The World Health Organization (WHO) and the World Trade Organization (WTO) both are hosting key global meetings aimed at improving global access to COVID-19 vaccines and fair medicine prices this week behind closed doors.

The WHO Fair Pricing Forum started on Tuesday and its stated aim is to activate “additional support for countries to achieve more affordable and fairer access to pharmaceutical products during the COVID-19 pandemic and beyond”.

Meanwhile, on Wednesday, the WTO Director General, Ngozi Okonjo-Iweala, will host a meeting on “COVID-19 and Vaccine Equity: What can the WTO Contribute”.

The Fair Pricing Forum (FPF), supported by the Ministry of Health of Argentina and running virtually until 22 April, is likely to focus on transparency of medicine prices and production as well “upstream innovation” aimed at widening the manufacturers’ pool. 

This is according to Suerie Moon, co-director of the Global Health Center of the Graduate Institute of Geneva and a member of the FPF expert advisory group, who describes the forum as an “important space for governments to connect and co-operate”.

Transparency and the Innovation System

“There’s a lot of focus on transparency in the agenda. COVID-19 raised public awareness of the problem of confidentiality. But there is a lot governments can do on transparency that they haven’t yet done – there also needs to be a strengthening of backbones,” she said. 

Moon added that linking high prices to the underlying innovation system “has never been so front and centre of discussion as it is now”.

“There is an entire strand of the conference on innovation, looking at how governments can change innovation incentives, how they can rewrite the rules that structure innovation and pricing of medicines,” said Moon, of the meeting, which paradoxically is taking place away from the media and public eye..

She added that while the discussion in the WTO’s TRIPS Council over the IP waiver is split along predictable North-South lines, more informal alliances are easier to build at the Forum where there are “challenges common to countries in the North and South and shared concerns vis-à-vis the medicine pricing practices of the pharmaceutical industry”.

Health Policy Watch has seen two discussion papers to be discussed at the Forum, which look at how medicines pricing could be made more “sensitive to health systems’ ability to pay”, and “incentives for pharmaceutical innovation to achieve fair pricing” respectively. These were developed by two technical working groups formed at the last FPF meeting in South Africa in 2019.

Global Framework to Address Pricing

The first paper suggests a global framework to tackle the “unaffordability of medicines and vaccines”. It also flags that the lack of transparency relating to prices and contracts undermines good governance ‘especially when the public expects full accountability for public spending’. 

It highlights the success of cross-border collaborative initiatives in ensuring more affordable medicines, including global initiatives such as Stop TB Partnership’s Global Drug Facility; the Medicines Patent Pool; Gavi, the Vaccine Alliance; and the WHO co-sponsored COVAX global vaccine facility; as well as regional efforts including the Pan American Health Orgqanization’s “Revolving Fund for Vaccine Procurement” and the Beneluxa initiative of smaller European countries, including Belgium, the Netherlands, Luxembourg, Austria and Ireland, to coordinate policies on pharma purchases and pricing.

The second paper argues that ‘“pharmaceutical innovation is a hybrid public and private effort”, with the public sector paying for about 30% of the upfront total investment in pharmaceutical R&D and the private sector paying for about 60% of upfront investment in the later, relatively lower-risk stages, with the remaining 10% coming from sources such donors.

It also flagged the need for “frameworks for global governance”, noting that “the bilateral agreements for COVID-19 vaccines are a sober reminder that public sector stewardship at the national level sometimes may serve narrower national interests at the risk of disregarding larger issues of global health equity”. 

WTO Invites Wide Range of Pharmaceutical Companies 

Meanwhile, the WTO’s Wednesday meeting includes various trade ministers, including those from the European Union and the United States, as well as India and South Africa, which are co-sponsors of the WTO proposal to waive intellectual property rights on COVID-19 health products for the duration of the pandemic.

A wide range of pharmaceutical companies are also invited, including representatives from Pfizer, Moderna and Astra Zeneca, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA); the Developing Countries Vaccine Manufacturers Network,  the European Federation of Pharmaceutical Industries and Associations (EFPIA), the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Japan Pharmaceutical Manufacturers Association (JPMA).

Speaking at meetings in the US last week, Okonjo-Iweala said that equitable worldwide access to COVID-19 vaccines “is necessary for economic growth and trade to bounce back from the pandemic and that a reinvigorated multilateral trading system would strengthen both the health response and the economic recovery”.

The first session of the  WTO meeting focuses on challenges to “equitable vaccine distribution”, including a focus on export restrictions and trade barriers.

Thomas Cueni, IFPMA Director General, confirmed to Health Policy Watch that his association and a number of its member company experts “have accepted the Director General’s invitation to speak at the WTO event”.

‘“We believe this is an important opportunity to contribute to the DG’s expressed desire to find pragmatic outcomes to increase vaccine production.  We hope to be able to share our experience of the complexities in researching, developing, registering, manufacturing and distributing COVID-19 vaccines,” said Cueni

However, over 240 civil society organisations wrote an open letter to Okonjo-Iweala on Tuesday expressing concern “over the emphasis on industry-controlled bilateral agreements as the primary approach to addressing global production constraints and supply shortages”.

Referring to her “Third Way” approach, which they described as “appealing to pharmaceutical corporations to take voluntary actions”, the organizations said this had “proven to be insufficient in this pandemic”.  

Instead, they proposed that WTO member states approve the initiative to remove “barriers towards the development, production and approval of vaccines, therapeutics and other medical technologies necessary for the prevention, containment and treatment of the COVID-19 pandemic” by supporting the temporary waiver on intellectual property rules.

In a letter to @NOIweala, we join over 240 organisations from around the world calling for the removal of barriers to scaling up production of vaccines & other #COVID19 related medical technologies in order to make universal equitable access a reality: https://t.co/dLXpJhPSMj pic.twitter.com/cHFkUX3GfK

— Health Action International (@HAImedicines) April 13, 2021

Image Credits: WHO, ©WTO/Bryan Lehmann.