COVAX counts on dose-sharing to counter vaccine crunch, vaccine diplomacy makes it worse
Newsletter Edition #51 [The Weekly Primer]
One increasingly gets the impression that the messaging from Geneva is not only literally far removed from realities elsewhere but figuratively as well.
Take the one-year celebration of the ACT Accelerator, last week, which saw half a dozen leaders from around the world talk about the successes of the initiative. In that duration of 90 minutes, countries like India and Brazil witnessed scores of deaths from COVID-19. That WHO must use its time, resources, and name, to host such an event to promote its donors, at a time when every minute is precious is baffling. The time for symbolism is long gone. Quite literally a waste of breath, in our opinion.
Many of those who have not received a single dose of a vaccine, or those who are struggling to get access to diagnostics, would have wondered what all the fuss was about, if not outright insulted. It was amazing to witness the self-congratulatory notes from this event in the backdrop of unfinished tasks and mounting mortality.
Secondly, we have struggled to understand why WHO would not use symbolism effectively when it actually matters - such as in calling out erring countries. It has done so in a limited manner walking a diplomatic tightrope (Brazil, Tanzania). But hardly in every case. Just as WHO ended up having a China challenge, then an Italian episode, it may be beginning to have an “India problem”? (One top official, publicly self-censored emphasizing: “…I am not saying India has let its guard down..”) When we asked a question last week on whether WHO had praised India too soon, we were gently reminded that we must stand in solidarity with India. Asking questions is an act of solidarity with the Indian people, in the current circumstances.
Notwithstanding a slew of measures currently brewing to improve WHO’s emergency response, it would be useful to beef up WHO’s political might to deal with member states in general. In these complex times, WHO’s silent endorsement, or the lack of vocal criticism risks mutating into disinformation for meeting political ends, or worse, legitimizes inaction and risky behavior from governments.
WHO’s ability to ask difficult questions of member states, directly impacts its ability to deliver on public health goals, from seeking information on virus-origins to ensuring vaccine contracts are honored. So we hope WHO will have the means, and the political will to take on member states for the sake of the world’s people some of whom have been left to the devices of their own governments.
This week, we bring you a brief update on how the COVAX Facility is hoping to use dose-sharing to make good on suspended deliveries of vaccines in wake of the current Indian surge of COVID-19 which is devouring the subcontinent. We know that depending on the benevolence of “those who have”, is a failed business model in a pandemic. Ask those at the back of the queue with a COVAX stamp in hand.
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I. POLICY UPDATES
DOSE-SHARING: THE PLAN B FOR COVAX THAT RESTS ON BENEVOLENCE
In December 2020, Gavi spelt out the COVAX principles on dose-sharing for COVID-19 vaccines. Authorities had hoped that countries who had bought more doses than they require would be amenable to sharing the doses through the COVAX Facility. This was, what now seems like a far less challenging time, before the emergence of the variants, subsequent waves of the pandemic, vaccine shortages, export bans and legal threats between countries and manufacturers.
Not only has the situation exacerbated, unforeseen supply challenges have emerged for the COVAX facility in the context of the resurgence of COVID-19 in India. So even as COVAX has already paid a price for bilateral deals and relying on too few manufacturers in the acute phase of this disease, dose-sharing has emerged as an option to meet some of the shortfall in its supplies. This is concerning since we have seen that benevolence of high and upper middle income countries have not effectively contributed to alleviating shortages. In addition, countries continue to give away doses bilaterally to secure the gains from vaccine diplomacy. No one wants to be left behind, especially when catching up with the diplomacy efforts of China and Russia that have already won key friends in the developing world.
Diplomatic sources tell us, that the seeds of vaccine diplomacy sown now, will result in what will potentially be future markets for these countries. And hence the mad rush to rack up points on vaccine diplomacy.
In all of this, so far COVAX has not been able to attract enough supplies even through dose-sharing, never mind the promise of procuring and delivering in bulk for all countries. It has reached 120 countries and has delivered 48 million doses with a current shortfall of 90 million doses in the current period, top officials said.
The dose-sharing principles of COVAX specify safe and effective vaccines, early availability, rapidly deployable, unearmarked, and having substantive quantity. The principles also suggest that shared doses should be fully paid for by the contributing country, and that the Facility would cover some of the ancillary costs.
Apart from doses of vaccines already in the COVAX portfolio, the Facility is also open to sharing of other vaccines “if they meet WHO’s Target Product Profile and the standards set by the Independent Product Group for vaccines in the COVAX portfolio.”
We asked Gavi how the Facility was planning on addressing shortages in its pipeline and about its dose-sharing strategy. A spokesperson clarified:
“COVAX deliveries continue to take place, with delivery of AZ vaccines from AstraZeneca and delivery of Pfizer/BioNTech vaccines continuing at a steady pace.
As India confronts a truly dreadful wave of the pandemic, it is clear that all Indian vaccine production – for the next month at least – will be committed to protecting its own citizens. We offer the government of India our full support in their effort to bring the virus under control and stand ready to help in any way we can, as we continue to maintain an active dialogue with the government.
However, anticipating these types of barriers is one of the reasons COVAX has sought to diversify its portfolio from the beginning. As a result, we are in conversations with other manufacturers of other candidates on supply schedules, and will announce further rounds of allocation to Participants in due course.
We also anticipate announcing new deals for vaccines and vaccine candidates, and our partner CEPI is already expanding the R&D portfolio further, including to account for the emergence of new variants.
We further anticipate announcements on dose sharing from higher-income countries donating excess supply or transferring COVAX allocated doses to AMC participants.”
Gavi has said that France has decided to donate doses via the Facility with upto to half a million doses by June 2021 with a goal to provide at least 5% of all doses acquired by France over the course of 2021.
Reuters reported that Spain intends to donate 5-10 % of excesses doses to Latin America, but it is not yet clear if these will be shared through COVAX.
Both WHO and Gavi, have urged countries in recent weeks, to route their donations through COVAX. There does not seem to be much uptake for such appeals.
Finally, it appears that initial plans to use a trading concept for vaccines have not yet taken off. On whether the COVAX Exchange could spur countries to trade unused vaccines, a Gavi spokesperson clarified:
“COVAX is currently evaluating the feasibility and design of the COVAX Exchange mechanism. We will make a decision about operationalization in Q3 of 2021. Our priority right now is completing our necessary fundraising and ramping up volumes of deliveries to all Participants in order to protect the most vulnerable.”
Last week The Guardian reported on severe shortfalls in the COVAX Facility:
“Large countries such as Indonesia and Brazil have so far received about one in 10 of the Oxford/AstraZeneca doses they were expecting by May, while Bangladesh, Mexico, Myanmar and Pakistan are among those that have not received any doses of the vaccine through the programme so far.”
So essentially the Plan B for the COVAX Facility, at this point, appears to be grasping at the straws.
II. WHAT WE FOUND INTERESTING
Why the World Should Worry About India: The Atlantic
“Reports of double- and even triple-mutant strains of the virus, which experts fear could be driving the country’s latest surge, have prompted concerns that what has started in India won’t end there. Despite efforts to restrict the spread of India’s new COVID-19 variant, called B.1.617, it has already been identified in at least 10 countries, including the United States and Britain.”…
… “ “It’s very similar to what we saw in Manaus,” Christina Pagel, the director of clinical operational research at University College London, told me, referring to the badly hit Brazilian city. She noted that “it’s not a coincidence that these variants are arising in populations that have developed immunity through infection.” "
“ “Newly filed disclosure forms from the first quarter of 2021 show that over 100 lobbyists have been mobilized to contact lawmakers and members of the Biden administration, urging them to oppose a proposed temporary waiver on intellectual property rights by the World Trade Organization that would allow generic vaccines to be produced globally.
Pharmaceutical lobbyists working against the proposal include Mike McKay, a key fundraiser for House Democrats, now working on retainer for Pfizer, as well asseveralformerstaff members to the U.S. Office of Trade Representative, which oversees negotiations with the WTO.
Several trade groups funded by pharmaceutical firms have also focused closely on defeating the generic proposal, new disclosures show. The U.S. Chamber of Commerce, the Business Roundtable, and the International Intellectual Property Alliance, which all receive drug company money, have dispatched dozens of lobbyists to oppose the initiative.” "
Big pharma lobby’s self-serving claims block global access to vaccines: Corporate Europe Observatory
“EFPIA is Big Pharma's main lobby group in Europe, enjoying far-reaching access to and influence over EU decision-making, fueled by its lobby spending of up to €5.5 million in 2020, involving 25 lobbyists (an increased spend from €4.6 million in 2019). Lobby documents released as a result of our FOI request throw new light on EFPIA’s lobbying.
The internal documents released to Corporate Europe Observatory show thatseveral branches of the Commission have stayed in close contact with EFPIA since the outbreak of the pandemic. This includes discussions on supplies – particularly in the early days – and regular discussions on political issues, not least intellectual property rights. Mid-pandemic, EFPIA frequently met with EU civil servants to discuss how to secure stronger rules on intellectual property rights in bilateral trade agreements (with countries such as Australia, New Zealand, Canada, Indonesia, Chile) as well as enforcement.”
Corporate Europe Observatory
Clearest admission till date on the limitations and failures of The COVAX facility.
The Anguish of the World’s Doctor: New York Times
Nicolas Kristof got Dr Tedros to talk about his personal suffering flowing from the Tigray crises in Ethiopia. A must read.
“Biolyse is a small pharmaceutical manufacturer in Canada with a simple proposition: provide a recipe for a coronavirus vaccine, and it will produce 20m doses for nations in the global south. It has approached AstraZeneca and Johnson & Johnson, and even asked the Canadian government to help it with compulsory licensing – which would give it the authorisation to produce another company’s patented product for emergency use – but so far no one has taken up its offer.
When I reached him by phone this week, John Fulton, the vice-president of Biolyse, told me: “We’ve been passed over. We’ve got this production capacity and it’s not being put to use. If we had started this last year, we could have shipped millions of doses by now. This is supposed to be like a wartime effort, everyone in it together. But that doesn’t seem to be the case.”
It was news to use that geopolitical insecurities are dictating positions of the pharma industry. This story also discussed how USTR has “rattled” the industry.
“Vaccine makers have warned US officials that temporarily scrapping patents for Covid-19 shots would risk handing novel technology to China and Russia, according to people familiar with the talks.
As industry lobbying has escalated in Washington, companies have warned in private meetings with US trade and White House officials that giving up the intellectual property rights could allow China and Russia to exploit platforms such as mRNA, which could be used for other vaccines or even therapeutics for conditions such as cancer and heart problems in the future.”
“Asked to explain why not, Gates — whose massive fortune as founder of Microsoft relies largely on intellectual property laws that turned his software innovations into tens of billions of dollars in personal wealth — said: "Well, there's only so many vaccine factories in the world and people are very serious about the safety of vaccines. And so moving something that had never been done — moving a vaccine, say, from a [Johnson & Johnson] factory into a factory in India — it's novel — it's only because of our grants and expertise that that can happen at all."
Global Health Is In Disarray – But Is A Pandemic Treaty The Way Out ? Health Policy Watch
“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.
“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.”
Health Policy Watch
TRIPS waiver proposal being held hostage on “ideological” grounds: Third World Network
A helpful recap of the TRIPS Council Informal meeting last week.
FROM THE JOURNALS / REPORTS:
Global justice and the COVID-19 vaccine: Limitations of the public goods framework: Global Public Health
“Initial diplomatic attempts at reaching a consensus on the global response to COVID-19 sought to designate the vaccine a ‘global public good’. The phrase, which began to gain currency less than two decades ago, has been applied to a number of goods and services whose benefits are seen at the global scale. However, a closer examination of its aetiology and implications suggest that it may be of limited utility in providing an equitable framework for access to the vaccine.
The phrase was coined and developed in the context of development assistance for health, where funds from private philanthropic organisations and some Global North countries are allocated to countries in the South. The tools used for such allocation have not been designed for the global allocation of a good and would have to explicitly account for inequities between countries.”
Global Public Health
IFPMA report: The pharmaceutical industry and global health
III. WHAT WE ARE WATCHING:
TRIPS Council Formal Meeting: 30th April
Desperate efforts to fight the TRIPS waiver proposal as it continues to get political traction
IV. THE WEEK IN TWEETS
James Love has some information for all those seeking information on mRNA patents
Nirmalya Syam, a global health law expert in Geneva offers an interesting thought experiment on international solidarity:
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