At Risk: COVAX Plans to Vaccinate 20% of the People in LMICs; Guest Essay: A Critique of The Independent Panel Report
Newsletter Edition #57 [The Weekly Primer]
It might seem that the world is falling apart (it is), depending on where you are: Gaza, Myanmar, Ethiopia, among other zones of conflict. It is mind-numbing that conflicts are unfolding alongside a surge in infections of COVID-19 in some parts of the world. No neat categories in these messy realities.
We hope you benefit from reading today’s richly curated edition - a reflection of the many levers moving in global health Geneva.
Today we bring you our first guest essay - an opinion piece by a Geneva-based global health expert who shares her views on the independent panel report.
Also sharing our exclusive analysis from last week: Tied Funds To WHO, But Flexible Funds To Its Partners: Sustainable Financing Working Group Confronts Challenges. Sign up to read this story.
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I. GUEST ESSAY
“The Independent Panel did not meet the moment”: Sara (Meg) Davis
An Independent Panel for COVID-19 recovery
The Independent Panel tasked by WHO with reviewing the global management of the COVID-19 pandemic has fulfilled its terms of reference. But despite the best efforts of the panelists, it did not meet the moment. The world might still need an Independent Panel -- but one that is transparent, accountable and participatory.
This Independent Panel report does summarize many of the issues the world has witnessed in the past 14 months: weak pandemic preparedness, lugubrious bureaucracies, and government passivity. It poetically describes global inequalities, including the stark sacrifices of healthcare workers. However, its narrow recommendations sidestep many of these tough challenges in favor of expanding global governance: a Global Health Threats Council with heads of state, adopting new global statements and treaties, greater funding and authority for WHO, and a massive new $10 billion pandemic financing facility. It calls for countries to unite to establish a new international system for outbreak monitoring and alerts.
Some of these recommendations are sensible, others less likely, but in seeking to avoid assigning blame, the panel ducks accountability, and its vision falls short of the scale of the problems revealed by COVID-19.
The recommendations on vaccine access exemplify this. The panel urges funding for COVAX, a worthy goal; but COVAX’s 20% coverage targets cannot reach global herd immunity and prevent the spread of potentially dangerous new variants, and there is no clear plan for the remaining 80%. The panel called for high-income countries to speedily negotiate an intellectual property waiver and donate 1 billion doses by September 1 to low- and middle-income countries. Given the global need of 10 billion doses today, as Madhu Pai argued in his powerful intervention at the launch event of the report, this is vaccine charity, not vaccine equity. The panel does not address the stark inequalities among countries that have fueled the virus.
Troublingly, considering that several of the panelists have been outspoken human rights advocates in the past, the Independent Panel also sidestepped numerous grave human rights abuses in the COVID-19 pandemic: praising the world’s most brutal authoritarian lockdowns as models, without a single caveat about government overreach. In particular, as critics have pointed out, the report omits mention of Chinese suppression of health data, though it is well-documented that this has caused numerous real headaches for WHO.
In March 2020, China’s State Council cracked down on independent research, issuing a directive requiring political vetting of any research on the coronavirus. A Chinese scientist publishing the coronavirus genome sequence on an open platform had his laboratory closed. Over 800 Chinese individuals were sanctioned by police for COVID-related speech, and individual citizen journalists were disappeared while patients who organized online had their chat groups deleted. This is all consistent with the modern history of China’s health system struggling with whether to report up or censor outbreak alerts, from HIV to SARS to, most recently, H1N1.
Given this tortured history with health data, which has been repeated in other countries, it would have been reasonable for the Independent Panel to query when and whether the world will learn of the next outbreak of a new virus. If a UN panel cannot state that suppression of scientists is incompatible with the International Health Regulations, or even with the founding principles of the UN itself, how many doctors might hesitate to blow the whistle?
However, this aversion to sensitive political realities threads through the report, which mentions human rights only once, at the end. The report does describe staggering global inequalities, but without recommendations, though these could have been drawn from many sources: guidance from the UN Human Rights Office, from UNAIDS, from global associations of nurses and other medical workers, or even from the panel’s own commissioned background papers .
These omissions are concerning, but rather than blaming the panelists, we might reflect on the largely closed process. A process grounded in a robust, public consultation with civil society and community voices, frontline health care workers and trade unions, might have produced a different result.
To put an end to and recover from a catastrophe on the scale of COVID-19 requires greater scope. A democratic and public review of what happened and what did not happen in each region, with the public participating to reflect on what we lived through and bore witness to, could build the global public momentum for real learning and change.
Such open and transparent processes have taken place effectively as part of transitional justice in many countries. For example, we can reflect on the Global Commission on HIV and the Law: a global commission on a pandemic hosted by UNDP, it included regional desk reviews based on open submissions, public hearings recorded and archived online, and participation of community activists, who could then use the recommendations and tools that came out of the process to advocate for law and policy reforms at the national level. Its reports continue to be a reliable – and independent -- resource for scholars, officials, policymakers and activists.
An independent commission on pandemic policy could enable wider consultation that creates a lasting historical record, greater trust in science, and a global movement for transformational change. Are we ready to face the difficult truths that such a panel might show us?
Sara (Meg) Davis, Ph.D. is a senior researcher at the Global Health Centre, Graduate Institute, Geneva. She has authored The Uncounted: Politics of Data in Global Health. She can be reached at firstname.lastname@example.org.
II. POLICY UPDATES
COVID-19 Vaccine Manufacturing Working Group, ACT Accelerator
Germany and South Africa are co-chairs of this new working group. This was announced at the ACT A Facilitation Council Meeting last week. See story by Health Policy Watch: Global COVID-19 Vaccine Task Force Lays Out Plans To Scale Up Production and Fill US$18.5 Billion Gap.
At risk: COVAX plans to vaccinate 20% of populations in AMC countries - WHO official
The challenges for the world’s most vulnerable in accessing vaccine doses to protect themselves from a devastating pandemic gets more acute every week. Only 0.3% of the vaccine supply is going to low-income countries.
COVAX has so far delivered 65 million doses to 124 countries. The surge in cases has compromised global vaccine supply and there is already a shortfall of 190 million doses to COVAX by the end of June, WHO has said.
UNICEF was more direct in encapsulating the failure of the international mechanism: “The COVAX Facility will deliver its 65 millionth vaccine dose this week. It should’ve been at least its 170 millionth. The time to donate excess doses is now.”
A top WHO official admitted this week, that initial plans to vaccinate 20% of the populations in LMICs might be at risk. Bruce Aylward, who leads the ACT Accelerator efforts at WHO, said at a briefing that the Facility faces a gap of 150 million by the end of May and that gap will increase in June. This could put at risk, the goal of vaccinating 20% of the people in the AMC countries, he said. Nearly 25% of those countries who would otherwise not have had access to any vaccines, have got their doses through COVAX, he said emphasizing that the Facility works.
The need is to get control of the contracted doses and get countries who have committed to share doses to quickly ensure shipments of those doses, he added.
The Facility also expects more pledges and donations at the Global Health Summit on May 21 and at the G7 meeting in June.
The calls for more transparency in the supply forecasts from The COVAX Facility has gone louder in recent days, with even the International Chamber of Commerce calling for greater transparency on “when countries can expect shipments – and, if there are bottlenecks or issues getting orders to some countries, how these can be addressed.”
It was somewhat curious that CEPI, a partner of the COVAX Facility, which invested in vaccines doses acknowledged “the missed opportunity” in ensuring equitable access. “The great missed opportunity of 2020 is that the funders of vaccine development did not include access provisions in their funding agreements,” said Richard Hatchett, CEO of CEPI. Funders could develop and adopt common approaches to achieving equitable access including in their grant and contract provisions, he said at the COVID-19 Global Research & Innovation Forum last week.
In his remarks yesterday, DG Tedros drew up a list - it read like a litany of failed promises from vaccine manufacturers. Excerpts from his remarks:
“While we appreciate the work of AstraZeneca, which has been steadily increasing the speed and volume of its deliveries, we need other manufacturers to follow suit.
Pfizer has committed to providing 40 million doses of vaccines with COVAX this year, but the majority of these would be in the second half of 2021. We need doses right now and I call on them to bring forward deliveries as soon as possible.
COVAX partners are in discussion with Johnson & Johnson to receive doses in the second half of 2021 but this has not been finalised and we do not know when they will arrive.
Moderna has signed a deal for 500 million doses with COVAX, but the majority has been promised only for 2022. We need Moderna to bring hundreds of millions of these forward into 2021 due to the acute moment of this pandemic.
Once the devastating outbreak in India recedes, we also need the Serum Institute of India to get back on track and catch up on its delivery commitments to COVAX.
(Media reports say that Pfizer, for example, has delivered only 960,000 doses of the 40 million, for example. Also see Novavax Reports More Delays for Its Covid-19 Vaccine.)
Tedros also called on manufacturers to “publicly commit to helping any country that wants to share their vaccines with COVAX to lift contractual barriers within days not months. We also need manufacturers to give the right of first refusal to COVAX on any additional dose capacity.”
He also asked large vaccine manufacturers to enter into deals with companies like Teva, Incepta, Biolyse and others who are willing to use their facilities to produce COVID-19 vaccines. (Manufacturers refuse to do so, see Politico: Big vaccine makers reject offers to help produce more jabs)
In its statement, UNICEF has emphasized that, “Sharing immediately available excess doses is a minimum, essential and emergency stop-gap measure”. It also pushed for the expansion of vaccine manufacturing capacity, “including through proactive Intellectual Property licensing and technological transfer.”
“G7 leaders will be meeting next month with a potential emergency stop-gap measure readily available. New data analysis provided by Airfinity, the life sciences research facility, and commissioned by the UK National Committee for UNICEF, indicates that G7 nations and ‘Team Europe’ group of European Union Member States could donate around 153 million vaccine doses if they shared just 20 per cent of their available supply over June, July and August. Critically, they could do so while still meeting their commitments to vaccinate their own populations.
It is not clear when SII-related delays will be resolved, UNICEF said.
In response to our queries on whether, is there a change in the approach of the COVAX facility in engaging with manufacturers in the future, as a result of suspension of deliveries by SII, Gavi told us:
“COVAX’s goal has always been to own and manage the world’s largest and most diverse portfolio of vaccines. Two advance purchase agreements signed by Gavi in early May with Moderna and Novavax for a combined 850 million doses in 2021 and 2022 are expected to see new doses coming online early in the third quarter. COVAX continues to negotiate with other suppliers and expects to announce further advance purchases shortly.
At the same time, we urgently need countries with the largest vaccine supplies to share doses and trade early places in production queues with COVAX, so we can meet COVAX’s immediate supply needs. Manufacturers and governments should facilitate the fulfilment of deals so COVAX can deliver on its goal of at least 2 billion doses in 2021.”
Geneva trade wonks believe that this move by Bolivia could be a test case that illustrates the difficulties in using TRIPS flexibilities. And if indeed Bolivia manages use this provision, meaning that Canada issues a “compulsory licence” for Biolyse Pharma to make vaccines in Canada and export it to Bolivia - then this might work against the argument for a TRIPS waiver, some say. Read the KEI post on this.
Statement from co-sponsors of the TRIPS Waiver proposal: WTO
According to a communication from co-sponsors dated May 17, seen by Geneva Health Files, an amended version of the waiver proposal to move text-based discussions forward will soon be issued.
“The amended waiver proposal seeks to further clarify the scope of the proposed waiver while also addressing the period during which it will apply.” Co-sponsors also promise engaging in the process “with the necessary flexibility to ensure swift outcomes”. Any outcome in these negotiations must respect the wishes and common interests of the majority of Members of the WTO, they add. The co-sponsors “call on all delegations who have not yet indicated that they will join text-based discussions, to do so as soon as possible.” A failure to respond in a timely manner on the waiver proposal undermines the legitimacy and credibility of WTO, they have said.
Epidemiological Update, May 11
III. WHAT WE FOUND INTERESTING
A fascinating read on the importance of evidence-based medicine in this pandemic, but also raising a critical question on the limitation of using Randomized Controlled Trials for face masks.
EU to back expansion of vaccine production capacity in Africa: Financial Times
An excellent tool that examines the web of patents surrounding this technology between the various actors.
“In an attempt to demonstrate the complexity involved in IP protections and licensing deals surrounding COVID-19 vaccine technology, we developed a preliminary patent network analysis. We identified patents that were relevant to various vaccine technology platforms and used US Securities and Exchange Commission (SEC) filings to highlight pertinent licensing deals.”
“Article 66.1 of the TRIPS Agreement accorded LDC Members of the WTO an initial ten-year transition period, with an automatic right of further extensions, that entitles LDCs exemption from implementing most TRIPS obligations. This is in view of the special needs and requirements of the LDC Members, including their economic, financial and administrative constraints and their need for flexibility to create a viable technological base.
Adoption of the request should have been fairly straightforward as Article 66.1 of the TRIPS Agreement explicitly states that, “upon duly motivated request by a least-developed country Member”, the Council for TRIPS “shall” accord extensions of this period.
And yet there has been much delay in adopting the request leaving some to wonder if the United States and the European Union will intimidate the poorest and weakest segment of the international community, even as these countries face the worst social and economic crisis in 30 years.”
Third World Network
WHO: Should Members Pursue a Pandemic Treaty, In the Midst of a Global Pandemic? Third World Network
“Article 57 of IHR 2005 actually presents WHO and its member states with a lex specialis (a law governing a specific subject matter) to be invoked during the period of sustained PHEIC. It requires all other instruments and treaties to be interpreted consistently with IHR 2005. A framework convention, when it garnishes a higher political visibility, as mentioned in the FAQ, will diminish the focus on the IHR.”
Third World Network
“Roche does not make vaccines but it has been an important player in providing Covid-19 tests and medicines, including its anti-inflammatory drug Actemra, which has been used to treat Covid-19 patients, and in antibody therapy at Regeneron.”
Why Are There Shortages of Plastic Bags Needed for Vaccine Production? Monopolies and Patents: BIG by Matt Stoller on Substack
All you want to know about patents around “Single Use Bioprocessing Equipment” - now a bottleneck for vaccines production.
“The idea behind this argument is to frame the problem as a set of physical natural limits holding up vaccine production, rather than monopolistic legal structures.”
Matt Stoller on BIG
How India Can Survive the Virus: New York Times
Shortly after writing this opinion piece in the NYT, the author Shahid Jameel, virologist and director of the Trivedi School of Biosciences at Ashoka University, India, resigned from his position as the chair of the Scientific Advisory Group of the genome sequencing consortium set up late last year to track the variants of SARS-CoV-2 circulating in India.
An excerpt from this piece:
“…All of these measures have wide support among my fellow scientists in India. But they are facing stubborn resistance to evidence-based policymaking. On April 30, over 800 Indian scientists appealed to the prime minister, demanding access to the data that could help them further study, predict and curb this virus.
Decision-making based on data is yet another casualty, as the pandemic in India has spun out of control. The human cost we are enduring will leave a permanent scar…”
New York Times
The origin of COVID: Did people or nature open Pandora’s box at Wuhan?: The Bulletin of Atomic Scientists
Conversations on the Frontline: Challenges of Access to Medicines for Developing Countries: India China Institute, The New School
It examines the seeming contradiction of “how the Indian government positions itself in international forums and its demand of patent waivers, but on the other hand, its reluctance in the domestic terrain to avail of the tools that the WTO already provides?..”
FROM THE JOURNALS / REPORTS:
Politics of Vaccine Nationalism in India: Global and Domestic Implications: Forum for Development Studies
“Vaccines are political. Government-organized vaccination campaigns are projects that presume to shape the immunity of whole populations. This is not a neutral practice; it requires assessment in its relation to state power, national identity and the individual’s sense of obligation to self and others”
Forum for Development Studies
IV. WHAT WE ARE WATCHING:
WHO: Informal consultations on the proposed draft decision on a pandemic treaty (organized by Chile) and consultation on the proposed draft agenda item 17.1 Strengthening WHO Preparedness for and Response to Health Emergencies (organized by the EU): May 17
Global Health Summit: May 21
Webinar Watch This Week
The Virus of IP Monopoly Capitalism: Society for International Development