It has been more than a year since the COVID-19 pandemic hit the world. During this period, a lot of global and regional efforts have been made to find ways to save people from the devastating impact of the pandemic. At the 73rd World Health Assembly (WHA) in May last year, there was a recognition that a truly collective effort is required to fight the pandemic. As the 74th WHA begins on May 24, Monday, it is an opportune moment to look back critically and work towards bridging gaps which are hampering an appropriate response to COVID-19 and access to treatment for the majority of the world’s population.
The WHA in May 2020 saw the launch of the Access to COVID-19 Tools-Accelerator (ACT-A). Its vaccine pillar, Covax, was portrayed as synonymous with vaccinations across the globe. But Covax had only pledged the vaccination of 20% of the population of low and middle-income countries. The ACT-A and Covax are based on a model of voluntary contributions with companies pooling in technical know-how of medical products. However, the pharmaceutical industry has never compromised on its profits and it was not going to do so during this pandemic.
And thus, today we are faced with extremely high levels of inequity in vaccine delivery. As of May 21, 34% of the citizens of North America and the European Union have received at least one shot of a COVID-19 vaccine. In contrast, in Asia, the corresponding rate is 5%. Africa is at the bottom with a 1.5% rate of vaccination. In many poor countries, less than 0.1% of citizens have received vaccine shots, while rich countries have more stockpiles than what is needed for their entire population. The Covax pledge was insufficient and the voluntary model has proved to be a failure in equitable delivery.
Knowing that voluntary mechanisms do not work, in October 2020, the governments of India and South Africa submitted a proposal at the World Trade Organization to suspend patents and other intellectual property (IP) provisions for COVID-19 medical products. This proposal soon received the support of over 100 countries. If countries were to agree to waive off IP provisions under the Trade-Related Aspects of Intellectual Property Rights (TRIPS), known as the TRIPS waiver, then COVID-19 medical products would become more available with increased production, and probably become more affordable too. With a new text tabled for negotiations last Friday, the demand on rich countries that host big pharma, to take the required steps to control the pandemic rather than blindly protect industry’s profits, will only intensify.
The major issues that are on the table at the WHA include access to treatments for cancer and rare and orphan diseases, and the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA). There are many issues common to these agenda items. The originator companies of pharmaceutical products have to be regulated better, making transparency of various kinds of data a mandatory provision. This includes data related to the cost of research and production. The WHA in 2019 passed a historic resolution on transparency which charts out a way to make companies more responsible in sharing such information. It is necessary to build on that while looking at all topics that talk about IP, price and cost of medical products, and other similar matters.
The funding crunch and lack of flexible funds faced by the WHO is not a new phenomenon. This is highlighted in the submission made by the Independent Panel for Pandemic Preparedness and Response (IPPR) which was formed to review the WHO response to the pandemic. Similar observations were made in the Independent Oversight Advisory Committee (IOAC) for WHO Health Emergencies Programme and Review Committee on the Functioning of International Health Regulations (IHRRC). While these committees acknowledged the problems faced by the WHO, they only provided cosmetic solutions instead of recommending structural changes. The reality is that as long as the WHO has a budget the size of a large public hospital, the crisis will remain. Moving the decision-making on the use of these paltry funds from the multilateral member-state-driven space into a “multi-stakeholder” funder-driven space is no solution either.
Unfortunately, the WHO Foundation, established in May 2020, does precisely that. It is an independent grantmaking entity, legally separate from the WHO, that accepts contributions on behalf of the WHO from the general public, individual major donors, and corporate private partners. With the creation of the WHO Foundation, conflicts of interests and imbalance between donors and member-states in the WHO risk getting worse.
The Health Emergencies Programme of the WHO, established after the Ebola outbreak, is working extensively in tackling COVID-19. However, discussions on emergencies tend to focus on surveillance rather than also stressing the importance of strengthening national health systems for effective public health responses. The stress on surveillance also reflects a concern limited to health security i.e. the control of the spread of pathogens across borders, rather than ensuring the best standard of health for all. The WHO should be careful in not falling into that trap and base its work on solidarity through multilateralism, guided by the aims and objectives of the United Nations.
It is disappointing that again, issues related to human rights violations, economic collapse and mismanagement of the COVID-19 crisis response are inadequately covered in the documents for discussion under the COVID-19 agenda point.
Finally, a Pandemic Treaty has been put on the table. The proposed treaty will set out provisions and guidelines for future pandemics. It is aimed at preparing the world for any COVID-19-like emergency in the future. Many countries are not in agreement with the fast pace at which the treaty is being pushed. In addition, there are countries which are badly affected by COVID-19 and won’t be able to participate with sufficient preparation. Deliberations on a treaty of such importance should wait till everyone is ready.
Last year’s assembly ended with a positive energy. There was a show of solidarity, a possibility that developed and developing countries could come together to fight the pandemic. A year later, the situation is grim. It does feel like a deja vu moment. Last year, we were facing a peak of COVID-19 just before the WHA. The same seems to be the case this time also, albeit with a difference. Last year, the whole world was struggling with the new disease. This year, countries in the Global South are struggling way more than the nations of the north, save a few exceptions. Never before has inequality in health been more stark. The WHA will have to chart out radical measures to change healthcare as we have known it in the last one year.
For regular coverage of the WHA please visit https://phmovement.org/wha74-watch-statements-and-agenda/
*The WHO Watch team for the WHA 74 comprises of Aletha Wallace (Belgium), Gargeya Telakapalli (India), Jyotsna Singh (India), Nalianya Emma (Kenya), Luciani Martins Ricardi (Brazil), Metheus Falcao (Brazil), Shriyuta Abhishek (India), Surbhi Shrivastava (India/USA), Susana Barria (India), John Mahama (Ghana), Prithivi Prakash (India/Australia), Maarja-Liis Ferry (UK), Sarah Derdelinckx (Belgium), Sarai Keestra (Netherland) and Jasper Thys (Belgium).