Kenya
Selena Ruto, a community health volunteer, visits the Kibet family in Narok County in Kenya to discuss the risk of anthrax.

Africa’s brutal experiences battling Ebola and a range of other deadly diseases helped prepare health systems to deal with COVID-19.  And by the time the SARS-CoV2 virus landed on the continent, its Centre for Disease Control (CDC) had already “established regional coordinating centres, increased lab capacity and unified surveillance networks”. 

The lessons in emergency response had been honed by countries facing dire threats not only from Ebola, but other little-known pathogens such as anthrax and monkeypox, according to Epidemics That Didn’t Happen, a report launched on Tuesday by Resolve to Save Lives, an initiative of Vital Strategies.

In 2014, Nigeria was able to contain Ebola through a “herculean public health effort” that involved “effective communication, coordinated response activities and dedicated leadership”, according to the report.

Meanwhile, in 2019 only one Ugandan family was infected with Ebola before the country contained the disease, which has a fatality rate of 66%.

Within days of an Ebola outbreak being declared in the Democratic Republic of Congo (DRC) in August 2018, Uganda had opened multiple Ebola treatment centres and rapid testing laboratories near its border with the DRC, screening all people entering the country. By that November, Uganda had vaccinated almost 5,000 health workers and response staff.

In June 2019, a family returning to Uganda from the DRC were diagnosed with Ebola at a routine border screening point. They were immediately placed in an Ebola treatment centre and almost 300 of their contacts were vaccinated. There were no further Ebola cases in the country.

Meanwhile, a sharp-witted Red Cross volunteer in the Kenyan town of Narok along the Great Rift Valley triggered a community-based surveillance system after encountering three people who became sick after eating meat from a dead cow. This helped to contain a potentially deadly anthrax outbreak in 2019.

‘Now or Never Moment to Invest in Public Health’

The report shows “how the trajectory of an outbreak can be altered when a country invests in and prioritises preparedness combined with swift strategic action”.

“This is our now or never moment to invest in public health, to prevent the next pandemic, and ensure that as a world, we are never again so underprepared,” said Resolve’s President, Dr Tom Frieden. 

“This report highlights great work of public health professions from around the world and shows that epidemics don’t have to spread uncontrollably and cause devastating loss of life. If we work together, we can make the world a much safer and healthier place,” he added.

According to Resolve, the COVID-19 pandemic could have been contained if there had been adequate global pandemic preparedness.

Interestingly, Africa fares well – precisely because the continent has faced a number of serious disease outbreaks and developed a wide range of responses.

In contrast, a complacent US defunded its pandemic preparedness efforts shortly before the COVID-19 pandemic. This is best illustrated by the Trump administration’s decision to disband the Global Health Security and Biodefense unit and Predict, a $200-million pandemic early-warning programme designed to work with scientists across the world including in China, to identify viruses that had the potential to cause epidemics. Predict was ditched three months before the COVID-19 pandemic was declared.

Unlike the US, Africa’s CDC, which coordinates the continent’s response to COVID-19, has been honing its response to disease outbreaks over the past decade. 

“To date, the entirety of Africa has seen just over 100,000 COVID-19 deaths, a fifth of the death toll of the United States, despite having more than three times the population,” the report notes. 

“While emerging variants in South Africa and elsewhere remain a threat, and Africa CDC warns against declaring victory too early, it is clear that the coordinated response spurred by Africa CDC has saved lives while better preparing the continent to address future outbreaks,” the report concludes.

 

Image Credits: International Federation of Red Cross and Red Crescent Societies / The Kenya Red Cross Society.

India’s Armed Forces Medical Services (AFMS) deploys doctors and paramedics at Sardar Vallabhbhai Patel (SVP) COVID hospital in Delhi to respond to the surge in COVID-19 cases.

PUNE – Indian twitter for days has been a desperate space. There are appeals for oxygen cylinders, cries for funding to meet healthcare costs, and panic-stricken relatives scouting for hospital beds for their loved ones. Hospitals are now approaching the courts for help as they run out of oxygen. And even prominent lawyers and influencers are scouting for help online. 

In the Indian state of Karnataka, deaths are so high that the government has allowed the dead to be buried in land owned by family members, or on farm property, as the crematoriums are flooded with dead bodies. Not only are hospitals discouraging COVID patients from even coming for treatment, but COVID tests have now run out in many parts of the country. While the international community is now proffering offers of assistance – observers fear it will be too little too late.  

Government Held To Blame 

The government has been blamed for the mismanagement of the crisis – most recently for allowing the super spreader religious event called the Kumbh Mela, involving  mass gatherings of prayer goers in the Ganges River and on land. 

Indian Prime Minister Narendra Modi’s own election rallies in the election-bound state of West Bengal have also contributed to the rising cases in that state. Modi’s BJP government even offered voters free vaccines if it came to power in the state, whose eight-phase election will continue until 29 April.

The Prime Minister, meanwhile, has not only downplayed the crisis – but even gone so far as to argue before the country’s Delhi High Court that there has been no shortage of oxygen – despite the public pleas from patients and hospitals around the country on social media. 

india
India’s Health Minister Harsh Vardhan visits the Sardar Patel Covid Center, near Chhatarpur Temple, in New Delhi on April 24, 2021 – an emergency facility set up to cope with the current crisis.

Opposition leaders have highlighted instances where tweets criticizing the government’s handling of Covid-19 also have been deleted from social media platforms.

They also note that government public health officials utterly failed to restrict the mass Hindu religious gatherings, while Modi has personally boasted about his own the mass election gatherings – despite the clear risks both poised to public health.  

Amidst all this the country has been reporting close to 350,000 new cases daily, outpacing the highest daily case rates of the worst-affected country in the world, the United States (US) at the peak of its third pandemic wave. In terms of cumulative cases, as well, India now ranks second after the US. 

Opening Up Domestic Vaccine Market 

On May 1 the government will open up vaccines to those above the age of 18 – but it’s clear that in light of the severe vaccine shortages, many people will still not be able to access vaccines for several months. 

And at the same time, the country is opening up its vaccine market to private players as Health Policy Watch reported earlier.  

Some 50% of the total available vaccine supplies will be offered by the vaccine manufacturers directly to the States and private hospitals. But this means that they will now have to negotiate directly with the manufacturers, as well as competing with each other to procure limited supplies at significantly higher prices than the national government is paying. 

Meanwhile, only those people over age 45 eligible for free national government supplied jabs – with individual states having to decide on whether or not to subsidize the costs of vaccinating other population groups. 

Most states so far have said they would provide the vaccines free of cost – at a huge financial toll. 

Critics said that the privatization move, effectively, means that the national government has  shifted its vaccine costs to the state budgets. 

India’s former health secretary took to Twitter to criticize the move and called it an abdication of fundamental duty by the government and one that will lead to chaos and confusion from May 1 onwards as state governments and private hospitals jostle to procure vaccines. 

Leena Menghaney, a public health lawyer specializing in vaccine pricing in India, said the new policy would create inequities in access to the vaccine within the country. “In no other country you would see the price one for the central government and one for the state.” 

Vaccine prices shoot up amidst case surge

While vaccines sold to the central government will continue to be priced at Rs 150-400 ($2-$5), the new prices set by India’s two vaccine manufacturers, Bharat Biotech and the Serum Institute will range from Rs 400 – 1200 ($5-20). 

SII’s CEO Adar Poonawalla recently declared that the company lacks capital for investing in vaccine manufacturing scale-up,  particularly in light of the fact that it has to pay AstraZeneca some 50% in royalties to locally-manufacture the AstraZeneca vaccine. 

Earlier he also told an Indian news channel that the price of $2 was profitable but meant that SII was forgoing “super-profits” that would allow them to invest  in vaccine research and development.

COVAX Also Affected – While International Community Proffers Help

India’s crisis also affects the 91 low-income countries depending on vaccine supply through the Covax agreement. Currently the exports of vaccines are frozen given the magnitude of the humanitarian crisis in the country. “It (India’s crisis) comes at a great cost where other most vulnerable populations in developing countries are still waiting for vaccines,” said Menghaney.

Poonawalla has said that he expects the export situation to ease in two to three months. 

Following the global outcry over India’s situation the United States, the United Kingdom, European Union, as well as other countries from around the world have stepped in to offer help – including emergency oxygen supplies and PPE. 

And Pakistan’s Prime Minister Imran Khan expressed concern for India’s explosive infection situation – putting aside decades of geopolitical friction over Kashmir and other disputed areas to do so. 

Significantly, the United States also has agreed to lift an export ban on the raw materials required by the Serum Institute of India to manufacture the local version of the AstraZeneca vaccine (Covishield) after initially refusing to do so. The country has also offered to help India with rapid diagnostic test kits, ventilators, and Personal Protective Equipment (PPE). Ashish K Jha, dean of the Brown Institute of Public Health has called these excellent steps.

Also on Monday, the United States was reported to be poised to donate excess vaccine doses to the WHO co-sponsored COVAX initiative – and if so, Indian observers were hopeful, some of those could be directed to the subcontinent. 

https://twitter.com/JonLemire/status/1386723272721588229

The World Health Organization (WHO) also announced additional help to India, with WHO Director General Dr Tedros Adhanom Ghebreyesus calling the situation “beyond heartbreaking” in a press briefing on Monday. 

Around 2,600 WHO staff members will be deployed to India he said to support the response effort along with dispatches of PPE and other equipment.  

 

-Disha Shetty is an independent journalist based in Pune, India who writes on public health, environment and gender. 

 

 

Image Credits: Press Information Bureau (PIB), Credit: Press Information Bureau (PIB).

Red and white capsules in pharmaceutical production line.

Amid a huge global push for the World Trade Organization (WTO) to waive intellectual property (IP) rights on products related to COVID-19 for the duration of the pandemic, the pharmaceutical industry launched a document on Monday – World IP Day – asserting that a “strong IP system advances public health” .

According to the 10-point IP Principles for Advancing Cures and Therapies (IP PACT), IP is the “cornerstone” for the creation of new diagnostics, treatments and vaccines.

The industry declares that “society benefits from the disclosure and dissemination of the information contained in patents and patent applications” and commits itself to “support voluntary and meaningful initiatives that make information about patented medicines more easily available and accessible, and improve the public understanding of the global patent status of approved medicines”.

“We believe that intellectual property is a key facilitator of medical progress and we are committed to patient and societal benefit as guiding principles in our IP practices,” states the document’s first principle.

Meanwhile, it’s 10th and final principle declares that “all countries, including Least Developed Countries (LDCs), stand to benefit from the implementation of the TRIPS Agreement and effective IP regimes”. 

But in recognition of socio-economic challenges faced by these countries, the industry proposes “a time-based transition period for LDCs to meet the TRIPS standards while they focus on overcoming these structural challenges and work towards implementing the necessary framework to protect and enforce IP”. 

Industry Commits to Engaging with Least-Developed Countries

In the meantime, the industry commits to engaging with LDCs in a way that “takes into account their unique challenges”, and this could include “voluntary licensing, non-assert policies or selective approaches to filing, in addition to supporting capacity-building initiatives”. 

“IP has been the oil in the machine of collaboration during this pandemic that has seen unprecedented cooperation and sharing of know-how,” explains Andrew Jenner, Director-General of Interpat, the pharmaceutical industry organisation that focuses on patents and IP.

Jenner says that the IP PACT explains how the industry uses IP in practice for the benefit of patients and society.

Corey Salsberg, Novartis Vice-President and Global Head IP Affairs, told the launch that the IP PACT had been developed to ensure that patients and broader society “have a better understanding of how we approach IP, which is as a means to drive life-changing medical innovations, and as a tool to advance our efforts to contribute solutions to the world’s healthcare challenges”.  

“Several of the principles pertain specifically to themes that are on full display in the COVID context, such as the important role that IP plays in enabling collaborations and partnerships, driving innovation, and bringing together the expertise and capacity needed to achieve things like manufacturing breakthrough technologies on a global scale,” added Salsberg.

An investigation by Intercept published last week revealed that over 100 lobbyists have been paid to approach US politicians to urge them to oppose the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Waiver proposed by South Africa and India at the WTO.

It also comes a few days after the claim by the People’s Vaccine Alliance that Pfizer, Johnson & Johnson and AstraZeneca have paid $26bn in dividends and stock buyouts to shareholders in the past year – enough to cover Africa’s entire COVID-19 vaccination programme.

Babies and children in 50 countries are missing out on routine immunisations.

Fifty countries have not yet resumed routine immunisations disrupted by the COVID-19 pandemic, affecting 228 million people – mainly children – and there have already been serious measles outbreaks in Yemen, Pakistan and the Democratic Republic of the Congo, according to World Health Organization (WHO) director general Dr Tedros Adhanom Ghebreyusus. 

To address this, the WHO, UNICEF, and the global vaccine alliance, Gavi, launched the Immunization Agenda 2030 (IA2030) to strengthen global immunization systems at the WHO biweekly press conference on Monday. 

UNICEF Executive Director Henrietta Fore

The main targets to be achieved by 2030 are: 

* 90% coverage for essential vaccines given in childhood and adolescence

*Halving the number of children completely missing out on vaccines  

* Completing 500 national or subnational introductions of new or under-utilized vaccines, such as those for COVID-19, rotavirus, and human papillomavirus (HPV) .

Dr Kate O’Brien, the WHO’s head of immunisations, said that if these goals are achieved, “the latest estimates show that the strategy would avert over 50 million deaths of children and adolescents”.

Over half of the 50 affected countries are in Africa, highlighting “protracted inequities in people’s access to critical immunisation services”, according to WHO.

“The pandemic has made a bad situation worse, causing millions more children to go unimmunized. Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines. We have no time to waste. Lost ground means lost lives,” said Henrietta Fore, UNICEF Executive Director. 

Fore added that, due to pandemic-related disruptions, UNICEF delivered 2.01 billion vaccine doses in 2020, compared to 2.29 billion in 2019.

“We are embarking on an unprecedented global [COVID-19] immunisation campaign. But this campaign cannot come at the cost of childhood vaccinations,” said Fore.

”We cannot trade one global health crisis for another. In a year when vaccines are at the forefront of everyone’s minds, we must sustain this energy to accelerate efforts on all three fronts: providing equitable access to COVID-19 vaccines, catching up on missed vaccinations due to the pandemic lockdowns and, critically, extending immunisation efforts to all children currently missing out on vaccines entirely.”

Gavi CEO Dr Seth Berkley said that “to support the recovery from COVID-19 and to fight future pandemics, we will need to ensure routine immunization is prioritized as we also focus on reaching children who do not receive any routine vaccines, or zero-dose children”. 

COVAX Depending on Dose Donations

COVAX had expected another 90 million vaccine doses from the Serum Institute of India in March and April for low income countries but these had been kept for domestic use given the COVID-19 “crisis” in India, according to Berkley, whose organisation co-leads COVAX.

“We are in early days on discussions on dose sharing,” added Berkley. “We had an announcement last Friday from French President Macron that he would be sharing up to a half a million doses and we’ve also had an announcement from New Zealand, that they would be sharing 1.6 million doses and we’ve heard from the Spanish Prime Minister that they would be sharing doses, so we’re beginning to see engagement from many on dose sharing.”

He confirmed that COVAX was “waiting for when supplies will resume [from India], and we’re looking at other options at the same time”.

Meanwhile, on Monday the US announced that it would be releasing 60 million doses of AstraZeneca vaccines that it had ordered “as they become available”, according to Andy Slavitt, White House Senior Advisor on COVID-19.

Maria Van Kerkhove, WHO Lead on COVID-19

 

Tedros described the situation in India as “beyond heartbreaking”.

“WHO is doing everything we can, providing critical equipment and supplies, including thousands of oxygen concentrators, prefabricated mobile and field hospitals and laboratory supplies,” said Tedros, adding that it had redeployed 2,600 staff “to support the response on the ground, providing support or surveillance, technical advice and vaccination efforts”.

Dr Maria Van Kerkhove, the WHO Lead on COVID-19, described the exponential growth in COVID-19 cases in India as “really, truly astonishing”, but warned that “this can happen in a number of countries if we let our guard down”. 

“We’re in a fragile situation, with nine weeks of case increasing, with more than 5.7 million new cases reported last week, and that is certainly an underestimate,” said Van Kerkhove.

“The situation can grow if we allow it to, and this is why it’s important that every single person on the planet knows that they have a role to play,” she added. “We need governments to continue to apply comprehensive approaches and enabling populations so that they know what they need to do to keep themselves and their loved ones safe.”

 

Image Credits: © UNICEF/Claudio Fauvrelle, Jaya Banerji/MMV, UNICEF.

Civil society groups demonstrate in February 2021 outside embassies of the United States, United Kingdom, Australia, Canada, Brazil, and other countries, which oppose a temporary WTO patent waiver on COVID-19 health products.

As the hotly contested proposal for an IP waiver on COVID-related health products comes up again for debate on Friday, 30 April at the World Trade Organization’s TRIPS Council, legal expert  Hyo Yoon Kang looks at the foundations of IP law to challenge “TRIPS waiver” naysayers. 

Geneva Health Files [GHF]: You have argued that IP law must serve the global public, not national interests, saying, ‘There is no logical reason why patent law’s grant of monopoly power cannot be curtailed, if its public purpose is not fulfilled.’ Can you elaborate?

Hyo Yoon Kang [HYK]: With my statement, I was transferring the commonly held justification for patent law at the level of national jurisdictions to the global level. Much of modern patent law’s legitimacy rests on the belief that the public will be better served by granting a limited monopoly right in an invention than allowing market competition. This is commonly known as the ‘patent bargain’: private risk is rewarded and incentivised in return for a limited private monopoly right, which in turn is supposed to benefit the public at large in a trickle-down or trickle-across effect. Yet the scale of such a bargain has arguably not been in an equilibrium for some time, as pharmaceutical companies’ price hikes and ever-greening practices [nb. referring to efforts to extend the life of some patents] have shown. Also, not all inventions have the same importance for the public. It is not sensible that medicines are treated in the same way as hair dryers in patent law.

Patent Bargain is Skewed 

In the current COVID-19 pandemic, the scale of the ‘patent bargain’ has become even more skewed against the public interest because monopoly rights are being claimed for inventions that have been effectively de-risked and funded with public taxpayers’ money, not to mention the decade long public support for basic research that has led to these products, such as the United States National Institutes of Health (NIH) funding of  mRNA vaccine technologies. These arguments have been published in the research literature, including The Lancet.. While there is no need to repeat what has already been said, it bears pointing out that – a year into the pandemic – governments have created a de-facto oligopolistic market dominated by a handful of companies that have been subsidised by the public sector, providing fora range of intellectual property protections, ranging from  patents to trade secrets.

How does such a skewed patent bargain play out on the global scale? At least since the 1995 World Trade Organization agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS), what counts as ‘public’ and ‘private’ in the context of IP can no longer be national categories. Yet the understandings of what is ‘public’ and ‘private’ in much of IP law discourse have remained rooted at the national level. The result is a dissonance of legitimacy between a transnationally enforceable IP legal structure and its justification based on 19th century concepts of sovereignty, colonisation and industrialisation.

Existing WTO IP flexibilities enshrined in “31bis” of the TRIPS agreement still make it difficult to export health products manufactured under a compulsory license to other countries in need.
Impracticability of Article 31bis

The history of TRIPS, including the de-facto impracticability of Art. 31 bis is one example. The unwieldy restrictions around, and consequent limited use of this provision – which is supposed to facilitate a country’s export of medicines produced under a compulsory license WTO members that cannot produce the needed medicine in sufficient quantities – illustrates how institutional design has not been a level playing field, and favoured certain multinational corporations over others from the start. We can currently observe the unequal effects of such a legal institutional design in the pharmaceutical industry’s resistance to any compulsory licensing, to the WHO proposed C-TAP patent pool,  and the TRIPS IP waiver  proposal. They clearly illustrate that particular, private interests hosted by a minority of nation-states are pitted against the global majority public health interest.

Serving the Global Public Interest 

This is why we ought to go back to the initial motivation that legitimised patent monopolies in the first place and conceive of the notion of a public clearly as a global public, and not a national one. If TRIPS is the legal architecture that underpins the ability to extract monopoly rent on a global scale, then by the same token, transnational patent law needs to serve a global public’s interest.

Lastly, the public interest in rewarding ‘inventions’ is often erroneously conflated with ‘innovation’ as a desirable good in itself. For example, the term “technological innovation” has been included as TRIPS’ objective in Article 7 of the TRIPS Agreement, albeit with a caveat that it should be of mutual benefit to producers and users of “technological knowledge”. 

Additionally, while much of the PR generated by intellectual property offices, the pharmaceutical industry and the media assume that they are interchangeable notions, in fact “inventions’’, “‘patents” and “innovations” are not the same. The belief that ‘patents equal inventions equal innovation’ is rather a myth. Economic historical research has been inconclusive as to the benefits of patents to innovation until to date.

[GHF] You have also spoken about how “the entanglement of governments with university science-entrepreneurs, venture capitalists and preferred industrial champions, further complicates the notion of what is ‘public’.” Can you elaborate?

[HYK] The notion of ‘public’ is used by a variety of actors with different interests without asking: who does the ‘public’ include, who does it exclude? Are governments acting in the best interest of their citizens?

Sciences are implicated in the erosion of the notion of ‘public’ since at least the Bayh-Dole Act 1980. (It allows for the commercialization of US federally funded research.) But the relationship between scientific research & development and  industrial implementation/production  stretches back to the 19th century and before. Publicly-funded universities and public research organisations are avid users of the intellectual property system, as recent European Patent Office analysis of pharmaceutical patent applications has shown. As much of their interests are monetary in nature now, university science departments, both fundamental and applied, cannot be necessarily understood as  ‘public’ without qualifications; for instance, the high profile CRISPR patent dispute involved scientists in universities or public research institutions, and their spin-offs.

Problem of Profit Motives Pervading Underfunded Universities is Complex 

In my Critical Legal Thinking piece, I  explained the patent interests of Oxford University and their scientists. These existed prior to Gates’ push for an exclusive contract with AstraZeneca, and it is not entirely accurate to portray the university scientists as the innocent victims of commercial influence. There are, of course, some exceptions to the (now unfortunately normalised) figure of the ‘scientist-entrepreneur,’.  I am thinking about Katalin Karikó who was instrumental in inventing the mRNA technology, [but holds no patents on it]. The pressure exerted on scientists by the university administration to apply for patents is not negligible, and the problem of private profit motives pervading underfunded public universities is a complex one.

In relation to a government’s public duties, the pandemic has laid bare how particular, private and corporate interests have permeated what ought to be essentially public processes and decision-making power beyond an advisory capacity. 

‘Venture Capitalist’ Thinking In Government

For example, in the UK, the Boris Johnson government has favoured certain private actors under the guise of having no time for public procurement processes during a pandemic. Some journalists have argued that it was such ‘Venture Capitalist  (VC) thinking’ that led to the UK’s vaccine success. The UK ‘vaccine tsar’, Kate Bingham, is a venture capitalist who has expressed that her vaccine procurement responsibility was ‘outside’ of politics (“Politics is separate”). In a recent FT interview, she claimed such VC thinking entailed that the government could not afford to be “penny pinching,” even if it was public money that she was spending. What is interesting is that the government, or the civil service, is regarded to have no capacity to direct and shape the process of vaccine manufacturing and distribution, whilst being expected to give a carte blanche. In other words, it is asked to pay and shush.

Some US patent academics had, moreover, argued on social media that more financial incentives should be given to pharmaceuticals by the government in order to scale-up vaccine production. Yet the COO of BioNTech stated on German TV that it was not the lack of financial incentive that made the scaling up of vaccine production difficult at the moment.

Need to Strengthen Public Sector Capacity – After Years of Austerity

What this pandemic has demonstrated very clearly, is that we need to strengthen public sector capacity after years of austerity rather than diminishing it. This will reduce the present dependency on corporate actors. Also governments and their officials need to negotiate harder on the public’s behalf instead of accepting without question financial sector mentality in which maximising profit margin is the rational thing to do. Such a mentality forgets that it is the taxpayers’ money, not their own, that they play with. The public underwrites all risk whilst the financial gain is all private and distributed among a small number of shareholders or corporate owners.

Without wishing to diminish the exceptional advances in vaccine development that we have seen in the past year, it is equally important to remember the extraordinary mobilisation of public funding into medical research and supplies which has been unprecedented in our lifetime.

Should the Government Act like a Venture Capitalist? 

It seems therefore odd and disproportionate to me that there doesn’t seem to be a single contract in the UK or US, in which a government has taken co-ownership of a vaccine patent or receives future royalty, precisely because the vaccine development efforts were headed by a venture capitalist or a former pharmaceutical executive who would normally demand such returns on their investments. Beyond this incongruence, there is the fundamental political question – should the government  act like a venture capitalist, at all? For example, the UK government runs the biggest venture capital fund in Europe which has received little scrutiny and is also reported to have taken a stake in Vaccitech, the Oxford University spin-off behind the Oxford/AstraZeneca vaccine. Alternative ways to balance public and private interests could be through IP restrictions on certain subject matters, national compulsory license legislation, and the enforcement of price ceilings on publicly funded inventions, but it will also be interesting to think about higher taxation on IP rent income.

[GHF] Some believe that IP is not a barrier for medicines during the pandemic. Particularly with respect to vaccines. It has been suggested that the WTO TRIPS IP waiver will not sufficiently address access barriers to vaccines or wider medical products – particularly since the waiver itself would  not force technology transfer.

[HYK] The TRIPS waiver proposal does not only comprise patents, but also copyright, industrial design and importantly, undisclosed information, such as trade secrets, in relation to the fight against Covid-19. Trade secrets are also part of IP. They are especially relevant in relation to Pfizer because it has decided to keep its vaccine manufacturing know-how secret.

Some argue that waiving patents is not sufficient because the knowledge-transfer and sharing of know-how are needed. This is certainly true, and also because of the low standard of the disclosure requirements in different national patent laws: the disclosed inventive information in patent documents is often woefully insufficient to be used as a “recipe” or for reverse engineering. That is also why analogising patents with recipes and copies is not accurate.

I find the arguments advanced against the TRIPS waiver proposal claiming that as “patents are not the problem” disingenuous because, even if know-how was shared, tech was transferred, and a vaccine was developed, it would be illegal to produce it without a license –  if the substance, its parts, or its process of manufacture, remains under patent protection. 

The patent holder would continue to hold the power to block vaccine production, regardless of existing or shared expertise and capacity. This is not a good way of clearing all barriers for scaling-up vaccine production in a global pandemic. The IP waiver is therefore necessary as an integral part of a concerted effort to share know-how and scale up production. We need the waiver in order to end the pandemic instead of prolonging it through artificial scarcity. Both IP waiver and tech transfer need to go hand in hand.

Turning the argument on its head, we may ask why is the pharma lobby and Gates Foundation  defending IP so much if it does not matter?  If they are not the problem right now, then why not waive the IP rights temporarily? It seems to me that they are fighting so vehemently against the IP waiver because patents do enable monopoly power, and a future profit pipeline of a huge global market desperate for the vaccine.

From a Purely Financial Perspective – It’s not In the Vaccine Makers’ Interest to End the Pandemic As Soon As Possible

From a purely financial perspective, it is not in the vaccine makers’ and their shareholders’ interest to end the pandemic as soon as possible. Even though policy makers and governments are reluctant to push the pharmaceutical players too hard, the pharmaceutical industry, universities and their technology transfer offices will not self-regulate and voluntarily open license their patents through C-TAP or share their know-how in the latest announced WHO Technology Transfer pool, precisely because it is contrary to their rational commercial self-interest to do so. In my view, there must be both a carrot and stick approach towards the vaccine makers to change their present course. This could include the introduction and implementation of national compulsory license measures.

[GHF] How do you see these IP issues, and the consequent  “capitalisation of knowledge” play out in the future with respect to  biological resources and digital health?

[HYK] I don’t think I can answer the question about biological resources and digital health accurately without looking more into detail into the main issues and players in these fields, but in relation to the latter we will see an increasing overlap of copyright and patent law issues because the key value driving digital health will be access to datasets for pattern recognition and correlation tracing. The current debates about privacy, social media and regulation of AI are instructive for digital health. Similar to internet companies, the valuation of digital health companies will be data and computing-capacity driven.

The role of IP law in the capitalisation of knowledge is that it creates a link between knowledge and speculative value through a legal monopoly right.

In a way, this is nothing new. Intellectual property rights have always acted as currencies of international trade (chemical patents in the 19th century, for example), and have been hence nationalistic instruments of trade policy. It is also nothing new that academic or university science departments have been implicated in industrial policy since the 19th century, which in turn shaped the foundations of modern patent law. Historians of science, science studies scholars, and myself from the patent law side, have studied the different phases and modalities of co-option of science into industry.

What has been novel since roughly the mid-1990s, is the pursuit of IP as not only monopoly for extracting monopoly rent in a commodity market, so via monetisation, (this is the case presently in the Covid-19 vaccine oligopoly), but using IP as a financial tool: either to raise more equity or as technique of financial arbitrage. I have analysed the financialisation of patents as assets. The financial forward-looking, speculative function of IP is reflected in the total reversal in the proportion between physical and intangible assets value in the S&P 500 index between 1975 and 2017. The last forty years have been characterised by increasing financialisation of knowledge-making and uses via IP, both through copyright and patent laws. As already noted, inventions, innovation and IP are routinely and misleadingly conflated today, partly as a result of patent office rhetoric that equates more IP with more innovation. Patents are seen as a key asset in the so-called “knowledge economy” of disruptive innovations. In turn, knowledge enclosures create new forms of colonial dependencies, as we observe now in this current pandemic.

As much of the current financialised economy rests upon monopolies that are enabled through intellectual property law, unless health data and knowledge about them are safeguarded through privacy or other rights-based measures, they will become as monetised and financialised as any other data. If they concern matters of global public health, IP rights will again stand in the way of health equity. I can only hope that we will learn the lessons of this pandemic.

Intellectual property law expert,  Hyo Yoon Kang,  is a Reader in Law at Kent Law School, University of Kent, United Kingdom. Kang works at the intersection of law, history of sciences, and science and technology studies.

Hyo Yoon Kang, IP specialist at University of Kent, United Kingdom

Adapted from the article first published in Geneva Health Files by Priti Patniak, GHF founder and publisher.

Image Credits: Tadeau Andre/MSF , AstraZeneca, Image credit: Shariq Siddiqui).

India’s first ‘Oxygen Express’ train is transporting liquid medical oxygen from steel plants that produce oxygen to different parts of the country in desperate need of supplies to support treatment of seriously ill COVID patients.

India recorded the world’s highest daily toll of new infections for the second consecutive day on Friday, while Japan plans to impose its third state of emergency, just three months before the Tokyo Olympics are set to begin. 

India is currently facing its worst outbreak of SARS-CoV2 since the pandemic began, with over 330,000 new cases recorded on Friday – more than triple India’s previous peak in late September, and surpassing the US record of 300,669 new cases on 8 January 2021. 

Over the past week, nearly 1.6 million new COVID-19 cases have been recorded across India. 

Daily deaths are also on the rise, 2,263 deaths were recorded on Thursday, bringing the total COVID-19 deaths up to 186,920, according to health ministry data. 

“The second wave is a consequence of complacency and mixing and mass gatherings,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in New Delhi, told Reuters

Hospitals Call for Help as Oxygen Supplies Dwindle 

Health officials in northern and western India are raising the alarm that hospitals in major cities are becoming overwhelmed, pleading for government assistance. Oxygen supplies are running low. 

The low pressure of oxygen could be the cause of 25 deaths recorded over the last 24 hours at the Sir Ganga Ram hospital in Delhi. 

“Oxygen will last another two hours. Ventilators and Bipap not working effectively. Resorting to manual ventilation in ICUs and Emergency. Major crisis likely. Lives of another 60 sickest patients at risk, need urgent intervention,” the Sir Ganga Ram hospital in Delhi said in a statement to the government early Friday morning. 

“Need oxygen to be airlifted urgently. Governments please help,” the statement said. 

Max Healthcare, a healthcare provider operating 16 facilities across North and West India, also sent out a warning about a shortage of oxygen, asking for “immediate assistance” on Twitter.   

The Max Smart Hospital and Max Hospital Saket received emergency supplies of oxygen shortly after the SOS call, however, it was only sufficient to last two hours and the facilities are still awaiting more supplies. 

Admissions to Max Healthcare hospitals in Delhi were suspended until the oxygen supply stabilised.

A Fortis Healthcare hospital in Haryana announced that it had “only 45 minutes of oxygen left” on Thursday evening, calling on Prime Minister Narendra Modi to dispatch an oxygen tanker to the hospital urgently. 

According to the city government of New Delhi, six hospitals in the city have run out of oxygen and neighbouring states have been accused of holding back supplies to service their own hospitals and blocking oxygen tankers at border crossings.

Sites producing oxygen are ramping up manufacturing to meet demand and a train, dubbed the ‘Oxygen Express,’ made its first trip carrying seven tankers, each filled with 15 tonnes of liquid medical oxygen on Thursday evening. 

Government hotlines are reportedly mostly down in the worst affected states, leading individuals to seek information on available hospital beds and oxygen supply on social media, sharing experiences and photos of patients waiting outside of emergency rooms that are over capacity. 

Urgent Imports of Oxygen Arranged

The Indian government has arranged to import 23 mobile oxygen generation plants from Germany, which will arrive within a week. The Armed Forces Medical Services will also airlift oxygen cylinders, essential medicines, and medical personnel from other regions to Delhi. 

Plans to import 50,000 metric tonnes of medical oxygen to meet the demand are underway, with Russia offering to supply both oxygen and Remdesivir. Imports are expected to begin within 15 days. 

China has also extended support to India to assist in getting the current outbreak under control. 

“China takes note of the recent grave situation in India with a temporary shortage of anti-epidemic medical supplies. We stand ready to provide India with necessary support and assistance to get the epidemic under control,” said Wang Wenbin, Spokesperson for the Ministry of Foreign Affairs of the People’s Republic of China, at a press conference on Thursday. 

At the same time, a growing number of countries are severely restricting or barring travelers from India, putting the country on the travel ‘red list.’ These include countries in Europe, as well as Canada, Britain, Hong Kong, Singapore, and New Zealand –  amid mounting concern about the surge of cases in India. 

The US Centers for Disease Control and Prevention issued a level 4 warning for India, advising travelers to avoid all travel to India. 

As India’s catastrophic second wave of COVID-19 rages on, only 8.1% of the population has received at least one dose of a COVID-19 vaccine. The national vaccination program will open to all individuals over 18 on 1 May, however, experts warn that the vaccine supply is not sufficient to cover the hundreds of millions of people who will become eligible. 

Japan Issues Targeted State of Emergency

Meanwhile, Japan has also declared a new state of pandemic emergency in Tokyo, Osaka, and two other regions. New restrictions will go into effect on Sunday until 11 May, the government announced. 

“We absolutely have to limit the movement of people, and we have to do it decisively,” said Yasutoshi Nishimura, the minister in charge of the country’s COVID-19 response, at the announcement of the new restrictions on Friday. 

The state of emergency coincides with the Golden Week, a public holiday when domestic travel is expected to be widespread. Restaurants and grocery stores will close early and the public will be asked to work from home, but school will remain open. 

Japan recorded over 4,300 new cases on Friday, 1,162 were reported in Osaka and 759 in Tokyo. 

The rise in cases is taking place just three months before the Olympics games are set to begin on 23 July. The emergency measures are expected to be lifted by 11 May, ahead of a visit by the International Olympic Committee (IOC) President Thomas Bach.

Despite opposition from the Japanese public and worries expressed by health experts, the Japanese government, supported by the International Olympic Committe (IOC)  has remained determined to have the games go ahead.  

“We’re not thinking about cancellation. We’re thinking about how we can prepare in a way that prioritises safety and makes people feel it can be held safely, and makes them want it to be held,” said Seiko Hashimoto, President of the Tokyo 2020 Olympics Organising Committee, on Friday. 

According to Prime Minister Yoshihide Suga, Japan has no say in whether or not the Olympic games take place. 

“The IOC has the authority to decide and the IOC has already decided to hold the Tokyo Olympics,” said Suga. “We aim to hold the games while taking strong measures to protect people’s lives from the further spread of infections.”

Image Credits: Prasar Bharati News Services.

Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

World Malaria Day is a reminder that, as the world battles with COVID-19, we still haven’t beaten a much older pandemic. Malaria is a mosquito-borne disease that has plagued humanity for millennia and still kills over 400,000 people per year – mainly children under five. 

In fact, that grim number will almost certainly have increased in 2020 and will do so again in 2021, as COVID-19 has severely disrupted malaria testing and treatment services in many of the most affected countries. 

New data from Global Fund spot-checks of 504 health care facilities across 32 countries in Africa and Asia in 2020 revealed a 31% drop in malaria diagnoses over a six-month period compared to the previous year, and a 13% drop in malaria treatment. Since swift diagnosis and treatment are key to preventing death, and there’s no reason to believe that the number of cases has fallen, such a sharp reduction in diagnoses and treatment will inevitably translate into increased mortality.

It could have been even worse. The first line of defence against malaria are insecticide-treated mosquito nets that protect people from mosquitoes. When the pandemic first hit we were extremely concerned that supply chain disruptions and the challenges of distributing millions of mosquito nets during lockdowns would leave hundreds of millions of people unprotected. 

A massive effort, led by countries’ national malaria campaigns, supported by the Global Fund and the U.S. President’s Malaria Initiative (PMI) and with huge engagement of community organizations, prevented what could have been a catastrophe. While some mosquito net distribution campaigns were delayed in 2020, almost all were successfully implemented.

Sustaining Community Health Workers’ Test-and-Treat Ability

Community health workers are crucial to the testing and treating of malaria in rural parts of Africa.

This year, the challenge will be to sustain community health workers’ ability to test and treat malaria. In much of rural Africa, community health workers are the lynchpin of the health system, and in the highest burden regions of central and western Africa, most of their time is spent treating malaria cases.

I recall talking to a community health worker in Mali, who told me the malaria situation was much better than it was years earlier when she first started. But when I looked at her register of patient visits, I was surprised to see that every single entry was a malaria case. When I asked her to explain, she said the big difference was in the number of deaths; rapid testing and effective treatment had dramatically reduced mortality. Since 2000, the worldwide malaria death rate has dropped by 60% thanks to the tireless efforts of community health workers like her.

 But given the number of people they interact with, community health workers are extremely vulnerable to being infected with COVID-19 and often have limited access to basic personal protective equipment (PPE) like gloves and masks. In the same round of Global Fund spot-checks of health facilities last year, a shocking 55% of facilities in Africa didn’t have enough basic PPE available for their workers. If a community health worker falls ill, there’s often no back-up.

 Community health workers will also be called on to play a vital role in COVID-19 vaccination campaign as these get going. It is crucial to protect people from the new virus, but we also need to ensure that the diversion of focus doesn’t lead to an escalation in malaria deaths.

Increasing Malaria Grants

An infant and mother under an insecticide-treated mosquito net in Ghana – such nets remain a key prevention technique.

 In the poorest countries in Africa it seems quite likely that unless we take decisive action, the knock-on impact of the pandemic in terms of incremental malaria deaths may well exceed the direct impact of COVID-19.

As the largest funder of malaria programmes worldwide, the Global Fund is working urgently with partners to prevent such a disastrous outcome and get us back on track towards ending malaria. 

From January 2021, we have increased malaria grants by 23% on average, and are committed to deploying about US$4 billion over the next three years. In addition, our COVID-19 Response Mechanism is providing US$3.7 billion in funding to help countries respond to COVID-19, mitigate the impact on HIV, TB and malaria services, and make urgent fixes to health systems.

 For malaria, the priorities in 2021 are to continue to ensure we maintain campaigns for mosquito net distribution, spraying of insecticide in homes, and the provision of seasonal malaria chemoprevention for children, and to step up support to community health worker networks. We need more community health workers and we need to support them better – financially, with technology, with training and with personal protective equipment.

Looking beyond 2021, we should take COVID-19 as a catalyst to rethink our approach to malaria. Global policy-makers are already discussing how to better protect the world from future pandemics. Let’s not forget the imperative to finish the fight against older pandemics like malaria, which may not threaten those in Washington DC, London or Paris, but still kill hundreds of thousands of people every year.

Building Pandemic Preparedness

An infant receiving the RTS,S malaria vaccine in Ghana in 2019. New malaria vaccines hold promise of significantly reducing childhood infections and severe malaria cases.

In fact, the best way to build pandemic preparedness in many of the poorest parts of the world would be to mount a significant step-up in the fight against malaria. The capabilities needed to prepare and respond to any new pathogenic threat are largely the same as those needed to defeat malaria – primary health care that reaches everyone, however remote; rapid diagnostics; genomic sequencing to detect variants; disease surveillance including the ability to trace individual infections; supply chains that ensure essential medicines are available everywhere. New potential malaria vaccines could be used to pilot accelerated models for clinical trials, regulatory approval and deployment.

Rather than predicate pandemic preparedness on hypothetical threats, pathogens that might cost lives, let’s build such protection by beating malaria and by doing so save millions of lives – the vast majority of them young children. 

For too long we have accepted people dying of a treatable disease we know how to eliminate – and that we have eliminated in dozens of countries. Now we should make this happen everywhere, and in doing so reinforce our defences against other pandemic threats.

Peter Sands is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

Image Credits: What is Malaria, WHO.

Stephane Bancel, CEO of Moderna, says company is close to agreement on supply of its mRNA vaccines to COVAX.

A group of leading pharmaceutical industry executives called upon global health leaders to work together to unlock export barriers, open up supply chain bottlenecks, and encourage high-income countries that are hoarding vaccines to redirect their excess doses to the WHO co-sponsored COVAX global vaccine facility – as ways to rapidly scale up equitable vaccine access and beat back the pandemic.

The executives, including the CEO of Moderna and India’s Bharat Biotech, as well as GSK’s head of global vaccines, and the heads of the Developing Countries Vaccine Manufacturers Network (DCVMN) and the Biotechnology Innovation Organization (BIO), were speaking at an event Friday marking a year since the establishment of the WHO co-sponsored Act Accelerator COVAX initiative.

Patents and other IP constraints are not the main obstacle to expanding access to vaccines, they asserted.  And increasing vaccine manufacturing capacity in lower-income countries, while important, will take time to develop – given the complexities of vaccine production, they said, speaking at a forum sponsored by the International Pharmaceutical Manufacturers and Associations (IFPMA).

Rather, the best way out of pandemic lockdowns and losses of life is to make better use of available resources, they stressed, including smoother supply chains and vaccine sharing schemes with COVAX.

“We are on track to make a billion doses this year, and potentially to have up to 1.4 billion doses for 2022,” said Moderna CEO, Stephane Bancel, at the press briefing, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine through the global vaccine equity pool.  But he stressed that expanding manufacturing capacity further, and in more locations, would sap efforts to produce doses this year – and could ultimately even cost lives.

“We need to focus on delivering as many vaccines as we can this year,” he said, while trying to add more manufacturing capacity risks “being a distraction limiting what we can do in 2021… and by next year there is going to be way too many vaccines for people on the planet.” 

United States Raw Inputs Are Key To Global Vaccine Manufacturing Supply Chains

Michelle McMurry-Heath, CEO BIO

Added Michelle McMurry-Heath, a former US Food and Drug Administration expert, unlocking supplies of key raw products and vaccine dose sharing are important low-hanging fruit in the battle against the virus:

We need to recognise that there are only a handful of manufacturers across the globe who have that expertise on hand, and we need to focus on getting them the materials that they need to produce as many doses, as quickly as possible, and to release backlogs,” said Heath, who is now CEO of BIO, a global trade association organisation that represents biotech researchers in government, the private sector, and academic institutions.

This this includes items as basic as single-use plastics and filters for the vaccine manufacturing process, some of which can only be supplied from in the United States. Currently the US Defense Production Act (DPA) restrictions are holding up release of many of those raw inputs, she stressed, adding that: “the US has to take a hard look at itself…. This Defense Protection Act, which was really designed to withhold capacity, expertise, doses and raw materials to the US, customer was well intentioned – but somewhat misguided at this stage –  we need to get those raw materials, out to the limited manufacturing capacity that exists around the globe.”

In addition, she added, high income countries need to be encouraged to start dose-sharing with the COVAX initiative – following on the example of France’s announcement only today that it will share 500,000 vaccine doses.

“The US is projected to have as many as 200 million excess doses on hand by the spring, we need to focus on getting those doses to COVAX,” said Heath. 

Vaccine Companies Can be Counted In ‘Double Digits’

Vaccine quality, which require adherence to strict biosafety requirements as well as to sterile conditions, is also a critical issue, she underlined. And quality control failures in manufacturing plants, such as ones seen recently in the case of a Johnson & Johnson vaccine plan, can undermine already shaky public confidence in the quality of brand-new COVID-19 vaccines.

Added Sai Prasad, CEO of Bharat Biotech, which has developed the first indigenous Indian COVID-19 vaccine, “Vaccine companies you can probably count in double digits so we need to be careful about whom we are transferring technology to, and whether they can receive it as well.  Technology transfer cannot be done with an entity that has no experience.”

Sai Prasad, CEO Bharat Biotech

“I think that as industry, we need to increase the partnerships between innovators and vaccine manufacturers…. We need to be agnostic as to whether these companies are US, Europe, India, China or Brazil, for example. And I think there is [already] a good track record of that,” he added, noting that over 200 partnerships between big pharma innovators and developing country manufacturers have been formed already.

At the same time, he said, supply chain bottlenecks and export barriers are a big threat to scale up: “Some of the vaccines take 150 to 200 little components that come from different parts of the world. “So interruptions in just one component, can slow production significantly, he pointed out, referring to the Serum Institute of India’s recent problems securing certain inputs from the United States.

“We’ve had reports from the Serum Institute having problems with certain single use materials that are supposed to come from the United States… plastic bags for example which we think is a mundane consumable, because maybe a decade ago industry, as such, we were all thinking about going into single use systems, which involved a lot of single use consumables – but now this unfortunately has become an impediment, and a bottleneck.”

Rajinder Suri, CEO DCVMN

Rajinder Suri, CEO of the Developing Countries Vaccine Manufacturing Network (DCVMN), echoed that saying:  “We are on the verge of expanding and ramping up the capacities, which are really required to meet the global demand…..and we are certainty facing some of the bottlenecks, from cell culture mediums and serum adjuvant filters, and single use plastic bags, to bio reactors.

“Most of these materials are coming from the US – so if the DPA is not handled properly, then the supply chain will get impacted, and building the global capacity will adversely get impacted.” 

COVAX Distributions Should Accelerate – With Stronger US Support

On the brighter side, meanwhile, Heath said she was confident that with stronger support for COVAX from the new US administration of President Joe Biden, the global vaccine facility can make up for its comparatively slow start in the second quarter of the year.

“COVAX didn’t have full support of all the developed countries. Now that this is up to speed…. we need to focus on great efforts like COVAX which are just beginning to fully ramp up, and can deliver very affordable vaccines around the globe. I is the fastest way to get high quality doses to developing countries, and that speed is so critical,” she said. 

Added Bancel, “we are focused on working with COVAX to provide vaccine, right now.  COVAX is the way for us to get maximum access on the planet.” 

See entire press briefing:

 

 

Ghana, Africa
Health worker Evelyn Narkie Dowuona holds up her vaccination card after receiving a dose of the COVAX-delivered AstraZeneca COVID-19 vaccine at Accra’s Ridge Hospital in Ghana.

One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday.

The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far.

“Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. 

Other key achievements in the past year include:

  • procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar 
  • supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar
  •  Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs.
  • Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. 

While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. 

Equitable Access Still a Long Way Off

“The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners.

While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. 

Of the more than 950 million vaccinations that have been given,  0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO.  

“Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros.

India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen.

South African President Cyril Ramaphosa

South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”.

South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body.

TRIPS Waiver and Technology Transfer

“South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” 

He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”.

Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator.

“At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX.

Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. 

Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year.

However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver.

Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. 

“Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating  “global access to safe, effective and affordable COVID-19 treatments and vaccines”.

French President Emmanuel Macron

Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”.

“The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator.

“We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.”

Surge of COVID-19 in India is ‘Really, Really Difficult’

Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. 

“There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It  is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan.

Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”.

However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. 

 

Image Credits: WHO.

Rwanda
Lines of people wait their turn to receive the AstraZeneca COVID-19 vaccine in Rwanda in early March, after WHO-supported COVAX facility supplies are delivered. Should countries build a new pandemic treaty – or bolster existing mechanisms? 

Despite rising calls for a pandemic treaty, including from 25 world leaders in an open letter last month, some global health experts doubt that a treaty would be the most efficient way to quickly strengthen the world’s capacity to beat COVID – and prevent future pandemics. 

“I don’t think we have time to negotiate another treaty on vaccines. I mean, we really are in this emergency,” said Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia, Canada. 

Lee was one of four panelists featured at a session on “Global Health in Disarray-What Next,” hosted by the Geneva-based Graduate Institute’s Global Health Centre to mark the launch of its newly appointed International Advisory Board (IAB).

The wide-ranging session covered a range of issues, from the feasibility of a pandemic treaty, to the challenges of achieving vaccine equity and the lack of progress made in strengthening health systems in low-income countries, despite years of international funding. 

A Pandemic Treaty Is Not Essential 

Kelley Lee, Chair in Global Health at Simon Fraser University in British Columbia. 

“Do we need a treaty to move forward? The answer is no,” said Esperanza Martinez, the Head of COVID-19 Crisis Management at the International Committee of the Red Cross (ICRC). “I don’t think that we are short of frameworks and short of treaties… there are already enough mechanisms to act.”

According to Lee, legal frameworks such as the World Trade Organization’s TRIPS agreement, and accompanying TRIPS flexibilities create frameworks under which countries can gain access to lifesaving products during health emergencies. 

And the legally binding International Health Regulations (IHRs), which mandate countries to report on disease outbreaks, and share information with WHO and other member states, is another “useful” framework that should not be forgotten, added Finland’s Director for International Affairs Outi Kuivasniem, another panel member. 

Rather, the global health community needs to find ways to reform existing frameworks so that they serve us better, panelists suggested. 

Esperanza Martinez, Head of COVID-19 Crisis Management at the International Committee of the Red Cross

In particular, there is a need to reform the IHRs, Kuivasniem said, because countries have not always complied – including by enacting export bans on vital health products or inputs, which have destabilized crucial supply chains, including those relating to vaccines and other essential medicines. 

Treaty Would Need Strong Member State Alignment 

At the same time, panelists acknowledged that a pandemic treaty could have some use if it was closely linked to existing legal frameworks like the IHRs and international humanitarian law, and generated greater adherence from countries, as well as support from civil society.  

“If we have a treaty, we need to have a conversation about what makes sense to have in the treaty so that it has an impact, and that countries are willing to adhere to those promises that are [made] through a treaty,” warned Kuivasniem. 

Allan Maleche, Executive Director, Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN)

Conversely, a “lack of political alignment” between governments and between government and civil society, could frustrate efforts to develop a new pandemic treaty, cautioned Allan Maleche, Executive Director of Kenya’s Legal & Ethical Issues Network on HIV & AIDS (KELIN). 

And other “political solutions” are also on the table, she and other panelists pointed out, to accelerate pandemic response. Few would actually require a treaty.

Those initiatives range from the WHO co-sponsored COVAX global vaccine facility to proposals for an IP waiver under the TRIPS rules of World Trade Organization the COVID-19 Technology Access Pool (C-TAP), and tech transfer initiatives. Despite controversies over some initiatives, such as the IP waiver, none really require a pandemic treaty to be implemented. 

Should a pandemic treaty be negotiated, civil society should really drive its development, Maleche underlined.

“If we are serious about getting our pandemic treaty in place, it’s important for scholars, academics, human rights lawyers, civil society groups, and affected communities to push their governments and [define] what should be that framework,” he said. 

“A treaty would be important but the more important is respect and implementation of that treaty so that it can have an effect on the lives of people,” he said.

Stronger Business Case Needed For Investing In Health Systems in LMICs 

Healthcare workers treat a patient with drug-resistant TB in Myanmar, using drugs procured by the  Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

Beyond the immediate pandemic, however, a stronger business case is needed to convince governments that global health is a long-term investment that makes economic sense, stressed Martinez – particularly in LMICs. 

“We need to have a business case, an economic case for investment in global health,” she said, pointing out that while the case has recently been made for investment in vaccine access, “there’s a need for making a stronger case for global health in general… as a way of also bridging the conversation gap between government and the private sector.”

Meanwhile, Maleche expressed dismay that decades of international funding meant to strengthen healthcare delivery in developing countries such as Kenya had failed to create more sustainable health systems.   

“Has this money actually been fixing the health systems?” he asked. “Because the time we needed the health system to be fully functional, COVID came and exposed the things that are not working.

“COVID also exposed the underbelly of things that many countries don’t normally give priority,” he added. “You’re telling people: wash your hands, put on a mask, social distance, but in certain countries including Kenya and in other low- and middle-income countries, some of those things are luxuries as people have never seen clean running water in taps.”

In addition, Maleche added, COVID-19 has highlighted the fact funds are also misspent by governments  lacking public transparency and accountability: 

“Even within a pandemic we still are able to see that resources are not accountably used, we see that governments are not transparent. So again, this comes to show that some of the bad habits that we had when we had a normal sort of situation in the globe are played out in quite an extreme picture, in the context of a pandemic. ”

In the humanitarian sector, in particular, financial support for fragile healthcare systems has been particularly scarce, added Martinez.

“Very little has been done to strengthen health care systems in LMICs,” she asserted. “We have been speaking for years about the need to strengthen healthcare systems in developing countries and in humanitarian crises, but really when we look, very little has been done. 

In terms of vaccine access as well, “fundamentally there is a lack of production, science and research and development in the global south, and unless we address that issue, we will not have a sustainable solution to these [vaccine production] needs that we have globally,” she added. 

“There is a need for investment, but the investment at the level that is required is not coming through.”

Regional Initiatives and Grassroots Action As Way Forward 

Ilona Kickbusch, Founder and Chair of the International Advisory Board, Global Health Centre

“There is a feeling in the air [that] we need to reform,” said Ilona Kickbusch, founder of the Global Health Center, and chair of the new International Advisory Board, and moderator of the panel discussion. 

“Now there’s a number of suggestions on the table, for how global health, both in terms the way we do research and the way the global health regime and organizations are set up, could be changed. 

“And it’s interesting that right now we’re facing a pressure to some extent from above, top-down, from heads of state and government who are saying, ‘we need a new treaty in global health,’ and as many of you know we only have one so far…

“On the other hand, there’s this movement from below that says we need to decolonize global health, we need totally different ideas, approaches, and we need to be much clearer about equity and access, and the social justice agenda.”

Among the new ideas, Kickbusch pointed to regional initiatives that are underway, particularly in Africa, to chart a more strategic direction for the continent’s pandemic response.  

While many countries turned inward during the pandemic, Africa started working together more closely at the regional level, she pointed out. 

A new African region multi-hazard warning system will seek to link early warning, and responses to natural hazards, pandemics and pests and diseases as well as conflict.

That collaboration has stimulated initiatives ranging from AU-based vaccine procurement to the new AU/Africa CDC partnership with the Coalition for Epidemic Preparedness Innovations (CEPI), announced just last week to ramp up vaccine research, development and manufacturing in the region – with funding from Afreximbank and the Africa Finance Corporation.  In addition, the African Union and Africa CDC are developing a new COVID-19 Disaster Recovery Framework and multi-hazard warning system for the continent to better link responses to climate, health, and environmental emergencies. 

“It is one of the encouraging things in global health..that there are these regional initiatives,” Kickbusch said. “Particularly in the African Union, we’ve seen the activities of the African CDC during the pandemic, and seend that a true consensus is building up.” 

Said Martinez, “This pandemic is precisely an example of how critical it is for us to have this broader view of health…

“So we have the pandemic crisis and we also have the climate change crisis. And if we look at the issue we need to think beyond climate change [and] understand that polar bears are drowning in the Arctic, to think about the millions of people that today are facing diseases that were confined to the tropics. 

“We [need to] link all of those elements to the broader components of human health and health systems. I think that’s when we truly talk about human global Health.”

Image Credits: WHO, The Global Fund / John Rae.