Brussels lessons for Geneva

Newsletter Edition #27 [The Weekly Primer]

Hi,

Looking back at 2020 and these early weeks in 2021, future political pundits are very likely to be in awe at the rate at which politics challenged assumptions on a weekly basis. Politics everywhere. Barely did we catch our breath from the past week which saw European Commission naively risk upending protracted negotiations, we also read with concern of the military coup in Myanmar and continuing censorship in India. All this in the midst of an evolving virus attack.

Given the times we live in, there is seldom a moment for reflection, but nevertheless we try to make sense of these events. Journalists have a penchant to look for narratives, it is comforting and clarifying to sift through the mess of reality.

This week we tried to understand what the developments in the EU can mean for multilateral Geneva, particularly the discussions at the TRIPS Council which meets this week for an informal meeting to discuss the waiver proposal.

Also if countries fail to cohere around a regional block on matters as sensitive as vaccinations, can we expect them to lead on global health issues at WHO? Write to us and help us understand.

We hope you enjoy this curated edition.

Look out for our analysis of the week on Friday.

Cheers,

Priti

Feel free to write to us: patnaik.reporting@gmail.com or genevahealthfiles@protonmail.com; Follow us on Twitter: @filesgeneva

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I. Inconsistencies in the opposition to the TRIPS Waiver

It has become increasingly inconsistent for the EU, the U.S., and others,  to oppose the TRIPS waiver proposal at WTO. Prevailing production bottlenecks in the EU have demonstrated the costs of such inconsistencies.

This has come to a stead now, with the new EU export regulations that went through a hasty birth late last week, to finally re-emerge over the weekend even as the damage had already been done.

It is telling how impossible it is to separate matters of public health from the politics. Competition for vaccines has taken on a color that few would have predicted even late last year. Germany and France, prominent donors to WHO, pushed for export controls as the EU regulation was being hashed out.

Image credit: Photo by Gabby K from Pexels

As the EU has come to realize, problems in the scaling up of manufacturing of complex products such as vaccines has actively hurt the response to the pandemic. Belatedly, we have seen examples of Novartis and Sanofi step up to produce vaccines of other companies.

Why then would the EU continue to oppose plans at WTO’s TRIPS Council to liberate protected manufacturing practices which would help manufacturers worldwide to step in and meet demand for the production of vaccines, while creating capacities for the future?

While the burden of the pandemic continues to deepen in the U.S. and the E.U, and other parts of the world, the argument that vaccines are a priority in only certain parts of the world given the intensity of current transmission is a fallacious one, given the unpredictability around the variants of SAR-CoV-2.

EU says its export restriction rules will not have an impact on the deliveries to the COVAX facility.

COMMISSION IMPLEMENTING REGULATION (EU) 2021/111 of 29 January 2021 making the exportation of certain products subject to the production of an export authorisation [published 30th January 2021):

(10) Based on the principle of international solidarity, exports to enable the provisions of supplies in the context of humanitarian emergency response, exports to the COVAX facilities, and in particular to low and middle-lower income countries given their vulnerability and limited access to vaccines, exports of COVID-19 vaccines purchased and/or delivered through COVAX, UNICEF and PAHO with destination to any other COVAX participating country and exports of COVID vaccine purchased by Member States under the Union’s APAs and resold or donated to a third country should be excluded from the export authorisation requirement.

But who knows how this will pan out in practice? Many political institutions are under pressure from a variety of sources.

Even before the export restriction rules came last week, Charles Michel of the European Council suggested recourse to Article 122 under which EU states could legally take “measures appropriate to the economic situation, in particular if severe difficulties arise in the supply of certain products ”. Michel is President of the European Council, the institution which sets the political direction for EU member states.

So while there seems to be an appetite within the EU for legal measures to address the demand for vaccination and to be answerable to the public, there is no corresponding position to the same challenges at the multilateral level.

At a press briefing last week, WHO officials noted that while the agreements of manufacturers with COVAX may be safe, “the real question is of volumes.” WHO has suggested that countries have been told about “indicative allocations” based on projections from manufacturers and preferences made by countries, but hinted that volumes could be subject to production glitches as witnessed recently. (In response to a rising number of questions on the allocation of vaccines, WHO DG Tedros suggested yesterday, that providing information on exact country allocations of vaccines cannot happen through the media and that there was a dedicated channel with countries for communicating this information.) Clearly, the pressure is building everywhere.

The export bans discussion has triggered concerns on whether it will affect access to vaccination and as a result, influence the epidemiology of the disease. Seldom has trade been more inextricably linked with health.

(The current circumstances also prompted WTO this week to step in and call for international cooperation for vaccination.)

The TRIPS Waiver discussions may have received an inadvertent boost on the back of EU’s vaccination woes.

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II. WHAT WE FOUND INTERESTING

NEWS:

  • Faced With a Vaccine Emergency, the EU Made an Enemy of Everyone: Bloomberg

    As we remarked on twitter, this story captures how health concerns are shaping and driving geopolitics.

  • Governments Sign Secret Vaccine Deals. Here’s What They Hide: New York Times

    An excellent story that goes deep into the kinds of specific information that have been highly protected in vaccine contracts, from price per dose to delivery times.

    See this excerpt that we thought was significant:

    Some Governments Are Profiting

    Early in the pandemic, the European Investment Bank, the lending arm of the European Union, provided a $100 million loan to the German company BioNTech, which partnered with Pfizer in producing a vaccine.

    In addition to the interest on the loan, the European bank will receive up to $25 million in vaccine profits, according to a redacted version of the contract that BioNTech filed with securities regulators.

    The bank said profit-sharing arrangements reflect the risk involved in early financing. Mr. [Zain] Rizvi, of Public Citizen, argued that it puts governments on the same side as the drug makers and reduces any incentive to make drugs cheap and widely available.

  • How Europe fell behind on vaccines: Politico

    A great story which nearly succeeds in describing the layered complexity in the procurement of vaccines in the European Union.

  • The Folly of Hoarding Knowledge in the COVID-19 Age: Let Vaccine Producers in Poor Countries Help End the Pandemic by Tahir Amin in Foreign Affairs

    Read this article to understand the historic [calculated] missteps that have led us to the situation we are facing today with respect to vaccines scarcity and the forces that perpetuate these resulting inequities.

    “…Those defending the current system also contend that low- and middle-income countries do not have the technical capacity to manufacture and distribute vaccines at scale, especially ones that depend on sophisticated mRNA (messenger RNA) technology, such as those from Moderna and Pfizer-BioNTech. But this argument rehearses a tired trope, the likes of which have been disproven in the past.

    In the 1980s, a Western firm refused to transfer vaccine technology to the Indian company Shantha Biotechnics, claiming that Shantha’s scientists would not be able to understand the required recombinant technology to produce the vaccines. Shantha subsequently went on to develop its own recombinant vaccine for hepatitis B, which became available for $1 per dose and enabled UNICEF and other organizations to undertake low-cost mass vaccinations. Indeed, the Indian company Gennova has already entered into phase I/II clinical trials with its own mRNA COVID-19 vaccine. Alternative manufacturing capability for sophisticated COVID-19 vaccines very likely exists in the developing world. …”

    Tahir Amin in Foreign Affairs, January 2021

  • High Level Independent Panel on financing the Global Commons for Pandemic Preparedness and Response: Bank of Italy press statement

    Last week, G20 Members decided to establish a panel, proposed by the Italian G20 Presidency to “assess the current financing systems and propose viable solutions for the longer term.”

    Check out the glitterati from the world of finance who are members of this panel.

    “The G20 High Level Independent Panel is tasked with:

    • Identifying the gaps in the financing system for the global commons for pandemic prevention, surveillance, preparedness and response;

    • And proposing actionable solutions to meet these gaps on a systematic and sustainable basis, and to optimally leverage resources from the public, private and philanthropic sectors and the International Financial Institutions.

    The Panel, co-chaired by Tharman Shanmugaratnam, Former Deputy Prime Minister and Minister for Finance, Singapore, Lawrence Summers, Former United States Treasury Secretary, and Ngozi Okonjo-Iweala, Former Finance and Foreign Minister, Nigeria, will build on WHO’s assessment of gaps in pandemic preparedness and on ongoing international initiatives aimed at enhancing global preparedness and response. In particular, the Panel will interact with main relevant Global Health actors, including the Independent Panel for Pandemic Preparedness and Response (IPPR) established by the WHO and in line with the goal of the International Health Regulations (IHR).

FROM THE JOURNALS / REPORTS:

  • Funding of Pharmaceutical Innovation During and After the COVID-19 Pandemic: JAMA

    “…a major shift in the funding of product commercialization during the pandemic. Government agencies and philanthropic organizations are offering large sums not only to support research but to fund late-stage product development, the expansion of manufacturing capacity, and efficient systems for distribution. In the past, these activities have been funded largely by the pharmaceutical industry. The policy question now becomes whether the tilt toward public and away from private sources will be sustained after the COVID-19 pandemic recedes, or whether the funding of the life sciences will revert to the status quo. Given the size and importance of drug discovery and product commercialization, this has important implications for the future of medicine and health care…”

  • Difficult trade-offs in response to COVID-19: the case for open and inclusive decision making

    “To institute and broaden deliberative processes should therefore be a priority in the context of pandemic response and in anticipation of future heath crises. In the short term, it can build legitimacy and support for hard decisions that need to be made in response to the pandemic and prevent further erosion of trust. In the longer term, it can contribute towards virtuous cycles of trust-building and more effective policies.”

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III. WHAT WE ARE WATCHING

  • WTO TRIPS Council Informal Meeting: 4th February 2021

    Countries opposing the TRIPS waiver proposal do not wish to move towards text-based discussions. Proponents have been pushing for discussing the language of such a proposal including negotiating on the scope and the time-frame for the application of such a waiver.

IV. TWEETS OF THE WEEK

Less is more: In a three word tweet, Hyo Yoon Kang, an expert in intellectual property law, expresses frustration at the redaction of the AstraZeneca contract published by the European Commission last week.

James Love of KEI, raises a pertinent question on the costs of policy decisions in Geneva. See this important thread in full here:

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