Ten African countries, supported by China, have appealed to the World Health Organization (WHO) to support increased local production of medicines, vaccines and other health products – to improve their access and drive down prices, according to a draft resolution presented to WHO’s Executive Board Friday.

Ethiopia, supported by nine other African countries – eSwatini, Ghana, Kenya, Namibia, Rwanda, South Africa, Sudan, Togo and Zimbabwe – led the appeal to WHO for support to develop “national policies and evidence-based comprehensive strategies and plans of action for local production”.

The resolution brings to the fore a key issue that emerged in the first months of the pandemic when the globalized and highly concentrated global supply chains for critical medicines were interrupted – leaving both high and low income countries in the lurch. Anchoring more manufacturing in a wider range of countries would help address similar future risks – while also bolstering technology transfer and economic development in low- and middle- income countries, advocates of the proposal say.

The intervention came as the executive board discussed WHO report on expanding access to effective treatments for cancers and rare and orphan diseases, the prices of which are usually unaffordable for low and middle-income countries. WHO points to high prices preventing 72% of African countries from providing hepatitis B vaccinations despite the high prevalence of this disease.

Speaking at the EB session, WHO Director-General Dr Tedros Adhanom Ghebreyesus praised Ethiopia, his home country, for its initiative and leadership in championing the resolution. Ethiopia has worked hard to establish its own pharmaceutical industry, offering various incentives to the pharmaceutical industry over a number of years to establish local manufacturing businesses.

COVID Pandemic Highlighted Need To Expand Manufacturing Capacity

“The COVID-19 pandemic has shown the great need to strengthen and expand global manufacturing capacity to timely meet global health demands for priority COVID-19 products to combat the pandemic,” Dr Tedros told the board meeting.

“Local production can play a critical role in expanding global manufacturing capacity and achieve equitable access to COVID-19 vaccines, therapeutics and medical devices and equipment,” added Tedros, stressing that this was “of particular importance to address equitable access”.

“WHO is committed to working with member states and partners from the public and private sector for strengthening and scaling up local production, promoting technology transfer and reducing barriers to quality assured safe, effective, and affordable medicines and other health products,” said Tedros.

Also thanking Ethiopia, Dr Mariângela Simão, WHO’s Assistant Director-General for Drug Access, said that the pandemic had highlighted that “we live in a world where there is a concentration of production in some countries”, and there was a need to “diversify and increase manufacturing capacity in different locations in the world”.

She also thanked Costa Rica for championing the COVID-19 Technology Access Pool (C-TAP), an initiative set up to promote sharing intellectual property and scientific knowledge to address the pandemic.

 

However, according to Simão only 40 member states support C-TAP, which highlights how hard it has been to get countries to share information.

Earlier today, renowned medicine access activist and academic Ellen ‘t Hoen of Medicines, Law & Policy, released an article saying that the “elephant in the room” at the WHO executive board meeting was that “most pharmaceutical companies refuse to share the know-how and technology needed to produce vaccines on a large scale”.

“Despite the fine words of European leaders who, just under a year ago, promised that no one could ‘own the vaccine’, C-TAP is empty. Forty one countries officially support C-TAP in words but few with action. This failure cannot be bought off with donations to the COVAX facility. COVAX after all, also needs the success of C-TAP to be able to buy affordable vaccines on a large scale,” said t’ Hoen.

Health Access International and the People’s Vaccine alliance also expressed unhappiness with C-TAP’s functioning in a letter delivered to the board meeting today. In it, they asked for “clarification of the strategy for C-TAP, who is providing political leadership, and who is providing the necessary technical leadership with regards practical issues for the transfer of know-how and technology for manufacturing” and also called for “bi-weekly public briefings to report on the progress of C-TAP”.

WHO Working for Access To Medicines With Other Agencies

Simão says that WHO implementing its roadmap to improve access to medicines on a number of fronts, including through a “tripartite collaboration” on intellectual property (IP) with the World Intellectual Property Organisation (WIPO) and the World Trade Organisation (WTO), and through initiatives with a range of UN agencies on IP, technology transfer and voluntary licenses.

Indonesia, which invested in the rapid expansion in its pharmaceutical industry, said told the board meeting that “expanding equitable access needs to be supported by transparency of market for medicine, vaccines, other health products”. It added that the prices of medicines and medical devices were available online.

Meanwhile, Bangladesh said that high cost meant that treatments for cancer and other rare diseases “is still limited in our country”, and urged WHO to both support local production and make available “clear and equitable pricing” for these diseases.

Colombia reported that it had saved itself R18-million since last March by controlling the prices of “approximately 2,513 commercial medicines and 279 active ingredients”.

Even high-income Norway reported that “unreasonably high prices on new medicines threaten sustainability of our health budgets and our ability to provide universal health coverage”.

“Industry demands for confidential prices contribute to our struggle to explain access decisions to the public,” added the Norwegian delegate. “Without transparency, it is challenging to justify to the public why we accept the production of some new medicines. while rejecting others.”

Norway expressed support for the WHO’s report on increased transparency on the prices of health technology, which combines earlier proposals by South Africa and Peru.

“However, to achieve more transparency, we need to collaborate, both with our national health authorities international organizations, and other stakeholders. We cannot do this alone,” stressed Norway.

Japan stressed that “incentives to develop new therapeutic tools” had to be maintained, urging “dialogue with relevant stakeholders, including stakeholders in industry, such as the International Federation of Pharmaceutical Manufacturers & Associations (IFMPA).

Image Credits: Wits University, WHO.