More than 3 million people have died of covid-19. Countless others have become ill, and the numbers continue to rise. Many public health experts predict that it will take anywhere between a year and three years to ensure truly global vaccine access. Tragically, those last in line overwhelmingly live in the most impoverished communities and countries.

A major reason for the delay in rolling out vaccinations is that rules protecting intellectual property are slowing production. Vaccines such as those for the coronavirus typically require around 200 individual components, most of which are patented by various corporations. Globally, these patents and other intellectual property concerns fall under the protection of “TRIPS” — the Agreement on Trade Related Aspects of Intellectual Property Rights — which is overseen by the World Trade Organization (WTO).

The need to make more vaccines faster is clear. That is why a wide coalition — from the South African and Indian governments to nonprofits such as Oxfam, Public Citizen and ActionAid to 170 Nobel laureates and former heads of stateare demanding that the WTO issue a “TRIPS waiver.” This action would temporarily suspend WTO intellectual property protections, allowing more companies and countries to produce coronavirus vaccine components. So far, the idea has been met with, at best, ambivalence by representatives from key economic powers, including the European Union, Canada, Brazil and the United States. Meanwhile, major pharmaceutical companies and lobbies largely oppose a TRIPS waiver.

This coronavirus is a newer virus. But debates around corporate power, intellectual property, pharmaceuticals and global inequalities have long histories. For over four decades, activists have worked for a fairer global regime of medicine production and distribution. Today’s campaign for a TRIPS waiver marks a crucial moment in the long struggle by globally minded activists to forge systems of international governance that serve the interests of the world’s most impoverished and marginalized.

The modern pharmaceutical industry took form in the late 19th century. World War II and its aftermath catalyzed growth, as corporations such as Pfizer became international powerhouses. As multinational drug company sales ballooned, so, too, did attention to corporate practices. Critics claimed pharmaceutical companies engaged in manipulative marketing, pushed “inessential” medications and charged astronomically high drug prices, especially in the global South. These specific critiques mixed with wider scrutiny of multinational corporations arising in the 1970s — from environmentalist and consumer activist campaigns to demands from some global South countries for a new international economic order.

As part of this wave of organizing aimed at reining in multinationals, in 1981, a global band of public health professionals, policy thinkers and anti-corporate campaigners created a new research and policy advocacy organization, Health Action International (HAI). Highlighting issues of inequality and corporate power, HAI espoused a transformative vision, including calling for the elimination of patent protections for “essential medicines” and backing massive efforts to promote the development and distribution of generic drugs.

While groups like HAI can apply political pressure, they do not have the power of national states. Thus, alliances between activists and governments can be crucial. Regarding pharmaceuticals, an early example of such an alliance arrived in 1982. Swamped by high drug costs amid grave poverty, the Bangladeshi government issued a new law banning some “nonessential” medicines, tightening regulations, lowering prices and promoting domestic medicine manufacturing.

While Bangladesh represented a minuscule percentage of the global pharmaceuticals market, multinational drug companies and some Western governments vehemently opposed the new law. They feared that Bangladesh’s challenge to Western capitalist interests could spur other countries to take similar actions. In response to the pressure campaign against the Bangladeshi government, HAI members joined other civil society groups to lobby their home governments to stop targeting Bangladesh. These efforts worked — Bangladesh maintained the law, domestic drug production increased and prices dropped.

Such successes proved rare. In particular, the rise of fervently pro-capitalist neoliberal politics around the world in the 1980s stymied activists’ efforts. As a pharmaceutical representative told the World Health Organization secretary general in 1988, while the “late ‘70s and early ‘80s might have been characterized as a period of confrontation … now we are entering a period of accommodation.”

The ascent of pro-corporate politics hit a new peak in 1995 with the launch of the WTO. Signatory countries gave the WTO a wide mandate to set norms across a wide array of economic sectors, from services to agriculture. One of the most dramatic of the new WTO agreements was TRIPS.

TRIPS set global enforcement standards for intellectual property. It included rules standardizing the lengths of patents and eliminating countries’ ability to treat domestic companies differently from multinational ones. TRIPS also included means for robust enforcement. A country or countries believing that another country’s policies violated WTO rules could employ “dispute resolution” mechanisms to press for compliance, including trade sanctions.

Within a few years of the WTO’s launch, tensions around intellectual property and pharmaceuticals access erupted. The cause: the HIV/AIDS pandemic. By the late 1990s, new medicines finally came online that held real promise. However, prices for these new medicines made them prohibitively expensive to the very populations most in need of them.

South Africa was one of the countries hardest hit by HIV/AIDS. In 1997, the new democratic government passed a law aimed at ensuring wide distribution of medicines. It included provisions such as compulsory licensing that challenged the predominance of intellectual property rights.

In response, a group of 41 drug companies, along with pharmaceutical industry lobbies, sued the South African government. Several global North governments also blasted the law. Both the companies and governments accused South Africa’s law of violating TRIPS. As with the Bangladeshi case, the companies and rich country governments feared a slippery slope; if South Africa succeeded in defying TRIPS, it could lead to the agreement becoming toothless.

The actions of governments such as the United States and the pharmaceutical industry provoked immediate global outrage. Social movements and advocacy groups across the world mobilized. In South Africa, the Treatment Action Campaign brought together people living with HIV, unions, faith groups and nonprofits to mount protests and file lawsuits defending the law. In the United States, activists disrupted public events featuring Vice President Al Gore (then campaigning for the Democratic presidential nomination), accusing the Clinton administration of engaging in a “morally reprehensible” defense of profits over people.

The campaign worked. Rich country governments ceased their diplomatic and economic pressure. Within a few years, pharmaceutical companies withdrew their legal challenges. Some even agreed to voluntary price reductions. In the years following, prices of antiretrovirals dropped substantially and, most critically, more people gained access to these medicines. However, internationally, the TRIPS framework remained.

This history continues to resonate. Recently, the head of the U.N. agency tasked with confronting HIV/AIDS, Winnie Byanyima, remarked that, “we cannot repeat the painful lessons from the early years of the AIDS response, when people in wealthier countries got back to health, while millions of people in developing countries were left behind.”

TRIPS is one reason for the disparities in vaccination rates between the wealthy and the impoverished of the world. However, recent history shows that activism can bring change. Pressure is growing on the Biden administration to back a TRIPS waiver, including a recent letter supporting this idea from 10 Senate Democrats, including Bernie Sanders (Vt.), Raphael G. Warnock (Ga.) and Elizabeth Warren (Mass). A TRIPS waiver would save lives. It would also offer a needed win for global civil society. It would empower the forces demanding that equity be a core principle in addressing the many crises, from pandemics to climate change, that we face today and will continue to face for the foreseeable future.