#WHA74 WRAP: Pandemic Treaty Talks Eclipse Prevailing Vaccine Inequities

Newsletter Edition #60 [The Friday Deep Dives]

Hi,

From the outside it seems like a stunning alignment of events:

Rome Declaration at the Global Health Summit (May 21); The World Health Assembly (May 24- June 1); an informal meeting of the TRIPS Council (May 31); the Gavi COVAX Advance Market Commitment (AMC) Summit (June 2); and the G7 meeting (June 11-13).

What these ‘light and sound’ shows actually mean in addressing the pandemic is yet to become obvious. The Rome Declaration that mostly adheres to status quo does not inspire much confidence. Each of these events are a crucial opportunity for the international community to address the weakest link in the system.

This week we listened to what countries had to say, and the response of WHO to the concerns of its member states. Our edition today is a synthesis of the discussions at the World Health Assembly, distilled into what it means for global health.

We hope that our readers will find this useful - presenting The Geneva Health Files Editorial.

Given the importance and the interest in the Assembly, this edition of The Friday Deep Dives is exceptionally being made available to all our readers. Thank you for your understanding.

While we are committed to critical global health journalism, reader subscriptions are vital for sustaining this initiative. Do consider contributing towards our reporting costs by becoming paying subscribers.

Until the dust settles, see you next week!

Priti

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THE GENEVA HEALTH FILES EDITORIAL

1. Pandemic Treaty Talks Eclipse Prevailing Vaccine Inequities at WHA74

More than half way into the 74th World Health Assembly, a serious discussion on the efforts to address vaccine inequities have been conspicuous by its absence. What has instead dominated much of the Assembly proceedings are talks for a pandemic treaty to address health emergencies in the future, and the important, but continuing push towards investigations on the origins of the virus, among other matters.

When this story went to print, the decision on the pandemic treaty was yet to be approved. The decision is expected to be approved at this Assembly. (See our story on this from earlier this week.)

To be sure, country after country has raised the issue of the lack of access to vaccines even as cases continue to rise in many parts of the world.

In his statement Prime Minister Gaston Browne, Antigua and Barbuda, called for the TRIPS waiver to end vaccine apartheid and he also criticised the vaccine allocation mechanism under the COVAX Facility particularly in relation to small island states.

Despite such statements, it seems that there has not been enough attention on the here and the now in the midst of all the discussions on preparedness. In our view, this risks looking away from and a silent acceptance to the mounting deaths from COVID-19. It also shows unwillingness to acknowledge and accept the limitations of the current mechanisms that have not met expectations on not only vaccine equity but an overall international mechanism for meeting the needs on diagnostics and treatments for COVID-19.  

Without even admitting that there is a problem with current approaches, it will be near impossible to solve the challenges in any meaningful manner.

Undoubtedly expending political capital to put in place processes to address future health emergencies is important, but this cannot come at the expense of without first putting out existing fires. 

We also understand that this is a difficult political tight rope to walk in the context of a fast-closing opportunity to build on the momentum to create lasting changes to fix how the world responds to disruptive health emergencies in the future.

This Assembly has shown that many member states have been unequivocal and clear about their preferences on the way WHO has to be run, financed, and the way it should fight future emergencies. Of course, agreeing on a future course of action on some of these issues by arriving at a consensus among 194 member states is another matter.

Despite the virtual nature of this event, and with 70 items on the agenda of the Assembly with a host of resolutions on different matters of international health policy from strengthening preparedness to local production of health products, the governing body meeting of WHO is a unique moment for countries to come together to assess what has worked and what did not during this pandemic. And yet, an opportunity that appears to have so far been missed.

This is perhaps not so surprising, given that in the Assembly which lasts more than a week, there is no dedicated forum where member states can discuss why vaccines have not been delivered as promised.

It is striking that even as the world’s worst health emergency in a century continues to unfold and decimates health systems in many parts of the world, WHO member states cannot seek accountability on these issues.

Given that WHO’s partner agencies have been leading on the delivery of vaccines, there appears to be no institutional mechanism that can enable member states to question powerful health agencies such as Gavi – The Vaccine Alliance, CEPI, and other actors, responsible for running the ACT Accelerator.

Set up by European Commission, France and The Bill & Melinda Gates Foundation in April 2020, and WHO as a coordinating hub, the ACT Accelerator, is meant to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

It has been clarified that:

“The ACT-Accelerator is not a decision-making body or a new organisation, but works to speed up collaborative efforts among existing organisations to end the pandemic. It is a framework for collaboration that has been designed to bring key players around the table with the goal of ending the pandemic as quickly as possible through the accelerated development, equitable allocation, and scaled up delivery of tests, treatments and vaccines, thereby protecting health systems and restoring societies and economies in the near term. It draws on the experience of leading global health organisations which are tackling the world’s toughest health challenges, and who, by working together, are able to unlock new and more ambitious results against COVID-19. The ACT-Accelerator has four areas of work: diagnostics, therapeutics, vaccines and the health system connector. Cross-cutting all of these is the workstream on Access & Allocation.”

If the ACT -Accelerator is not a decision-making body, it is highly problematic to map where the accountability rests.

The prevailing inequities - the result of a range of reasons from vaccine nationalism to legacy issues on the lack of health systems capacities in many countries, should in fact be a wake up call to revisit assumptions if indeed the ACT Accelerator is the right response for future health emergencies. Is the COVAX Facility the model way to address vaccines allocation and distribution? Can WHO member states meaningfully raise this question? More than a year into the pandemic, and scores of countries still waiting for vaccines, merits that such questions should be raised and these issues have to be addressed. (On average, in high-income countries almost one in four people have received a COVID-19 vaccine. In low-income countries, this is one in more than 500.)

The week began with WHO DG Tedros Adhanom Ghebreyesus calling countries to vaccinate at least 10 percent of the population of every country by September, and at least 30 percent by the end of the year as a minimum. He also added that “The number of doses administered globally so far would have been enough to cover all health workers and older people, if they had been distributed equitably. We could have been in a much better situation.”

This was followed by a statement from COVAX later in the week, that put in question whether the Facility can reach its objective of delivering 2 billion doses by the end of 2021. “If the world’s leaders rally together, the original COVAX objectives – delivery of 2 billion doses of vaccines worldwide in 2021, and 1.8 billion doses to 92 lower income economies by early 2022 are still well within reach,” the statement said. We read this as a shifting of goalposts, mired in non-transparency.

Tedros said, “The number of doses made available to COVAX remains vastly inadequate. To date, COVAX has shipped 70 million doses to 124 countries and economies. But that is sufficient for less than 0.5% of the combined population of those countries.”

A few days later, Gavi says, “… The AMC mechanism is how COVAX provides doses to lower income economies. Thanks to the generosity of its donors, the AMC has already secured 1.3 billion doses for delivery in 2021. This is enough to protect the most at-risk population groups: health workers, the elderly and those with underlying health conditions. We need an additional $2 billion to lift coverage in AMC countries up to nearly 30%, and we need it by June 2 to lock in supplies now so that doses can be delivered through 2021, and into early 2022.”

The time lag between securing doses and delivery of doses is costing lives.

Excess mortality showing up in water bodies and crematoria are not merely lasting images from a far-away dystopian reality – it is an indictment of the short-sightedness, self-interest and a steely resolve to preserve status quo at all costs.

The lack of effective action has costed nearly 3.5 million official deaths and counting.

While governments are partly responsible for these numbers, there is no question that international actors at the forefront of this pandemic response have to be accountable. And there needs to be a space to do that.

Image credit: Photo by Mohamed Khaled from Pexels

A FEW KEY UPDATES FROM THE ASSEMBLY:

Apart from considering and approving a range of resolutions from eye care, to oral health care, from diabetes, to committing to malaria elimination, member states also considered a Disability Action Plan. The next few days will also see matters on the election of the director-general.  

Below a few key questions which have emerged during the proceedings of the Assembly.

THE PANDEMIC TREATY DISCUSSIONS

The Assembly saw statements from Germany and Switzerland emphasizing the importance the pandemic treaty. In the course of the discussions over the past week, we saw nuanced statements from countries on the need for a pandemic treaty. Many have said more consideration is needed, and have called for greater scrutiny on the implementation of IHRs. There is no doubt that many want to focus on the acute phase of the pandemic, while also working on long term solutions to address emergencies.

While Tanzania called for an inclusive engagement of all member states on the discussions towards an international instrument and for an assessment of benefits for a treaty, Argentina called for examining recommendations from the review committees also underscoring the need for consensus on discussions on a pandemic treaty.

Russia expressed concerns on the Joint External Evaluations of the IHR and the limitations of these evaluations in reflecting the reality of the ability to health systems to respond to emergencies.

Germany said that with as many as 59 co-sponsors of the draft decision on the pandemic treaty, and consensus among countries for a special session to establish a process for a treaty, shows that this is a key signal from the Assembly.

WHO’s emergencies chief, Mike Ryan acknowledged during one of his interventions that countries have said that there should be “a clear focus on International Health Regulations as central to what we do.”  

In a statement, the South Centre discussed the simultaneous efforts WHO’s C-TAP, the TRIPS Waiver discussions at WTO and the emerging push for a pandemic treaty, and cautioned, “All the above initiatives and processes are interdependent and, in some respects, overlapping. Advancing on one of them without considering the others may result in contradictory or inconsistent outcomes.”

What was also interesting to note are the discussions on the various reports from the review committees, which are different to each other with rich recommendations, and yet the overall take-away from these reports seem to coalesce around the idea of a pandemic treaty, decisively contributing to a meta-narrative on this.  

SARS-CoV 2 VIRUS-ORIGINS INVESTIGATIONS

Important as the discussions on the virus-origins of SARS-CoV-2 is, it continues to further catalyse geopolitical tensions and fuel political opportunism.

On the question of investigations into the virus-origins of SARS-CoV-2, WHO’s Mike Ryan told health ministers this week that WHO DG Tedros would decide on further studies in this direction in the coming weeks. Meanwhile, the U.S. has called for a renewed push for further investigations. (See Health Policy Watch: Washington Calls to ‘Redouble Efforts’ on SARS-CoV2 Virus Origins Investigation – But Will There be Action at WHA?)

Whether WHO should be empowered to access outbreak sites in the future, as has been the demand of many countries in the context of the discussions on the emergencies preparedness resolution, has been a contentious matter. Some member states are of the view that there needs to be a trade-off between state sovereignty in allowing access, to the overall safety outcomes for the world at large.

(Also see this careful and important story from Nature: Divisive COVID ‘lab leak’ debate prompts dire warnings from researchers.)

GOVERNANCE QUESTIONS

Keeping aside, for a moment, the big picture global health governance questions on the multi-stakeholder approach, WHO member states have some key questions facing them.

COVID-19 not only revealed frail health systems in many countries, but what appears to be a susceptible leadership structure unable to cope from pressures from member states. There are “calls for an independent review of the disclosures made by former WHO researcher Dr. Francesco Zambon in the case of the sudden and highly controversial withdrawal of a report about Italy's response to the pandemic,” as The Geneva Observer reported.  (Transparency International calls on WHA to investigate WHO's Italian whistleblower disclosures.)

The Whistleblowing International Network sent a letter to the 74th WHA “use their mandate to ensure there is an independent review of the disclosures made by Dr Zambon, and a commitment to reform the WHO whistleblowing mechanisms and ensure the independence of the justice systems for future WHO whistleblowers.” (See The Geneva Observer: Transparency International calls on WHA to investigate WHO's Italian whistleblower disclosures.)

Then there is the other matter of the slow-handling of the response to sexual harassment allegations in the DRC by WHO. Felicity Harvey, who heads the Independent Oversight and Advisory Committee for WHO Health Emergencies Programme told member states this week that the committee expressed concerns on the slow progress of the fact-finding process.

“IOAC expresses its concern at the slow progress of the fact-finding process and reiterates its recommendations that WHO immediately implement preventive measures in areas that are potentially high-risk for sexual exploitation and abuse by adopting a people-centred approach to identifying systemic issues, strengthening existing whistle-blower and redress mechanisms, building on local partnerships and strengthening community trust in a systematic manner,” the IOAC report noted. Countries including The Netherlands, India and others also raised questions in this regard.

In addition, WHO’s external auditor has also noted, “There has been an increasing trend of complaints received, with a steep rise from 2018 onwards. The highest number of cases pertain to fraud (35%), followed by harassment (16%), failure to comply with professional standards (8%) and recruitment irregularity (8%). Allegations of sexual exploitation  and abuse, and sexual harassment are also significant as they constitute about 16% of the total complaints and their rising trend remains a matter of concern.”

FINANCING

Discussions on sustainable financing also stood out during the week with many member states being supportive of the process that has begun at the intergovernmental Sustainable Financing Working Group. Whether the deliberations of the working group be able to arrive at a consensus in the coming months remains to be seen, but it appears member states have specific suggestions and points of view on how essential functions of WHO be prioritised in the context of sustainable financing.

Member states also referred to the recommendations of the Independent Panel that suggested, “Establish WHO´s financial independence, based on fully unearmarked resources, increase Member States fees to 2/3 of the budget for the WHO base programme and have an organized replenishment process for the remainder of the budget.”

Countries such as Norway also cautioned about receiving funding from the private sector through the WHO Foundation: “For Norway it is important to secure the independence of the WHO and its normative role. This is especially important to keep in mind when the WHO receives funding form the private sector through the WHO Foundation.”

For all the brouhaha on emergencies preparedness, WHO continues to be severely constrained by finances. Only 8% of the World Health Organization's funding for its global COVID-19 response is flexible, down from 30% last year, Mike Ryan told the Assembly this week.

The IOAC said in its report, “In the longer term, further discussions should take place among Member States to review whether WHO is equipped with the strategic capacity to support country preparedness and response and whether WHO’s funding is adequate for the WHE Programme to lead multidimensional and large-scale emergencies such as the COVID-19 pandemic, alongside the increasing number of graded emergencies that it routinely manages.”

GEOPOLITICS AT THE ASSEMBLY:

We leave you with these tweets:

Also see: WHO Excludes Myanmar from World Health Assembly, Cites Pending Guidance from UN

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News in brief:

C-TAP RELAUNCH TODAY

WHO is giving a second shot at the COVID-19 Technology Access Pool [C-TAP], just as the TRIPS Waiver discussions are set to take off next week.

Later today, the C-TAP will be relaunched announcing support from new countries that have joined the initiative. Costa Rica and WHO have called for countries to support the initiative:

“..C­-TAP generates worldwide interest as a highly promising initiative; it works inside the patent system and provides a win-win solution for all, beneficiaries and owners of knowledge. Yet, it remains an underutilized tool.

As a global community we must leverage C-TAP's potential to accommodate different stakeholders and provide timely, sustainable, and effective solutions to promote access and accelerate local production. That is why we call once again on all Member States to renew and expand our collective commitment in the Solidarity Call to Action and to pro-actively engage with key stakeholders in their territories and encourage IP sharing and technology transfer through C-TAP. It is our responsibility to ensure a safer world for all, for this generation and for those to come.”

See our recent stories on this:

Constraints facing the COVID-19 Technology Access Pool (C-TAP)

WHO donors seek a new tech transfer hub under ACT-A, C-TAP sidelined


A PICTURE OF INEQUITIES IN THE ACCESS TO COVID-19 VACCINES

Image credit: Our World in Data


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