“There is really no moral, legal, justifiable ground for this level of secrecy, you need to bring the light in’’: Fatima Hassan on the Fight for Transparency of COVID-19 Vaccine Contracts

Newsletter Edition #49 [Treaty Talks - The Files Interview]

Oct 25, 2023

Hi,

Today we bring you a comprehensive interview with Fatima Hassan, a South African activist and lawyer, whose efforts have forced greater transparency around procurement practices and contracts of COVID-19 vaccines.

This expansive and timely interview, will hopefully illustrate the consistency of efforts by civil society actors fighting for accountability in global health, and the sheer power imbalances that underpin this ecosystem.

(Also check out our previous story on this: Dissecting South Africa’s COVID-19 Vaccine Procurement Contracts & their Global Implications)

For all this stellar work that shows how secrecy imperiled the access to medical products and affected lives during COVID-19, the newest draft of the Pandemic Accord, shies away from binding obligations to prevent confidentiality clauses in contracts.

Write to us with your thoughts.

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Thank you for reading. We will be back with our regular coverage starting next week.

Best,

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. THE GENEVA HEALTH FILES INTERVIEW

“There is really no moral, legal, justifiable ground for this level of secrecy, you need to bring the light in’’

Fatima Hassan, spearheads Health Justice Initiative, a Cape-Town based NGO. Hassan is an acclaimed activist and lawyer, recognized for her work on health and human rights. In a recent visit to Geneva in September 2023, Hassan took the time for our readers to talk at length about her motivation, efforts and the resulting outcomes, from pushing for transparency in the way the government of South Africa negotiated and bought COVID-19 medical products during the pandemic. Geneva Health Files is deeply grateful to her for explaining the many twists and turns in the tenacious advocacy efforts that have established a benchmark on how transparency is fought for and won.

Geneva Health Files [GHF] Q1. How did this fight for transparency begin in South Africa? What made you bring a case against the government of South Africa for greater transparency in the COVID-19 contracts?

Fatima Hassan[FH]: Thanks. So firstly, I mean, the case in South Africa builds on the excellent work that other civil society activists and NGOs have done in South Africa, on using access to information laws in South Africa that are considered quite progressive, and quite positive, in respect of more open procurement.

I live in a country with very high levels of inequality, where our health bill is quite high. But we don't necessarily see the right outcomes for the amount of money we spend.

And so the case comes within the context of where South Africa was asked to put billions and billions of public money on the table - we estimate anywhere between 11 to 14 billion Rand. This was at a time when not just South Africa, but everywhere else in the world, faced multiple knockdowns, when social relief support systems were not adequate for the most marginalized and those most affected by the COVID pandemic… And in our case mainly black African men and women in particular. When the world had basically entered this global pandemic, and we were promised a lot of solidarity, which didn't really materialize, we in Africa, were waiting and waiting for vaccine supplies.

We were told two things, one, that COVAX would be set up to support people like me, and others in South Africa and elsewhere in Africa and Latin America, and that we shouldn't worry, the “market will work’’. The system has our back, we don't need to enter bilaterals because COVAX will make sure that there is equity and allocation for low and middle income countries. And that never happened. And sorry to say, but like many other commentators have said, I think COVAX has been a spectacular failure.

I hope that there is not a repeat of [such a] mechanism in the next pandemic, because if that is the case, we will all wait for very long time for the market to try and, you know, “remedy itself’’, to try and prioritize our lives in the global south.

But at the same time that we were being told that there would be solidarity in the sharing of knowledge and resources, that we will prioritize all healthcare workers first around the world. And obviously, we know what happened. We are talking about deaths in the region of 20 million people within the space of three years directly and indirectly caused by COVID.

Our government had to scramble and we now know…. They have now conceded, three years later, [that they were] actually bullied into signing very onerous agreements in order to access very scarce supplies of vaccines. We can talk about the systemic factors that give rise to scarcity in a time of pandemic. But the bottom line is, they were eventually able to secure supplies from suppliers, three of which are pharmaceutical companies and one is supposedly a not for profit initiative, which is COVAX which is administered by GAVI. So those are the four suppliers. And we were concerned and we raised the alarm bells from 2020 already that if the response to this pandemic is no sharing of knowledge, and supplies and resources, as encapsulated also, in what's called the TRIPS waiver proposal, that we would have a situation of scarcity, manmade scarcity. …That we would have a situation of priority customers which we saw the global north was the priority customer and we now have the contracts to confirm that they were also placed you know, way ahead in the queue.

There was also the diversion of supplies of vaccines that were being filled and finished in South Africa for European customers first, while we were waiting for vaccines. So the better part of 2021 we were waiting for vaccines, our country has entered into these contracts. Because our government has told us to wait, the vaccines are coming. We have signed these contracts, we are waiting for supplies. And we basically waited and waited and waited for the better part of 2021. We were subjected to a drip feed of supplies, a few, you know, whimsical donations here and there, but largely a global supply chain that couldn't keep up with demand.

And again, that could have been very different. A lot of us, including our parents, or grandparents, you know, people with comorbidities in my country, people living with HIV and TB who really needed these vaccines. Alongside facing multiple travel bans, racist travel bans, I might add, alongside being really advanced in identifying new variants or having significant sophisticated genomic surveillance systems in South Africa. Alongside doing at least five clinical trials for vaccines research contributing to global scientific knowledge, we were told that your time will come... So this is what we mean by a drip feed of supplies.

And we tracked supplies as the Health Justice Initiative. And noticed that for the first three quarters of 2021, at least, we were getting very negligible amounts of supplies, which explains why South Africa could not have a national mass vaccination program. We had to do it but the entire program had to pivot from what initially they thought would be a Johnson and Johnson program. We were waiting for supplies and they were not coming. Later, we found out that actually 30 million at least J&J vaccines were diverted to Europe, and it wasn't for our benefit. And until the New York Times, broke that story, Johnson and Johnson gave no undertaking that they would pause the exports to Europe. And those vaccines were meant to benefit Africa.

So when we were told by government officials in our parliament, because we still have, a functioning democracy to a large extent, where the Minister is accountable to Parliament, and he has to answer questions [where there was a lot of public pressure around ‘’where are our vaccines’’, and our government was exclusively blamed for those delay]. They indicated, like many other countries in Latin America, that the demands by these companies were so one sided and onerous that the delays we were experiencing were also to satisfy these pharmaceutical companies.

And so what we saw was a rapid establishment, for example of a Vaccine Injury Fund. We only had 72 hours to make a submission on a really important mechanism, which had to be fully underwritten by the South African government that would give full indemnification to, in particular Pfizer, and Johnson and Johnson.

What we learned was that, unless the scheme was set up, the fund was set up and underwritten by the South African government that not a single vaccine dose would be delivered outside of a clinical trial to South Africa. So that was just the beginning of the indication that the power was so distorted, and that our government and all of us, by virtue of that, we're in a hostage situation, “if you want the vaccines, then these are the terms and conditions, you are going to have to agree to it’’.

And it is “a secret’’, it is subject to a “nondisclosure agreement’’. So “you can't share any of this with the public’’. We have [HJI] now remedied that and we can talk about that shortly. And on top of that, “we’’ will determine when you will get your vaccines at what price under what terms and conditions, whether “you’’ as a sovereign government have any power to impose export restrictions or any other limits. And at the same time, “we won't support your call as the South African government for a TRIPS waiver.’’

So it was, “we will not share knowledge, we will not share the contract terms and conditions and we will not share supplies and we will prevent others from being able to assist you because we will place bars and prohibitions on when donations can happen, how donations can happen, how excess stock can be moved around the world.’’ So really a hostage situation, excessive power by the industry.

And that is what made us concerned. It was not as if 14 billion RANDS was put on the table by wealthy philanthropists, that is not how we bought vaccines in South Africa. It was our money, the public's money. And if you believe in the rule of law, then you can't be selective in following the rule of law. Procurement has to be open. It has to be transparent. It has to be accountable, especially when you are using public resources.

And in the middle of a pandemic when you are trying to create trust in a national vaccination program so the more secrecy you have the more distrust there is in the vaccine program, and you allow anti vaccine movements to grow. So secrecy is not a useful public health safeguard.

That is the reason we as a health justice NGO were concerned that if you create a precedent for secrecy, and for nondisclosure agreements in the procurement of vaccines in this pandemic, then you create a precedent for secret procurement in any other epidemic or pandemic. And we as a country are moving towards national health insurance where the state will be the procurer of all medical goods. This is not the precedent we wanted, this would be dangerous as secrecy has no place in a pandemic.

There has to be, transparency, particularly when you're also dealing with a not for profit initiative like GAVI and COVAX. There is just really no moral, legal, justifiable ground for this level of secrecy, you need to bring the light in. So the amount of public resources, the fact that you're trying to foster trust, you want greater uptake into the vaccine program means you should actually be on the side of greater disclosure. And what we were told by our government was that they could tell us nothing and that everything was a secret - because the company has insisted on non-disclosure agreements.

[GHF]Q2. When did you actually file the case? And what did these contracts reveal? How difficult was it as an NGO to actually take this up to push the boundaries of this discussion.

[FH] So the Health Justice Initiative started this case in early 2022.

We are fortunate that our country has a set of access to information laws that allows any interested party, including a non-governmental organization to seek access to information on contracts or records that are not classified, broadly as a “state secret’’, and are not subject to a cabinet “privilege’’. So we are able to seek access to those records through a process and we file the access to information request, the Director General of the Department of Health, would notify the third parties involved [because this involves third parties]. It wasn't just records of our government. And our law allows us to ask our government for records relating to contracts or negotiations it entered into with a third party. In this case, it was pharmaceutical companies and GAVI. So we were told that they would be approached to see what their views were so that the government can make a decision.

There was no decision. We launched an internal appeal. And that was also refused. And our law provides that if an appeal is refused, you can approach the courts for relief. And that's when we filed our papers with the High Court. In 2023, by mid-2023, we were given a court hearing date. We argued the case, and really grateful for an excellent judgment by Miller, J. That came out a few weeks later, and the court basically ordered that it was in the public interest for people in South Africa to be able to view all of the COVID vaccine procurement contracts with all relevant parties, including the companies that we eventually got supplies from. And that we also have a right to see all the negotiation outcomes and minutes - the processes that underpinned a series of negotiations, including with other companies, such as Moderna.

You will note in South Africa, we managed to get supplies from the four entities we've talked about before Pfizer, Johnson and, Johnson Serum Institute of India and COVAX. The court also, and I think this is what's critical for transparency, found that there was no grounds to justify the non-disclosure or redacted disclosure. And so the court ordered that the unredacted versions of all of these documents and contracts must be made available to the HJI within 10 days. And fortunately, the Minister of Health in South Africa --and I think kudos to him for taking this decision-- decided not to appeal the judgment.

The other important aspect of the court judgment was that the court found that the application by the Health Justice Initiative and the entire set of proceedings was not defective just because we also did not cite the pharmaceutical companies. It found that the duty and the onus was on our government, to have consulted the companies and the other suppliers and include them, because we made reasonable efforts to find out what the legal service address of all of the relevant entities and suppliers were. But all of our efforts to try and establish that information were “rebuffed”- in the words of the court. So you will remember that we weren't only told that the terms and conditions were secret, we were also told by the government and all of these different offices, that the contracting parties details were a “secret”, and that they couldn't tell us who they were - legally.

So we couldn't serve legal papers on Pfizer or J&J, COVAX or Gavi, or Serum, or Moderna, or any of the other companies because they refused to provide that information. And so, that argument by the South African department of health that the case should not proceed because the companies were not before the court therefore, also failed.

But the Government of South Africa to its credit decided not to appeal the decision, asked for an extension to provide the documents and the Health Justice Initiative only granted an extension for the other records of [what we call the negotiation, minutes and processes and records and outcomes] that will be provided to us at the end of September 2023.

The four contracts that South Africa entered into, were handed to us in an unredacted form within the 10 days, and that has now been made public by the Health Justice Initiative. Our analysis with a group of other civil society organizations, academics, researchers -what we call the multi stakeholder group. The contracts are accompanied by our analysis of all of these different contracts. We will supplement that analysis once we get the balance of the documents.

And if you read the analysis, you will note some of the disclaimers [because we believe that there are one or two annexes that were not provided to us, which we are still trying to obtain]. But from the documents given to us what we found is huge variations and disparities in the price that were charged for vaccines for South Africa compared to other countries. In some cases we were actually charged more than countries in the Global North according to the contracts we've signed. Now, if there's been a change in that we do not have the amendment. We don't know the final statement of the account.

We don't know what refunds we received. And we don't know for how long the special pricing dispensations may have lasted. More egregious than the pricing disparities were the terms and conditions relating to the power of the industry. And in all four, there were no guarantees of volumes, there were no guarantees of price. There were no guarantees of exact timing of deliveries, which makes it really difficult to plan a National Vaccine Program to vaccinate the entire country if you can't have any certainty of when the supplies would come in.

On top of that, there were provisions which basically said that the companies would have full indemnification against any and all forms of liability for the use of the vaccine, but also that there was no penalty provisions for non-delivery of supplies or late delivery of supplies. So if you decided to buy 30 million vaccines, and they were delivered 18 or 24 months later, when there were already new variants, you would be liable for that….. the terms and conditions around the advance payment were particularly worrying. And if this is going to be replicated in the next pandemic, it just constitutes a lot of wastage of very scarce public resources.

And broadly, those advance payments’ terms and conditions provided that, in some cases, even if there was non-delivery, or if a country decided they didn't want the balance of vaccine supplies then you would be responsible like in the case of Pfizer for 50% of the advance payment. So you're basically guaranteeing a lot of money for these companies without necessarily seeing a significant return.

I think one of the most scandalous provisions that we found was in the Johnson and Johnson contract. And this was part of a breaking story that the New York Times did in late 2021. And the provision is as follows: it precludes the South African government from imposing any export restrictions on any vaccines sold by Aspen, a different company, a private company for Johnson and Johnson (via a voluntary license), during the time when we needed vaccines the most. So the net result of that is in 2021, while South Africans were waiting for vaccines and we were facing devastating wave after wave of infection We were waiting for J&J supplies and we were told them that they will come ‘’one day’’. And then we find out that this particular term in this contract with our government was inserted basically to benefit J&J and Aspen in its own separate contract. And at least the 20 million vaccines that were filled and finished by Aspen in the Eastern Cape in South Africa left our shores for the benefit of Europeans in Europe, they were the priority customer.

And this was at a time when we had also learned that the United Kingdom, for example, was a priority customer for the global set of supplies that were coming from AstraZeneca and the Serum Institute of India.

So it wasn't just that these global North countries weren't supporting the proposal on the TRIPS waiver or greater sharing of knowledge and doing everything in their power to delay that. It wasn't just that they were over ordering supplies from multiple manufacturers or not necessarily providing the right commitment and support and funding to COVAX. But they will also insert themselves as priority customers as if you are on a “first class’’ flight. And all of us were sitting in ‘’economy’’ waiting, you know, very patiently and very long while a lot of people were getting sick and dying for supplies. The Pfizer contract, for example, also includes a term, which is quite ironic, that they basically would be given protection against any IP infringement on their part. Yes, while Pfizer was blocking TRIPS waiver so they were seeking a waiver for themselves, but not supporting the goal for a global TRIPS waiver. And then there are other terms and conditions, which if you read the contracts, you'll find quite alarming, but I think that's sort of the gist of some of the most problematic provisions.

And then if you look at COVAX and Gavi, I think what was quite surprising agreement that was given to us, we couldn't find in that particular agreement, a confidentiality clause, so we are unsure why Gavi and COVAX held on to this contract as a secret for so long, they should have just made it open when it was signed. But they also didn't include the minimum price for the vaccine. They talked about a maximum price because there's still price uncertainty on the COVAX contract in 2021. By the end of 2021, they only delivered 1.3 million of Pfizer's vaccines, and we are concerned that they may have actually charged us more than what we actually paid to Pfizer directly, which is a real concern. There is also a premium, which is added to the price that is also unknown.

There are a series of unanswered questions that arise from these contracts and these terms and conditions beyond just the indemnification and confidentiality provisions.

One has to really ask if you're interested in global health, whether you're working at the World Health Organization, whether you work for any of the different foundations or in civil society, why the secrecy? Why the lack of transparency? And can we get an investigation into how this actually happened? If we're going to have a pandemic accord without any transparency norms and standards, then I really worry that this is what will happen in the next pandemic.

Because this took two and a half years for these contracts to be disclosed. We are a small NGO with limited funding that managed to get legal support on a pro bono basis. And luckily, we didn't have to take it to the highest court in the land, which would have been even more expensive. But there's something fundamentally wrong if the only way you can get a procurement contract that was signed during a global emergency – a health emergency to be open is through legal action by an NGO in every single country. I mean, are we going to have 180 lawsuits to be able to get transparency?

I think that tells you that there's something fundamentally wrong and I think the worst culprit is GAVI as a not for profit initiative. I mean, it should be setting itself apart from the industry and the pharmaceutical companies. Its board should really look into the way in which it's contracting because GAVI is not just procuring vaccines for COVID – it is procuring vaccines for a whole range of other diseases, on the grounds that it's actually trying to help low middle income countries. But I have to say that this kind of secrecy helps no one. And I don't think that these initiatives are doing us any favors by protecting the industry with so much secrecy.

Image Credit: Photo by Suvan Chowdhury, Pexels

[GHF] Q3. I think the timing of these revelations cannot be really overstated, because, as you know, as on September 2023, WHO member states are at the cusp of, beginning serious negotiations on the pandemic, accord and amendments to the IHR. Issues such as transparency, terms and conditions attached to public funding, on procurement, all of this will be negotiated. And one wonders whether some of the learnings from South Africa will be taken into cognizance by negotiators here in Geneva. Congratulations to you and your team for really bringing to light, these secret dealings as it were. All over the world, here in Switzerland, and at the European Union level, a lot of journalists and activists are actually fighting to get more transparency, particularly around the COVID-19 contracts. So what are the lessons and advice that you have for activists in other parts of the world? And would you think there will be sort of a domino effect in terms of potential implications for transparency, even outside of South Africa?

[FH] Thanks. I think, you know, there's two parts to that question. The first is that the case has obviously had an impact.

I was just at the UN meetings last week for all of the different General Assembly discussions around, declarations on pandemic preparedness around TB, around universal health coverage. And I think that it presents a reckoning moment of whether we want to go forward in global health, and even in the next pandemic, or epidemic with secrecy [and by all accounts, we could have another pandemic in the next 25 years.] So this is not a hypothetical situation.

And the reckoning is, how do we balance these demands for secrecy, and what we call ‘’bullying’’. That's what the contract shows: that the South African government was bullied, South African government officials since the disclosure of the contracts have conceded in multiple public interviews that they were bullied, and that it was not an ideal situation. And they were told “Take it or leave it’’. If you don't agree to these terms and conditions, the companies would not supply your country, they would walk away.

So the reckoning has to be how do we regulate private power? Right! And so that is the lesson: what are we going to do in relation to the Pandemic Treaty, which is now being deliberated. And there is a certain irony to Geneva somehow being the focal point for all of our health going forward, because it is not representative of the reality of most people in the global south and the fact that the WTO [the World Trade Organization], the World Health Organization, GAVI, COVAX, Global Fund, the Medicine Patent Pool [MPP] are all based here is, is a fundamental concern for me and a fundamental problem, because it is totally removed from any kind of reality of what's really going on of where the patients are and where the epidemics are and where the pandemics are the most acutely felt. So how are we going to deal with this in relation to the pandemic treaty? How are we going to regulate private power? And I think the contracts are just one symptom of how that power operates.

I mean, you can do a whole analysis of what happened in the last three years at the World Trade Organization in terms of the deliberations and delayed negotiations. We are still - in 2023- talking about how to deal with the request of a waiver on therapeutics and diagnostics for COVID... This is 2023!!! So 14 to 20 million deaths later, world leaders are still talking about this, that means it's a fundamental problem.

So what does it mean for other civil society groups and for the work we are trying to do around transparency in procurement, particularly in a time of a pandemic? There is a possibility to challenge that private power – even if it may take some time. But if you use the law quite creatively [what we did in South Africa - you have to sue your own government -as a proxy -for taking on private power. Because our law allow us to do that, because of the way in which our procurement laws are set up.

Now, in other countries, it may be different, but the experience of activists in Colombia has also been one of success and quite fascinating where they worked for the public disclosure of contracts. And while they were appealing a judgement the contracts were erroneously sent in an unredacted form to journalists who then shared it. But the consequences for the journalists were severe.

In South Africa it is quite different because we were not harassed. We saw the disclosure of the contracts differently. The experience of activists in the UK in the US is that they've only been able to receive so far redacted versions of contracts. So they don't, as yet have the full unredacted versions and stories. In the EU, there's a lot of efforts from groups on the left, and groups on the right, who are trying to access for different reasons, in particular the contract with Pfizer.

And again, I have to emphasize that the more secrecy you have, the more distrust you fuel, in a growing anti-vaccine climate in the world, and anti-health climate and anti-WHO climate context. And so it really is, I think imperative, that we deal with this issue of transparency. Because the more secrecy you have, the more it's going to harm a global health agenda. So the experience recently, in the last few weeks of Kenyan activists following from the South African cases, they too, are now using the laws available to them to try and get disclosure of the contracts [with the South African case as a precedent for the judiciary] to show two things.

One, even if you disclose the contract, the world is not going to come to an end, which is what the industry always tells us. And secondly, it's very difficult for a pharmaceutical company to actually exit your country because you've disclosed a procurement contract. If they do that, then I think that is something that would be so selfish, and so unreasonable that their shareholders as well as the board's would, have to have a major intervention. So I think there's a lot of threats that fly around when you want access to information, ‘’We will disinvest from your country, we will exit your country’’… .etc.

So when the rule of law is to the benefit of the industry on patent protection, or via the World Trade Organization rules, then those companies want to entrench those rules and seek protection via those rules. But when the rules of a country compel you to public disclosure, you know, then you have to comply. Because remember, the bottom line is that our money contributed to their profits in the last three years. And the profits are immense.

The People's Vaccine Alliance have talked about 40 billionaires in the space of two years. For Pfizer, in particular, you know, the vaccine, as well as the new of vaccines have given it immense profits, billions and billions of dollars. So we're not talking negligible amounts. And I think we have to grapple with the power imbalance that we're dealing with.

I think that governments in the global south have to stand up. And if the repercussions for South Africa, are what we have experienced in the last three weeks, which is not harmful, the disclosure has not been harmful….I think it gives impetus to activists and governments elsewhere. Because of the disclosure, numerous public figures and Nobel laureates and, others, including world leaders, have spoken about what these contracts entail and how one sided they were and how much bullying there was. So I think there is a greater appreciation for what activists had talked about, for the last three years - the pernicious bullying of the industry, the evidence is now there for everybody and hopefully it will inspire and catalyze a lot more activists to use the different access to information laws in their countries to its maximum potential to try and get disclosure of all the contracts.

At best what we should be having is an undertaking by the boards of all of these pharmaceutical companies that all the COVID vaccine procurement contracts for every single country in the world will be open. Transparency International, latest data is that less than 10% of all the contracts signed in this pandemic are actually open. Right, that is a shocking statistic that needs to be remedied.

[GHF] Q4. I certainly do think that there is an opportunity for WHO member states to at least partly address some of the power dynamics that you are talking about. Wrapping up, what's the next frontier for activists like you, specifically in the access to medicine space? Is it pricing? Is it antitrust? And how would you sort of build on the momentum based on your recent success?

[FH] So I think it builds on, you know, the work of the access movement for the last 25 years, and why transparency is so crucial. And it's not just transparency in contracting. It's also transparency in price, like you have mentioned, and transparency in the patenting strategies of these companies. So just, you know, following this scathing analysis of these one sided contracts where our government admitted that they were bullied because we found evidence that they were bullied - the Competition Commission in South Africa, which is the equivalent of an antitrust regulatory body elsewhere, announced a formal investigation into Johnson and Johnson, for its pricing, historical pricing of a key TB drug, but also -for the first time- in an unprecedented move and announcement -is looking at the “evergreening’’ conduct of Johnson and Johnson for filing a secondary patent, which gives it you know, even greater exclusivity on Bedaquiline. And looking at that conduct as exclusionary conduct, which is sort of a term used in South Africa's competition laws.

And I think that's significant, because finally, there is an understanding and deeper appreciation that if we're going to tackle the issue of transparency, you have to approach it from multiple entry points, and that there is a role for civil society. But a more certain way to ensure regulatory transparency and legal certainty is for governments in the global south to act, and for its regulatory bodies to act. So, we really are very supportive of this investigation, because it shines a spotlight on Johnson and Johnson, which was one of the more egregious contracts in the vaccine procurement saga, and I think that's the important part is that no company or CEO is immune from scrutiny. And that, you know, companies like Johnson and Johnson, Pfizer, Moderna need to be scrutinized for all of their practices and conduct. And I think that's what's important- that transparency is becoming a more important part of our vocabulary in dealing with the management of pandemics and epidemics.

[GHF] Thank you so much, Fatima, for joining us and for your inspiring work.

[FH] It's a pleasure to be here and thank you for all your work.

Geneva Health Files