Crafting health policy in the midst of an evolving pandemic is hard enough. Contending with commercial and political pressures, while doing so, makes it worse. Although much can be said about WHO’s response to the pandemic - sometimes shaped by factors beyond its control - there is no denying that the leadership has, on occasion, taken a clear stand when it mattered.
Take WHO’s recent decisive call for a moratorium on booster doses, or calling out increased prices by vaccine manufacturers on the back of life-costing scarcity of vaccines as it did last week. Germany, the biggest donor of WHO, and a professed leader of global health, will offer booster doses starting September. The U.S. also seems to disagree with WHO’s moratorium on booster jabs. How much we desire to witness these conversations between WHO and its biggest donors on these technical policy matters!
Few organizations, if at all, would take a position directly against their primary donors. Never mind semantics and diplomacy-speak, this is of note.
To be sure, the targets for vaccinating the “unjabbed” have shrunk to a woeful 10% in the short term in these vaccine-scarce countries. Relative to prevailing numbers, it appears even 10% seems ambitious at this point. High-income countries have now administered almost 100 doses for every 100 people, meanwhile low-income countries have only been able to administer 1.5 doses for every 150 due to lack of supply, WHO said last week.
Significantly, WHO DG Tedros basically tasked G20 with the future response to the pandemic. The G20, he said, comprises the biggest producers, the biggest consumers and the biggest donors of COVID-19 vaccines.
Accordingly, “It's no understatement to say that the course of the pandemic depends on the leadership of the G20. I repeat, it's no understatement to say that the course of the pandemic depends on the leadership of the G20 countries.” The G7 did not respond effectively, it remains to be seen whether G20 will.
And this brings us to India. See our exclusive from last week in case you missed it: Where does India truly stand on the #TRIPSwaiver? Q&A with Murali Neelakantan, a Mumbai-based IP lawyer familiar with the terrain of IP policies and politics in the country. Exceptionally this is accessible to all our readers.
Sign up to dig into our rich archives and be primed for what is coming over the next few months.
Feel free to write to us: firstname.lastname@example.org or email@example.com; Follow us on Twitter: @filesgeneva
I. POLICY UPDATES
Understanding the moratorium on COVID-19 vaccine boosters
Calling for a moratorium on booster doses, WHO said, “We need an urgent reversal, from the majority of vaccines going to high-income countries, to the majority going to low-income countries. Accordingly, WHO is calling for a moratorium on boosters until at least the end of September, to enable at least 10% of the population of every country to be vaccinated.”
Kate O’Brien, the WHO’s director of immunization, vaccination, and biologics, emphasizing the need for data to guide the decision on boosters, said, “If we're not really grounded in that clarity we're going to be in a place where we have forever uncertainty about what actually should be done.
O’Brien, one of the most eloquent of WHO officials, cautioned against confusing vaccination policies for small sub-groups who may need boosters, with “the policy or the evidence to determine a policy on a broader issue of whether booster doses should be given.”
While acknowledging that there is increasing evidence that there are some populations, small subgroups who don't respond to the vaccine as well as the general population does, she reminded that “This is not a new phenomenon for a COVID vaccine.”
So even though vaccination rates are increasing, COVID-19 cases have also been increasing. However, the failure of vaccines is not what is driving the increase, officials suggested.
“There are lots of reasons for that, not the least of which is when that happens at a time when vaccines are increasing the public doesn't understand always that an increase in cases is not because of a failure of vaccines; it's because there is a release of the other interventions that are what is really maintaining the reduction in transmission.”
Also see her lucid interview with STAT News on the matter:
“When we are in a position where the evidence is weak and yet people proceed with the intervention, it’s really difficult to walk back from that. One can envision that there would be a world five years from now, 10 years from now where we’ve sort of backed our way into giving doses where we actually can’t fully defend the evidence on which that decision was reached.”
Kate O’Brien to STAT News
Also see “To boost or not to boost” from Nature: COVID vaccine boosters: the most important questions. (China, Russia, the UAE, Israel are others on this list of countries endorsing the move for boosters)
WHO on vaccines’ pricing of Moderna and Pfizer
Close on the heels of the propensity of some countries for booster doses, the world read with disbelief about increasing prices of mRNA vaccines. Like others, we wondered on what this collectively meant. After all, everything is connected.
At the weekly press briefing, Mariângela Simão, WHO’s ADG who steers access policies, said:
“It's very important that we have a policy where companies [have] policies for affordable prices. One year on, after these vaccines were developed and manufactured, we see both manufacturers, Pfizer and Moderna, had vaccines in the market by the end of last year.
Both of them have increased their manufacturing capacities, they have diversified their manufacturing plants and we understand also that they have increased efficiency in the production lines. So this would, in a normal market situation lead to a decreased price, not an increase in price.
So what we have is clearly a market where the demand is very high in comparison with the production and we, WHO urges companies to keep prices down and [have] affordable prices even if you're talking about countries that can afford. There are many countries around the world that cannot afford any higher price right now.
So I think it's urgent that we think about this in terms of affordable pricing in times where there is increased manufacturing from those two mRNA producers and we also hear that there are more efficient production lines as well.
WHO’s ADG Simão
She raised a very fundamental question in economics. Will be good to hear the industry’s retort to this.
And guess what’s muddying the waters? Countries’ differentiated abilities to pay and negotiate.
“The European Union has agreed to pay a premium on new orders of COVID-19 vaccines because it is requiring tougher terms to be met, European officials said, as the bloc tries to protect supplies after a rocky start to its vaccination campaign.”
…“Another big change since the early contracts is the emergence of variants and concerns vaccines may not be effective against them.”
Now read this piece on the price increase and how this connects to the TRIPS waiver at WTO:
Matt Stoller who writes BIG on Substack, says: Pfizer and Moderna Mock Biden, Raise Vaccine Prices. A must-read.
….. “But another set of health agencies - which we call pharmaceutical firms - are taking an entirely different approach. Earlier this week, Pfizer/BioNTech and Moderna, who make vaccines that are effective against the Delta variant of Covid, raised priceson their vaccines. According to the FT, the European Union must now pay an extra 25% than it did for the Pfizer vaccine, and 10% more for Moderna’s.
The extra revenue is purely a result of market power, not higher costs. Pfizer has already raised estimates to investors, telling them it will generate $33 billion this year selling the vaccine. At the same time, these vaccine monopolists are not making enough doses to vaccinate the world, because they are focused on production to sell to rich countries, rather than ending a pandemic.”
Matt Stoller in his newsletter BIG
Africa announces the rollout of 400m vaccine doses to the African Union Member States and the Caribbean: United Nations Economic Commission for Africa
This announcement marks “the start of monthly shipments of vaccines acquired by the AU / African Vaccine Acquisition Trust (AVAT) to the AU Member States today. An initiative by the AU Member States to pool their purchasing power, the AVAT, on 28 March 2021, had signed the historic agreement for the purchase of 220 million doses of the Johnson & Johnson single-shot COVID-19 vaccine, with the potential to order an additional 180 million doses.”
II. WHAT WE FOUND INTERESTING
My colleague Rithika has pulled this together for you:
Who owns COVID-19 vaccines?: The Seattle Times
Counting the uncounted - India's Covid-19 death toll: The Indian Express
How Two Peruvian News Outlets Revealed “Vaccinegate”: Global Investigative Journalism Network
I treat pediatric covid patients. What I’m seeing in our hospital scares me.: The Washington Post
Maximum Disclosure: Secrecy in COVID-19 Vaccine Contracts and Other Shortcomings of Colombia’s Vaccine Rollout: The International Commission of Jurists (ICJ)
Don't let CureVac's COVID-19 vaccine supply chain go to waste: The Peterson Institute for International Economics (PIIE)
FROM THE JOURNALS/REPORTS
III. WHAT WE ARE WATCHING
WHO consultation on COVID-19 vaccines research – 13 August 2021
IV. TWEETS OF THE WEEK
A sign of things to come?
V. PODCAST CORNER
Global health is everybody’s business. Help us probe the dynamics where science and politics interface with interests. Support investigative global health journalism.
If you want a subscription but cannot afford it, you can respond to this email for a reduced rate.