Pakistan health workers getting vaccinated with Sinopharm.

As India restricts COVID-19 vaccine exports to address its domestic surge, the World Health Organization (WHO) is poised to give the Chinese vaccine, Sinopharm, emergency use listing (EUL) this week – potentially catapulting China into becoming the biggest global supplier of COVID-19 vaccines for low- and middle-income countries (LMIC).

However, Sinopharm is reported to be one of the most expensive vaccines on the market, with the most recently reported price $36 a dose paid by Hungary – in comparison to $2.15 for AstraZeneca.

Global vaccine alliance Gavi, on behalf of the COVAX Facility, confirmed to Health Policy Watch on Thursday that it is “in dialogue with several manufacturers, including Sinopharm, to expand and diversify the portfolio further and secure access to additional doses for Facility participants. We will provide updates on any new deals in due course.”

After delivering over 49 million vaccines to 120 countries, the vast majority of which were AstraZeneca vaccines manufactured by the Serum Institute of India (SII), COVAX deliveries have ground to a halt because of domestic demand in India – causing panic in LMICs reliant on COVAX.

China joined COVAX late last year and announced in February that it would be donating 10 million vaccine doses to the facility – but this cannot happen until the WHO grants the vaccines EUL.

WHO Decision on Sinopharm This Week

A decision on Sinopharm is expected by the end of the week, but late last month Alejandro Cravioto, the chairperson of WHO’s Strategic Advisory Group of Experts (SAGE), told a media briefing that both Chinese vaccines, Sinopharm and Sinovac, have presented efficacy data that meets WHO requirements. 

“The information that the companies shared publicly at the [SAGE] meeting last week clearly indicates that they have levels of efficacy that would be compatible with the requirements that WHO has asked for this vaccine,” Cravioto told the briefing.

The WHO has set 50% efficacy against the virus as the lowest bar for EUL, and its decision is based on a risk-benefit analysis. 

The decision on the other Chinese vaccine, Sinovac, is expected next week, but reports indicate that it has lower efficacy than Sinopharm. 

A decision on the Moderna vaccine is expected on Friday, but the WHO has already issued interim recommendations on the use of Moderna and no impediments are expected for it.

“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 told a press briefing last week, adding that the company is also “in the final stretch to get an agreement with COVAX,” for distribution of the mRNA vaccine.

However, Moderna, like the Pfizer vaccine, needs ultra-cold storage which precludes its use in many low income countries.

COVAX Searching for New Vaccine Suppliers

COVAX confirmed last week that 90 million AstraZeneca vaccine doses it had expected the Serum Institute to deliver in March and April have been kept for use in India, which is facing a massive surge in cases.

Seth Berkley, CEO, Gavi, the Vaccine Alliance.

Seth Berkley, CEO of vaccine alliance Gavi, acknowledged last week 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”. Gavi co-leads COVAX with the WHO and CEPI.

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

Berkley also said that COVAX was “in early days on discussions on dose sharing”.

“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,” explained Berkley.

A Gavi spokesperson explained to Health Policy Watch that dose-sharing can happen “through the transfer of vaccine doses purchased by self-financing participants to the COVAX AMC economies, as pioneered by Norway and followed by New Zealand, or by donating own doses purchased for domestic consumption to COVAX AMC economies, in line with the recent French announcement”. 

“We welcome commitments of intention to share doses from other countries, including Spain, and continue to be in close dialogue with these countries who have expressed interest. We expect further announcements on this to take place over the coming weeks and months,” added the spokesperson.

Sinopharm To Produce One Billion Doses This Year

In contrast to the vaccine shortage in India, Sinopharm’s manufacturers claim that they have already sent 50 million vaccines to other countries, according to a report published last week.

By the end of February, China said that it had supplied 69 countries with vaccines – some as donations as some as sales. Recipients include Zimbabwe, Guinea, Egypt, Pakistan, Serbia, the Maldives, and the United Arab Emirates.

Meanwhile, Botswana announced this week that it had bought 200,000 Sinopharm doses to supplement a donation of the same amount.

Bangladesh also turned to China this week after being forced to suspend its vaccination programme when India told the country that it could not deliver its second batch of AstraZeneca vaccines to it any time soon. Six million Bangladeshis have already received one dose of the AstraZeneca vaccine.

China has offered to give Bangladesh 600,000 doses as a donation and the country will buy the rest. However, the cost of Chinese vaccines could cripple LMICs. 

On Tuesday, China’s foreign minister, Wang Yi, hosted a virtual meeting of the foreign ministers of Afghanistan, Pakistan, Nepal, Sri Lanka and Bangladesh at which the ministers “agreed to deepen cooperation as South Asian countries are facing a new wave of the COVID-19 pandemic”, according to the Chinese media agency.

According to Wang, China is willing to “promote vaccine cooperation” in South Asia through “flexible methods such as free aid, commercial procurement, and filling and production of vaccines”, to ensure “more diversified and stable vaccine supplies”.

India was invited but did not attend the meeting, but Wang said that “China is ready to provide support and assistance to the Indian people at any time according to the needs of India”.

Yu Qingming, chairman of Sinopharm Group, indicated last month that the state-owned pharmaceutical group expected to produce over one billion doses of its vaccine, according to Chinese state media.

Yu added that the annual output of the vaccines could reach three billion doses “in the future”.

The UAE and Serbia have also signed contracts with China to produce Sinopharm while Egypt has signed an agreement with China to produce Sinovac.

Yin Weidong, CEO of Sinovac’s producer, Biotech, said last week that his company was producing six millions doses a day, had sent at least 156 million doses to other countries, and could produce two billion doses this year.

In China itself, by Tuesday over 230 million doses of COVID-19 vaccines had been administered across China, according to Chinese health authorities. But the most populous country in the world estimates that it will be able to cover all 1,4 billion citizens by early next year.

Little Data About Chinese Vaccines

However, both Chinese vaccines are viewed with skepticism in many parts of the world because virtually no independent scientific information is available – only company information.

Sinopharm has claimed efficacy of 79.3% – 86% in multi-country trials, but these results are unpublished. 

Sinovac has also failed to publish peer reviewed results, but company announcements of Phase 3 results in four different countries have also yielded wildly varied efficacy scores ranging from 50.3% – 91.3%, according to Health Policy Watch research.

Researchers at Brazil’s independent Butantan biomedical centre said that Sinovac  displayed 50% efficacy in its clinical trial in Brazil.  

Interestingly, Serbia recently reported results in which it compared the antibodies of 10,000 citizens vaccinated with Pfizer, Sputnik and Sinopharm – all the vaccines currently in use in the country. 

With Pfizer and Sputnik, good antibody responses were noted after the first jab. But people vaccinated with Sinopharm only developed antibodies around two weeks after getting their second dose, and men over the age of 65 did not generate a strong antibodies response. The Sinopharm-vaccinated also showed a faster decline in antibodies than those vaccinated with the Pfizer and Sputnik vaccines.

US AstraZeneca Vaccine 

On Monday, the US announced that it would pass 60 million doses of AstraZeneca vaccines on to countries in need “as they become available”, according to Andy Slavitt, White House Senior Advisor on COVID-19.

However, it is unclear when these vaccines will become available as they are supposed to be manufactured by Emergent BioSolutions, the company that recently had to destroy millions of contaminated AstraZeneca and Johnson & Johnson vaccines.

It is also unclear who will receive the doses or how they will be delivered. Gavi would not comment on whether COVAX would receive any of the 60 million US AstraZeneca vaccine doses. A Gavi spokesperson simply said: “We welcome the US Government decision to share surplus doses as a positive step towards addressing the pandemic on a global scale. We will not be safe anywhere until we are safe everywhere.”

Image Credits: 中国新闻网, Gavi/Tony Noel.

A South African protest, Tuesday 2 February 2021, calling on the US and EU to support a World Trade Organization ” TRIPS” waiver on patents and other IP related to all COVID-19 drugs, vaccines, diagnostics.

Nearly 400 members of the European Parliament (MEPs) and of national parliaments from across the European Union issued a joint appeal Tuesday calling for the European Commission to drop its opposition to a proposed WTO waiver on IP related to COVID-19 health technologies for the duration of the pandemic, being co-sponsored by India and South Africa.

The proposed IP waiver is due to be debated once again Friday, 30 April, by the WTO’s TRIPS Council, which oversees the Trade Related Agreement on Aspects of Intellectual Property Rights that govern global IP rules.

Proponents are pushing for the Council to move to “text based” negotiations on the draft waiver proposal, as a means ot advancing the initiative through TRIPS Council approval, so that it could go before the entire WTO General Council later this year.

But those moves continue to be opposed by the Europe, the United Kingdom, the United States and other industrialized countries – along with pharma industry voices that have stressed that manufacturing capacity – and not IP – are the key barriers to faster vaccine scale up.

“We stand with the Director-General of the World Health Organization, over 100 national governments, hundreds of civil society organizations, and trade unions, and join them in urging the European Commission and EU member states to discuss at the highest levels and support the temporary waiver of certain obligations under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

“The waiver proposed by South Africa and India would facilitate the sharing of all intellectual property and know-how. It will lift IP monopolies, remove legal uncertainty, and provide the freedom to operate to enable collaboration to increase
and speed up the availability, accessibility and affordability of COVID-19 vaccines, tests, and treatments globally,” stated the letter by MEPs.

“Variants show how no one is safe until everybody is safe. We need more vaccines quickly. Lifting patents and transferring technology are absolutely key to ramping up vaccine production. Private profit should never stand in the way of public health,” said MEP Marc Botenga, of the European Parliament’s “Left group.”

MEP Call Among Spate of Recent Initiatives

The call by MEPs was just one among a number of recent initiatives, including one by a group of Brazilian parliamentarians, addressed to WTO’s new director general Ngozi Okonjo Iweala, and another by US civil society groups targeting US President Joe Biden.

In a closed-door WTO meeting involving pharma and global health leaders, convened by Iweala in mid April, the focus was also on tech transfer and supply chain strengthening as “third way” options out of the crisis.  However, in the meantime, India has all but halted its export of COVID vaccines to countries in Africa and elsewhere, in the face of a huge increase in COVID cases. And that has amplified civil society calls upon global leaders to act more assertively – calls that could also reverberate in the next round of TRIPS Council discussions.

In related moves, the United States appeal, issued by some by some 66 US health and development groups, called upon President Biden to jump start an “urgent manufacturing program to help provide billlions of additional COVID-19 vaccine doses to the world” including open sharing of mRNA vaccine technology that has been the basis for the most effective vaccines produced so far – currently by Pfizer and Moderna.

The letter to Ngozi by Brazilian parliamentarians, meanwhile, was written to protest the opposition of the rightist government of Brazilian President Jair Bolsanaro to the IP waiver – a policy stance that the parliamentarians said goes against Brazil long tradition of public health advocacy.

Image Credits: Peoples Health Movement.

NAIROBI – A new drug combination therapy to fight COVID-19, unveiled on Tuesday, will be tested in a multi-country clinical trial that is already ongoing in Africa. The drugs nitazoxanide and ciclesonide will be used in the ANTICOV clinical trials testing treatments for mild to moderate COVID cases across groups in 13 African countries.

A consortium of 26 organizations of African research institutions and international health organizations is conducting the trials, which is coordinated by the Geneva-based Drugs for Neglected Diseases initiative (DNDi) – a non-profit research and development organization.

The ANTICOV clinical trials, launched in November 2020,  are the largest such trials in Africa testing remedies for people with mild COVID-19 disease. This new effort is particularly important, especially considering that access to vaccines across the continent remains very low, while the spread of new variants remains a big concern.

Dr John Nkengasong, the director of the Africa Centres for Disease Control and Prevention (CDC), said in a press statement released by DNDi: “We need urgently to identify affordable and easy-to-administer treatments that can prevent the evolution to a severe form of the disease and slow the rate of infection.

“In many African countries our worst fears are being realised, as already-strained intensive care units are beginning to fill up with COVID-19 patients. Yet the number of vaccine doses that are reaching the African continent is too limited. The rapid spread of new variants also threatens to reduce the efficacy of existing vaccines, which is another cause for concern.”

The New Combination Therapy

The drugs to be used now in the trials are a known parasite drug (nitazoxanide) and a form of inhaled steroid (ciclesonide). Used in combination, these drugs can work synergistically and at different sages of infection, researchers believe.

Trials of the anti-parasitic and steroid combination will replace other antiretroverial and anti-malaria drugs that ANTICOV had originally tested or planned to test, but have since been discarded because of the lack of evidence of efficacy – in the open-ended trial design.  

The study will explore whether the antiparasitic drug can reduce the initial viral replication of SARS-COV-2 infection, while the steroid reduces inflammation that can begin a few days later. No treatment currently exists for early stage COVID-19, and identifying effective therapies could also help prevent advance of the disease to a more severe condition. 

“It has been more than a year since COVID-19 was declared a pandemic, and while we have vaccines registered for use, there are still very few treatment options – especially for the early stage when we could prevent severe progression, potentially reduce transmission, and maybe prevent the risk of developing post-COVID condition,” Dr Nathalie Strub-Wourgraft, director of the COVID-19 Response for DNDi was quoted as saying. 

In addition to new treatments, there remains a need for simple, reliable, and more affordable SARS-CoV2 tests, according to Dr Monique Wasunna, director of DNDi’s Africa Regional Office.

These tests, maintains Dr Wasunna, could serve as the backbone of test-and-treat programmes led by African governments. The ANTICOV trials employs a flexible design platform, which allows for treatments to be added or removed as new evidence emerges. 

First participants in the clinical trial will be enrolled in the Democratic Republic of Congo (DRC) and the Republic of Guinea. This will be followed with others from Burkina Faso, Cameroon, Cote d’Ivoire, and Equatorial Guinea. Participants from Ethiopia, Ghana, Kenya, Mali as well as Mozambique, Sudan and Uganda will also take part.

Image Credits: UCT.

The European Union is suing coronavirus vaccine manufacturer AstraZeneca for delayed vaccine deliveries.

The European Union (EU) is suing coronavirus vaccine manufacturer AstraZeneca over an alleged breach of its vaccine supply contract and for not having a “reliable” plan to ensure timely deliveries. 

The European Commission – the EU’s executive branch – said the legal action emanates from a longstanding dispute over shortfall in vaccine deliveries.

The 27 nations of the EU had ordered 300 million doses of the Covid-19 vaccine from the British-Swedish drug maker to be delivered by the end of June, with an option to purchase an additional 100 million. However, AstraZeneca has said that it will be able to deliver only a third of those doses – sparking the fight over the terms of the contract.

“This action is due to the continuous breach of the terms of the contract and to the lack of a reliable strategy by the company to ensure the timely supply of vaccines in the current circumstances,” Stefan De Keersmaecker, a spokesman for the European Commission, said during a televised appearance on Monday. 

Earlier this year, AstraZeneca said its supplies would be reduced because of production problems. Of the 80 million doses planned for delivery in the first quarter of 2021, only about 30 million were sent. However, Pascal Soriot, the company’s chief executive, has said that the contract with the EU is not absolute – requiring the pharma company make its “best efforts” to deliver the promised doses.

According to the European Commission, AstraZeneca has said it will provide the bloc with only 70 million doses in the second quarter of 2021 instead of the 180 million that were initially arranged.  Despite the AstraZeneca delays, the European Commission on Tuesday tweeted that there will be enough vaccine doses to immunise 70% of all EU adults by July. 

 

The EU originally planned to use AstraZeneca as the main vaccine in its roll-out, but following the supply issues, the bloc now relies mostly on the Pfizer-BioNTech jab. 

Health Commissioner Stella Kyriakides on Monday tweeted that the commission’s priority was to “ensure Covid-19 vaccine deliveries take place to protect the health of the European Union”. “Every vaccine dose counts. Every vaccine dose saves lives,” she wrote.

AstraZeneca Will Contest Lawsuit 

AstraZeneca said the lawsuit was “without merit” and that it would “strongly defend itself in court”. In a statement responding to the announcement, AstraZeneca said it had “fully complied” with its agreement with the EU, and hoped to resolve the dispute as soon as possible.

“Following an unprecedented year of scientific discovery, very complex negotiations, and manufacturing challenges, our company is about to deliver almost 50m doses to European countries by the end of April, in line with our forecast,” the company said. “We are making progress addressing the technical challenges and our output is improving, but the production cycle of a vaccine is very long which means these improvements take time to result in increased finished vaccine doses,” the statement read.

“AstraZeneca has fully complied with the Advance Purchase Agreement with the European Commission and will strongly defend itself in court. We believe any litigation is without merit and we welcome this opportunity to resolve this dispute as soon as possible,” the statement read.

AstraZeneca had previously said that the contract obliged the company to make its “best effort” to meet EU demand, without compelling it to stick to a specific timetable.

Under the contract, any legal action would be heard by Belgian courts.

AstraZeneca’s Continuing Vaccine Headaches

The EU legal action is only the latest in a long series of mishaps that have plagued the roll-out of the vaccine that has been billed as the cheapest and most temperature stable option among those vaccines currently available. 

Shortly after the vaccine was registered in the United Kingdom and in the EU, AstraZeneca came under scrutiny in the United States over the way it had presented its clinical trial data with respect to efficacy in older adults. 

Some European countries also initially also advised against using the jabs among older adults, because of a lack of trial data in those age groups. of the continent.

While those questions were later resolved, reports of a rare but sometimes fatal blood clotting condition put a spotlight on the vaccine again. Those questions revolve mainly among use in younger adults, mostly women. Despite a European Medicines Agency review and assurances that the vaccine is safe for all age groups, some European countries, such as Germany, decided to recommend the vaccine only among older people. Other countries, such as Denmark, scrapped use of the vaccine altogether. 

Shortly after that, AstraZeneca’s Indian manufacturer, the Serum Institute of India, which was supposed to be the main pillar of vaccine deliveries to the WHO co-sponsored COVAX global vaccine initiative, halted shipments to COVAX – in order to redirect vaccines to the surging needs in India.  That has left many African countries, in particular, worried about receipt of their next vaccine supplies.  

Schoolchildren gather in the playground as they return to classes at Lepeltier Primary School in La Trinite, near Nice, amid the coronavirus disease (COVID-19) outbreak in France.

Some European Countries Ease COVID Restrictions

On a more positive note, the European Commission’s announcement of legal action on Monday came even as some EU countries began to ease COVID restrictions as new cases European vaccination campaigns began making small inroads into recent surges in COVID cases.  Around the continent about 20% of the total population have received at least one vaccine dose, rising to about 28% in Serbia.  

Millions of French children returned to the classroom, as primary schools and nurseries reopened following a three-week shutdown. In Italy, restaurants and bars in much of the country were allowed to serve customers outside, while hairdressers in Belgium reopened their doors. Even so, the mayor of the Spanish city of Pamplona announced that the annual Sanfermín fiesta in July – with its famous running of the bulls – would be cancelled for a second year.

Outside of the EU, Turkey announced a coronavirus lockdown until 17 May in a bid to curb a surge in coronavirus cases and deaths.

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.

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).

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.

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.