The latest meeting of the World Trade Organization’s intellectual property council ended Thursday without a deal to suspend coronavirus vaccine patents as the United Kingdom, Germany, and other rich European nations continued to stand in the way, shielding the pharmaceutical industry’s stranglehold on production of the lifesaving shots.

Negotiations over the proposed patent waiver—introduced by India and South Africa and backed by more than 100 WTO members—have dragged on for more than a year, a period during which roughly 3.8 million people worldwide died of Covid-19. Poor countries across the globe, including dozens of African nations, still lack sufficient access to coronavirus vaccines, and campaigners argue a patent waiver is necessary to remove legal barriers and ramp up manufacturing in struggling regions.

The Biden administration endorsed the patent waiver in May, but leading E.U. countries and the U.K.—facing heavy lobbying from the pharmaceutical industry—remain opposed to a temporary suspension of intellectual property (IP) rules, which give profit-seeking drug companies near-total control over vaccine manufacturing.

A year and a half into the pandemic, the production and distribution of vaccines are still highly concentrated in rich countries, leaving low-income nations to rely on inadequate trickles of donations.

In its contribution to Thursday’s talks, the U.K. government downplayed the role that patent protections have played in vaccine shortages in poor countries, asserting that “bottlenecks to equitable distribution lie outside of the IP system”—a familiar claim that waiver proponents, including many IP experts, have adamantly rejected.

“Today the U.K. once again opposed plans to allow low- and middle-income countries to produce their own vaccines. The government’s weasel words at the WTO could help prolong the pandemic indefinitely,” Tim Bierley, pharma campaigner at the U.K.-based advocacy group Global Justice Now, said in a statement Thursday. “How many more people must die from Covid-19 before Boris Johnson gets out of the way and lets low and middle-income countries produce their own vaccines?”

“Today the weight of history was on the prime minister’s shoulders—and he decided to shrug it off,” Bierley added.

The WTO’s TRIPS Council, which is tasked with overseeing the implementation of IP rules, does not have another meeting scheduled for this year. At the end of next month, the WTO’s top decision-making body—the Ministerial Conference—is set to convene in what public health advocates see as a make-or-break moment for the waiver talks.

While expressing confidence that nations will ultimately “find a pragmatic compromise on the IP waiver,” WTO Director-General Ngozi Okonjo-Iweala admitted Thursday that the negotiations are “stuck.” Bloomberg reported last week that any compromise agreement will likely be in the form of a “declaration,” not a legally binding document.

“We need to diversify and decentralize the manufacturing of vaccines, therapeutics, and diagnostics,” Okonjo-Iweala said in a speech in Washington, D.C. “Our current inequality in access to Covid-19 vaccines is morally unacceptable.”

Just 2.7% of people in low-income countries have received at least one coronavirus vaccine dose, according to Our World in Data. Nearly 70 countries—including 44 African nations—are currently not on track to provide at least one dose to 40% of their populations by the end of the year, as pharmaceutical companies resist calls to participate in tech transfer efforts that would enable developing regions to produce vaccines.

In a speech in Geneva on Thursday, U.S. Trade Representative Katherine Tai took a jab at nations that are stonewalling the patent waiver, which can only be approved if every WTO member supports it. Her remarks came after the U.S. faced protests over its passive approach to the ongoing talks.

“The TRIPS Council discussions have not been easy, and members are still divided on this issue,” said Tai. “The discussions make certain governments and stakeholders uncomfortable. But we must confront our discomfort if we are going to prove that, during a pandemic, it is not business as usual.”

HuffPost reported earlier this week that, with the patent waiver negotiations stalled, E.U. is pushing an alternative plan that critics say would do little to close the massive inoculation gap between rich and poor countries.

“Notably, while the E.U. text uses the word ‘waiver,’ it explicitly does not waive the TRIPS agreement’s requirements that countries provide extended monopolies for drug firms holding patents, copyrights, trade secrets, and other forms of intellectual property,” HuffPost noted.

Graham Dutfield, a professor of international law at the University of Leeds, told the outlet that “the E.U.’s counter-proposal is a delaying tactic that is not designed to solve the problem but to obstruct any workable resolution.”

“It will protect corporate profits without significantly challenging the artificial scarcities that intellectual property rights are designed to sustain,” Dutfield said.