-parece-alejarse-en-la-omc/>.

[11] See: <https://noticias.uol.com.br/colunas/jamil-chade/2021/05/31/brasil-arrasta-debate-na-omc-e-pede-mais-tempo-para-avaliar-patentes.htm>.

[12]  See: World Trade Organization, 2020. Developing and delivering covid-19 vaccines around the world: <https://www.wto.org/english/tratop_e/covid19_e/vaccine_report_e.pdf>.

[13] See: <https://www.theguardian.com/science/2021/apr/15/oxfordastrazeneca-covid-vaccine-research-was-97-publicly-funded>.

[14] See: <https://www1.folha.uol.com.br/mercado/2021/05/pfizer-lucra-centenas-de-milhoes-de-dolares-com-vacina-para-covid.shtml>; <https://www.bbc.com/news/business-56979406 >.

[15] See: <https://valor.globo.com/empresas/noticia/2021/05/10/biontech-parceira-da-pfizer-na-vacina-contra-covid-19-lucra-113-bi-de-euros.ghtml>.

[16] See: <https://valorinveste.globo.com/mercados/renda-variavel/empresas/noticia/2021/05/07/farmacuticas-ampliam-lucro-trimestral-com-vacinas-agora-sob-risco-de-quebra-de-patentes.ghtml>.

[17] See: < https://atarde.uol.com.br/coronavirus/noticias/2170190-farmaceuticas-vao-ter-receita-anual-de-ate-us-190-bi-em-vacinas-anticovid>.

[18] See:<https://atarde.uol.com.br/coronavirus/noticias/2170190-farmaceuticas-vao-ter-receita-anual-de-ate-us-190-bi-em-vacinas-anticovid>.

[19] See: <https://www.elcomercio.com/blogs/economia-de-a-pie/miles-millones-fin-pandemia-ecuador.html>.

[20] See: <https://www.cronista.com/financial-times/los-multimillonario-se-enriquecieron-aun-mas-durante-la-pandemia/>.