Standing up to Big Pharma is good politics – especially for a progressive. Yet when US President Joe Biden announced his support last week for a temporary waiver on vaccine patents, the lack of commitment in Ottawa's response left some people wondering if the government was opposed. Why the reticence?The idea of a waiver is certainly appealing, but the circumstances around it are complicated – politically, technically, and logistically. The real question is, will it work?At present, only 4.4 per cent of the people in Asia and less than one percent in Africa have received a vaccination, compared with 58 per cent in the United States and 43 per cent in Canada.If nothing changes, it will be another two to three years (at the earliest) before most people on these continents get their first shot. For the most part, they live in poor, densely populated countries, where mutations and infection rates threaten to explode. A massive human tragedy looms, and it may be far worse than anything in India.Trudeau has said repeatedly that Canada wants to help these nations, and now there is a serious proposal on the table. The co-sponsors, India and South Africa, argue that if these patent rights were waived, many companies would begin producing the vaccines, thus opening the bottle neck in production, and ramping up vaccination.Over a hundred countries have already signed on, along with legions of advocates around the globe, from Doctors Without Borders to Nobel prize winners. But the World Trade Organization's (WTO) 164 members operate by consensus, and some of the most powerful countries were resisting, including the US, the UK, and the EU.Then, out of the blue, Biden declared his support, and the logjam began to break, with the European Union and the UK also declaring their support.By comparison, Canada's response looked cautious and uncertain. Indeed, at a press conference the next day Trudeau had to reassure Canadians that his government was supportive: "I can assure you Canada is not interfering or blocking anything,” he insisted. We are “working for a solution that benefits everyone."The prime minister also took the opportunity to acknowledge concerns in the industry, and to note the technical and capacity issues around producing the vaccine. Neither is insignificant.Germany is home to BioNTech (Pfizer's mRNA partner), and Chancellor Angela Merkel has taken a stand with industry against the waiver. She argues that it could undermine the incentives for businesses to develop further medicines, including the response to COVID variants.This argument also has resonance in Canada. We may not produce COVID vaccines, but our pharmaceutical industry is the 9th biggest in the world, with over $30 billion in sales in 2019. Much of this work is done in Quebec, a Liberal stronghold, where patent protection is serious business. Trudeau is likely feeling some of the same pressures as Merkel.But there's more to this reticence than corporate profits or votes. Serious concerns are being raised about the viability of the waiver. Manufacturing these vaccines – especially, the mNRA ones – is not like following a recipe.It takes highly specialized skills, materials, and equipment, which, in turn, requires access to highly specialized supply chains. Even supporters acknowledge that reproducing the Pfizer or Moderna vaccines will take time, money, and help.Indeed, getting the WTO to waive IP rights may be the easy part. To be effective, the waiver likely needs to be underwritten by a major commitment to capacity-building and technology transfer – and so far, it is unclear where that will come from. Patent-holders aren't likely to provide it; nor can the WTO force them to.Lastly, the prime minister underlined the challenge of reaching consensus among 164 countries.Obviously, these issues are on his mind. Nothing in them says that the waiver is wrong, but they raise real questions about it, and they need answers.That will take a serious discussion – one that is guided by facts and a careful consideration of these and other questions: Where does COVAX fit in to this plan? What will happen to the excess stock from wealthy nations? Can patent-holders be persuaded to form strategic partnerships with other firms?Engaging 164 countries in such a discussion won't be easy, but it is in everyone's interest to have it. The world needs a solution that works. Ensuring a full and fair discussion is a critical step along that path.No one should assume this will happen on its own. The process needs some honest brokers – countries who are committed to getting the facts on the table, treating different views fairly, and taking the discussion where it needs to go.Trudeau has already said that he wants to help bring about a global consensus at the WTO. Why not let Canada take on the role of honest broker?Until now, these issues have been on the back burner. G-20 leaders have been largely focused on their own countries and populations. Meanwhile, the crisis in the developing world has been growing.But something big moved last week. In throwing his weight behind the waiver, Biden has put the issue of global vaccination on the international agenda and jump-started what is likely to be a vigorous discussion of how to solve it.This is the logjam that really needed breaking.Dr. Don Lenihan is Senior Associate at the Institute on Governance and an internationally recognized expert on public engagement, governance, and policy development. For more, visit his website at: www.middlegroundengagement.comAndrew Balfour is Managing Partner at Rubicon Strategy in Ottawa.