Africa/Global - Distant Horizon for Vaccine Equity

Editor's Note: "I need to be blunt: the world is on the brink of a catastrophic moral failure - and the price of this failure will be paid with lives and livelihoods in the world's poorest countries. Even as they speak the language of equitable access [to Covid vaccines], some countries and companies continue to prioritize bilateral deals, driving up prices and attempting to jump to the front of the queue. This is wrong. … The situation is compounded by the fact that most manufacturers have prioritized regulatory approval in rich countries where the profits are highest, rather than submitting full dossiers to WHO." - Dr. Tedros Adhanom Ghebreyesus, WHO Director-General

The Covid pandemic has not only revealed but also dramatically widened structural inequalities separating rich and poor, both within and between nations. The effect of the virus itself has been compounded by massive failures in the response, as the most vulnerable are also last in line in access to new treatments and to vaccines.

Now, even as unprecedented scientific collaboration around the world has yielded multiple vaccines, the rollout of the virus is hindered not only by predictable organizational obstacles but also by the dominance of profit-driven pharmaceutical companies and heightened price competition. In June 2020, the Global Vaccine Summit produced pledges to advance equal access for all to the vaccines. But, despite the efforts of WHO and other multilateral agencies, progress has been slow and crippled by lack of transparency in pricing.

Almost five months ago, the People's Vaccine Initiative launched an appeal that vaccine production be understood as a global public good. A global call from Covid survivors demanded that, to make this possible, corporations immediately license any intellectual property rights related to vaccine technologies to the WHO COVID-19 Technology Access Pool (C-TAP).

Unfortunately, that demand has yet to find an echo in the decision- making of governments and corporations. And predictions are that many around the world will not receive vaccines until 2022 or even later.

This AfricaFocus Bulletin contains (1) brief excerpts on the fundamental issue of equitable provision of vaccines; (2) excerpts from speeches by Dr. Tedros Adhanom Ghebreyes and Dr. Anthony Fauci; (3) a commentary by Steven Friedman on South Africa's failure to prioritize public health measures rather placing too much hope in the potential for technical solutions such as vaccines, and (4) links to additional recent articles and sources of data.

For the most recent updates, see the two links just below.

Data and analysis on vaccine roll-out worldwide Updated every 1 to 2 weeks https://launchandscalefaster.org/covid-19

Data updated daily https://ourworldindata.org/covid-vaccinations

For previous AfricaFocus Bulletins on health issues, visit http://www.africafocus.org/intro-health.php

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Key Points to Consider

Oct. 2, 2020 https://freethevaccine.org/2020/10/02/a-peoples-vaccine-the-global-call/

Excerpt:

On September 28th, over one thousand COVID-19 survivors, along with family members and susceptible individuals, signed an open letter to pharmaceutical corporations, demanding that they leave their monopoly-seeking greed behind as the world struggles to fight and recover from a virus that has already taken the lives of over one million individuals worldwide.

The letter asks that corporations immediately license any intellectual property rights related to vaccine technologies to the WHO COVID-19 Technology Access Pool (C-TAP). By doing so, Oxfam, UNAIDS, Free the Vaccine for COVID-19, and other organizations involved in the alliance are calling on governments around the world to keep diagnostic tools, treatments, and vaccines for COVID-19 away from the restrictive world of patents.

Jan. 5, 2021 What Will It Take To End The COVID-19 Pandemic? Transcript and 4-minute audio clip. https://www.npr.org/sections/goatsandsoda/2021/01/05/953653373/some-experts-say-temporary-halt-on-drug-patents-is-needed-to-stop-pandemic-world

Excerpt:

About 7 billion people live on the planet. Many of the new COVID-19 vaccines require two doses. So to stamp out the pandemic, companies need to manufacture about 12 to 15 billion doses.

Problem is, right now, the world doesn't have near that many doses and likely won't have them this year, Lusiani says. "In many pockets around the world, it's becoming increasingly likely that people will not get access to the COVID-19 vaccine in 2021."

Many families will have to wait until 2023 or 2024. And the pandemic will likely continue until then.

So why can't the world simply manufacture more doses? Lawyer Brook Baker at Northeastern University believes there's an underlying root cause: international patents on COVID-19 vaccines.

"The [vaccine] innovators hold patent rights and trade secret rights over those technologies, and they're unwilling to share them broadly to other manufacturers. So we have artificially constricted supply," says Baker, who studies how laws affect access to medicines.

The patent rights come from agreements within the World Trade Organization. Members of the WTO, which includes 159 countries, have agreed to honor patents for new pharmaceutical products at least 20 years after they're developed.

"This agreement was the brainchild of the pharmaceutical industry back in the 1980s," Baker says. "It ended up being a monopoly-based agreement, which preserves the rights of the pharmaceutical industry instead of allowing competition."

Jan. 23, 2021

If Poor Countries Go Unvaccinated, a Study Says, Rich Ones Will Pay https://www.nytimes.com/2021/01/23/business/coronavirus-vaccines-global-economy.html

Excerpt:

In monopolizing the supply of vaccines against Covid-19, wealthy nations are threatening more than a humanitarian catastrophe: The resulting economic devastation will hit affluent countries nearly as hard as those in the developing world.

This is the crucial takeaway from an academic study to be released on Monday. In the most extreme scenario — with wealthy nations fully vaccinated by the middle of this year, and poor countries largely shut out — the study concludes that the global economy would suffer losses exceeding $9 trillion, a sum greater than the annual output of Japan and Germany combined.

Nearly half of those costs would be absorbed by wealthy countries like the United States, Canada and Britain.

In the scenario that researchers term most likely, in which developing countries vaccinate half their populations by the end of the year, the world economy would still absorb a blow of between $1.8 trillion and $3.8 trillion. More than half of the pain would be concentrated in wealthy countries.

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WHO Director-General's opening remarks at 148th session of the Executive Board

18 January 2021

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board

Your Excellency Dr Harsh Vardhan, Chair of the Executive Board, thank you for your leadership for your leadership during these difficult times.

Excellencies, dear colleagues and friends,

Good morning, good afternoon and good evening to you all, and happy New Year.

40 years ago, a new virus emerged and sparked a pandemic. Life saving medicines were developed, but more than a decade passed before the world's poor got access to them.

12 years ago, a new virus emerged and sparked a pandemic. Lifesaving vaccines were developed, but by the time the world's poor got access, the pandemic was over.

One year ago, a new virus emerged and sparked a pandemic. Life saving vaccines have been developed. What happens next is up to us.

We have an opportunity to beat history; to write a different story; to avoid the mistakes of the HIV and H1N1 pandemics.

The development and approval of safe and effective vaccines less than a year after the emergence of a new virus is a stunning scientific achievement, and a much-needed source of hope.

Vaccines are the shot in the arm we all need - literally and figuratively.

The recent emergence of rapidly-spreading variants makes the rapid and equitable rollout of vaccines all the more important.

But we now face the real danger that even as vaccines bring hope to some, they become another brick in the wall of inequality between the world's haves and have-nots.

It's right that all governments want to prioritize vaccinating their own health workers and older people first.

But it's not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries.

There will be enough vaccine for everyone. But right now, we must work together as one global family to prioritize those most at risk of severe diseases and death, in all countries.

For the past 9 months, the ACT Accelerator and the COVAX vaccines pillar have been laying the groundwork for the equitable distribution and deployment of vaccines.

We've overcome scientific barriers, legal barriers, logistical barriers and regulatory barriers.

We have secured 2 billion doses from five producers, with options on more than 1 billion more doses, and we aim to start deliveries in February.

I use this opportunity to thank Gavi and CEPI.

COVAX is ready to deliver what it was created for.

But in recent weeks I have heard from several Member States who have questioned whether COVAX will get the vaccines it needs, and whether high-income countries will keep the promises they have made.

As the first vaccines begin to be deployed, the promise of equitable access is at serious risk.

More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25.

I need to be blunt: the world is on the brink of a catastrophic moral failure - and the price of this failure will be paid with lives and livelihoods in the world's poorest countries.

Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue. This is wrong.

44 bilateral deals were signed last year, and at least 12 have already been signed this year.

The situation is compounded by the fact that most manufacturers have prioritized regulatory approval in rich countries where the profits are highest, rather than submitting full dossiers to WHO.

This could delay COVAX deliveries and create exactly the scenario COVAX was designed to avoid, with hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption.

Not only does this me-first approach leave the world's poorest and most vulnerable people at risk, it's also self-defeating.

Ultimately, these actions will only prolong the pandemic, the restrictions needed to contain it, and human and economic suffering.

Vaccine equity is not just a moral imperative, it is a strategic and economic imperative.

A recent study estimated that the economic benefits of equitable vaccine allocation for 10 high-income countries would be at least 153 billion U.S. dollars in 2021, rising to 466 billion dollars by 2025. That's more than 12 times the total cost of the ACT Accelerator.

It's not too late. I call on all countries to work together in solidarity to ensure that within the first 100 days of this year, vaccination of health workers and older people is underway in all countries.

It's in the best interest of each and every nation on Earth.

Together, we must change the rules of the game, in three ways.

First, we call on countries with bilateral contracts - and control of supply - to be transparent on these contracts with COVAX, including on volumes, pricing and delivery dates.

We call on these countries to give much greater priority to COVAX's place in the queue, and to share their own doses with COVAX, especially once they have vaccinated their own health workers and older populations, so that other countries can do the same.

Second, we call on vaccine producers to provide WHO with full data for regulatory review in real time, to accelerate approvals. We also call on producers to allow countries with bilateral contracts to share doses with COVAX, and to prioritize supplying COVAX rather than new bilateral deals.

And third, we call on all countries introducing vaccines to only use vaccines that meet rigorous international standards for safety, efficacy and quality, and to accelerate readiness for deployment.

The theme for World Health Day this year is health inequality.

My challenge to all Member States is to ensure that by the time World Health Day arrives on the 7th of April, COVID-19 vaccines are being administered in every country, as a symbol of hope for overcoming both the pandemic and the inequalities that lie at the root of so many global health challenges.

I hope this will be realized.

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Dr. Anthony S. Fauci Remarks at the World Health Organization Executive Board Meeting

January 21, 2021

Contact: HHS Press Office, 202-690-6343, media@hhs.gov

https://www.hhs.gov/about/news/2021/01/21/dr-anthony-s-fauci-remarks-world-health-organization-executive-board-meeting.html

"Director-General Dr. Tedros, distinguished representatives, friends and colleagues:

It is an honor for me to be here, representing the United States of America, on behalf of the newly inaugurated Biden-Harris administration, and as the Chief Medical Adviser to President Biden.

I also am here to represent the scientists, public health officials and frontline healthcare workers, and community health workers who have worked so heroically this past year to fight COVID-19, developing medical countermeasures at truly phenomenal speed, adapting policy responses as we learn more about the virus, and courageously treating the millions of people who have been stricken by this historic scourge.

One year ago, to the day, the United States confirmed its first case of SARS-COV-2, in the State of Washington. Today, in my country and around the world, we have surpassed 90 million cases, a devastating number that continues to grow.

I join my fellow representatives in thanking the World Health Organization for its role in leading the global public health response to this pandemic. Under trying circumstances, this organization has rallied the scientific and research and development community to accelerate vaccines, therapies and diagnostics; conducted regular, streamed press briefings that authoritatively track global developments; provided millions of vital supplies from lab reagents to protective gear to health care workers in dozens of countries; and relentlessly worked with nations in their fight against COVID-19.

I also know first-hand the work of WHO with whom I have engaged in a collaborative manner touching all aspects of global health over the past 4 decades.

As such, I am honored to announce that the United States will remain a member of the World Health Organization. Yesterday, President Biden signed letters retracting the previous Administration's announcement to withdraw from the organization, and those letters have been transmitted to the Secretary-General of the United Nations and to you Dr. Tedros, my dear friend.

In addition to retracting the notification of withdrawal and retaining membership in the WHO, the United States will cease the drawdown of U.S. staff seconded to the WHO and will resume regular engagement of U.S. government personnel with the WHO both directly and through our WHO Collaborating Centers.

The United States also intends to fulfill its financial obligations to the organization. The United States sees technical collaboration at all levels as a fundamental part of our relationship with WHO, one that we value deeply and will look to strengthen going forward.

As a WHO member state, the United States will work constructively with partners to strengthen and importantly reform the WHO, to help lead the collective effort to strengthen the international COVID-19 response and address its secondary impacts on people, communities, and health systems around the world.

The Biden Administration also intends to be fully engaged in advancing global health, supporting global health security and the Global Health Security Agenda, and building a healthier future for all people.

I am also pleased to announce today that the United States plans to work multilaterally to respond to and recover from the COVID-19 pandemic. President Biden will issue a directive later today which will include the intent of the U.S. to join COVAX and support the ACT-Accelerator to advance multilateral efforts for COVID-19 vaccine, therapeutic, and diagnostic distribution, equitable access, and research and development.

The United States will also work with the WHO and Member States to counter the erosion of major gains in global health that we have achieved through decades of research, collaboration and investments in health and health security, including in HIV/AIDS, food security, malaria, and epidemic preparedness.

And it will be our policy to support women's and girls' sexual and reproductive health and reproductive rights in the United States, as well as globally. To that end, President Biden will be revoking the Mexico City Policy in the coming days, as part of his broader commitment to protect women's health and advance gender equality at home and around the world.

We realize that responding to COVID-19 and rebuilding global health and advancing health security around the world will not be easy. And in this regard:

We are committed to transparency, including those events surrounding the early days of the pandemic. It is imperative that we learn and build upon important lessons about how future pandemic events can be averted. The international investigation should be robust and clear, and we look forward to evaluating it;

We also will work with the WHO and partner countries to strengthen and reform the WHO, improve mechanisms for responding to health emergencies across the United Nations, and strengthen the International Health Regulations;

We will commit to building global health security capacity, expanding pandemic preparedness, and supporting efforts to strengthen health systems around the world and to advance the Sustainable Development Goals;

We will work with partners to develop new international financing mechanisms for health security;

We will seek an improved, shared system for early warning and rapid response to emerging biological threats;

We will support scientifically robust and ethically sound collaborative science, research and research capacity building, as well as the rapid sharing of research results, pathogen samples and data essential to research progress;

We will look to strengthen pandemic supply chain networks;

And we will work with partners around the world to build a system that leaves us better prepared for this pandemic and for the next one.

And finally, given that a considerable amount of effort will be required by all of us moving forward, the United States stands ready to work in partnership and solidarity to support the international COVID-19 response, mitigate its impact on the world, strengthen our institutions, advance epidemic preparedness for the future, and improve the health and wellbeing of all people throughout the world."

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No cure for South Africa's colonised medical minds

Elites have ignored the countries successfully using preventative measures against Covid-19. Instead, they've followed Western nations with their blind faith in technical solutions.

By: Steven Friedman

18 Jan 2021

https://www.newframe.com/no-cure-for-south-africas-colonised-medical-minds/

South Africa is no longer colonised. But the minds of its elites, including its medical scientists and health officials, still are. This is why Covid-19 stalks the land, sowing avoidable disease and death.

After months of indifference, the elites and the connected who use media now care about Covid-19 again. Rising infections and deaths, labelled "the second wave", fuelled in part by a new strain that spreads more easily, have bitten more deeply into the suburbs, which house the people who shape the debate. So, it is again the centre of attention, as it was when it arrived and no one knew who it would affect.

One sign of this new seriousness is that television channels, to the extent they are allowed to, now show the illness and pain inside hospitals. Until now, broadcast coverage of Covid-19 consisted largely of a parade of business people complaining about restrictions. If South Africans wanted to see what Covid-19 does to people, they had to watch international news channels.

But, while the virus is back on the agenda, there is still a strong air of fantasy about the way the elites see the disease. There is no recognition that the country faces a severe plague now because of what they did - and didn't do - about Covid-19 since it arrived.

In the main, the government, scientists and private power holders are doing what elites do when things go wrong - blaming the people. The president leads the way, offering televised addresses at which he announces weak measures to fight the virus and then berates citizens for behaving badly. The elite follows suit, blaming teenage parties, taverns, shoppers - everyone except those responsible for containing the virus.

For the rest, we are told either that a severe "second wave" was inevitable or that the new mutation took the scientists by surprise. Both are clearly false.

Prevention is better

Since Covid-19 arrived, medical scientists here - or at least those who are endlessly available for media interviews - have parroted the claim that it was inevitable that Covid-19 would ravage the population because no country could escape a severe outbreak.

This fails to explain why much of East Asia, New Zealand and Australia have avoided this - as have countries in Africa. Until a while ago, South Africa had as many cases and deaths as the rest of Africa combined - the gap is still so wide that, even if other countries have recorded only a quarter of their cases and deaths, this country is still the worst performer by a long way.

And, while almost the whole world is experiencing new infections and deaths, countries that have contained Covid-19 have a fraction of the 1,600 cases a day this country experienced between August and November, supposedly a time of "low transmission". (It is not clear that we ever got rid of the first wave, given how high our case numbers were when we were supposedly doing well.)

The claim that the mutation was a surprise is odd since scientists know viruses always mutate. What was avoidable is declared a law of nature; what was predictable is dismissed as a freak.

The power of the Global North

What has this to do with colonialism? This country has not fought Covid-19 because its elites, including its medical scientists, believe North America and Western Europe are the centre of the universe.

Those countries have done poorly at fighting the virus, although their health systems are touted as the best in the world. There, medicine is about using technologies to cure people, not preventing illness. But curative medicine is not that useful if there is no cure, which there isn't for Covid-19. East Asian countries have endured several pandemics and so have become very good at protecting public health. Some African countries, despite limited resources, have learned from experience how to make prevention measures work in the face of epidemics.

Our elites (including the scientists) never showed any interest in how South Korea, Taiwan, Rwanda and Senegal were dealing with Covid-19 - they weren't even interested in New Zealand, which should be more up their cultural alley. Instead, they reacted as decision-makers in North America and Western Europe did - their priority was to ready the health system, not to nip the virus in the bud. When they said no country had avoided a severe epidemic, they meant no country they take seriously - no major Western country. And they assumed, as those countries did, that the only way to fight disease is to get people into hospitals and give them the latest technical fix.

This seemed so obvious here that no one questioned it, despite the fact that where there is no cure and it is not even clear how well treatments work, there is a limit to what hospitals can do: even if they can help, they cannot prevent many people becoming ill and dying, which public health measures can do.

Given this, it is no surprise that the elites now punt a vaccine as the only way to fight Covid-19 - they understand only technical solutions. Vaccines do help people, and the country does need them. But the claim by some medical scientists that a vaccine is the only solution to Covid-19 shows the same tunnel vision as that which thought protecting hospitals was better than stopping the virus.

As important as vaccines are, they are products of the Global North to which our elites aspire. We are last in line for them because the rich countries know how to hog the best and leave the rest of us with crumbs.

This means we will, for some time, need the preventive health measures our elites don't understand. We won't get them as long as the heads of our scientists and power holders remain the property of rich Western countries.

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Links to Additional Recent Sources of Interest

Jan. 24, 2021 https://www.theguardian.com/commentisfree/2021/jan/24/coronavirus-vaccines-offer-the-world-hope-unless-you-live-in-africa

Jan. 24, 2021 Why Vaccines Alone Will Not End the Pandemic https://www.nytimes.com/interactive/2021/01/24/us/covid-vaccine-rollout.html

Jan. 23, 2021 https://www.washingtonpost.com/opinions/global-opinions/rich-countries-me-first-vaccine-hoarding-is-leaving-behind-low-income-nations/2021/01/23/3830e7d4-5c23-11eb-a976-bad6431e03e2_story.html

Jan. 22, 2021 https://www.theguardian.com/world/2021/jan/22/south-africa-paying-more-than-double-eu-price-for-oxford-astrazeneca-vaccine

Jan. 21, 2021 https://www.forbes.com/sites/roberthart/2021/01/21/fauci-praises-world-health-organizations-pandemic-leadership-says-us-will-rejoin/?sh=2ad1d3987a06

Jan. 21, 2021 COVID 'vaccine hoarding' putting Africa at risk: WHO https://news.un.org/en/story/2021/01/1082692

Jan. 21, 2021 Africa's long wait for the Covid-19 vaccine https://www.bbc.com/news/world-africa-55751714

Jan. 18, 2021 https://www.reuters.com/article/uk-health-coronavirus-safrica-vaccine/south-africa-to-get-9-million-jj-vaccine-shots-ministry-idUSKBN29N1D9

Jan 17, 2021 https://www.dailymaverick.co.za/article/2021-01-17-africas-covid-19-response-has-been-admirable-but-the-economic-costs-will-linger-for-years/

Jan. 17, 2021 Equitable recovery from COVID-19: bring global commitments to community level https://gh.bmj.com/content/6/1/e004757

Jan. 16, 2021 How Africa Is Leading From Behind in Global Coronavirus Vaccine Race https://allafrica.com/stories/202101180313.html

Jan. 6, 2021 https://www.hrw.org/news/2021/01/06/au-should-press-equitable-access-covid-19-vaccines

Jan. 3, 2021 https://www.theguardian.com/world/2021/jan/03/palestinians-excluded-from-israeli-covid-vaccine-rollout-as-jabs-go-to-settlers

Dec. 17, 2020 https://africacdc.org/news-item/majority-of-africans-would-take-a-safe-and-effective-covid-19-vaccine/

Dec. 10, 2020 https://www.gavi.org/vaccineswork/are-african-countries-ready-covid-19-vaccine

Dec. 5, 2020 An African plan to control COVID-19 is urgently needed

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32580-0/fulltext

Oct. 6, 2020 COVID-19 vaccines: how to ensure Africa has access https://www.nature.com/articles/d41586-020-02774-8

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter. For an archive of previous Bulletins, see http://www.africafocus.org,

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