A resolution approved at this year’s World Health Assembly to boost local production of medicines and other technologies recognizes the current uneven distribution of vaccines, but the plan has not resulted in agreement on how to ” improve access to vaccines.

This content was published on June 7, 2021 – 09:00

June 7, 2021 – 9:00 AM

Jamil Chade in Geneva

For many governments, specialists and international institutions, one of the legacies of the Covid-19 pandemic is the need to reorganize access to essential drugs such as Covid-19 treatments and vaccines.

For decades, WHO has collected statistics, from maternal mortality to infant malnutrition to basic life expectancy, which undoubtedly prove that access to health is unfairly distributed between the rich and the poor.

But it was Covid-19 that really made this injustice clear to the public and their governments. According to the WHO, high-income countries immunize their populations at a rate 75 times higher than low-income countries. Africa has so far received less than 5% of all doses administered.

Many countries have also imposed restrictive measures, banning exports of essential drugs. This has resulted in supply blockages for many poor countries.

What will the resolution achieve?

The resolution gives WHO a mandate to help developing countries build their own drug stocks. Over the coming weeks and months, technical teams will be dispatched to different countries to identify supply bottlenecks and create strategies to increase production, with the help of foreign investment and aid.

But while the move was widely applauded for its recognition of a failing system, it also showed a lack of agreement on how to increase vaccine production. The resolution, for example, does not mention the possibility of a patent waiver, a proposal supported by 63 developing countries and which many believe could help end the pandemic.

In October 2020, India and South Africa presented an initiative to the World Trade Organization (WTO) calling for a temporary waiver of patents on all products that could be useful in curbing the pandemic. Besides vaccines, this would include tests, medical equipment and possible treatments. If adopted, the derogation would be binding.

The idea is that laboratories around the world can access vaccine recipes for free and produce their own generic versions. According to the proponents, this would both reduce the cost of vaccines and increase global production.

When the resolution on strengthening local production was drafted for the World Health Assembly, it also included a reference to a possible patent exemption. But the EU governments, Switzerland, Brazil and Japan insisted on a clause stating that any transfer of technology should be voluntary and the idea of ​​a waiver was scrapped. Berne categorically rejected the idea of ​​giving up patents, both at the WTO and at the WHO.

Indeed, while the resolution was in the process of being approved at the World Health Assembly, another meeting in Geneva at the WTO showed that a patent agreement is still a long way off.

On May 31, the 63 developing countries returned to the WTO with a revised proposal on an intellectual property waiver to fight COVID-19. This time, the United States, China, Ukraine and New Zealand have joined in co-sponsoring the initiative.

The revised proposal provided for a specified waiver period of three years, while the original text left the decision on the duration open.

However, a dozen countries (including Switzerland, Australia, the UK, Japan and Brazil as well as the EU) continued to express doubts about opening negotiations and asked for more time. to analyze the revised proposal.

Many who oppose a patent waiver have argued that it would not solve the immediate crisis in which low-income countries have virtually no vaccine supply.

In a counter-proposal, which will be discussed at the G7 and the WTO on June 8, the EU said the immediate urgent goal should continue to increase production to share vaccines as quickly and as widely as possible.

This new approach focuses on three areas: first, trade facilitation and disciplines to limit export restrictions; second, expansion of production, including through commitments from vaccine producers and developers; and third, clarification and facilitation of flexibilities in the TRIPS Agreement relating to compulsory licensing.

A waiver, however, should not be considered (immediately).

Switzerland has taken a similar position. At the WTO meeting, Berne said he was “ready to consider any proposal that effectively contributes to the goal of expanding production of COVID-19 vaccines and health technologies and facilitating equitable access.”

But he also said that it “would require a holistic approach, consisting of strengthening supply chains, intensifying industrial partnerships, effective transfer of technology and know-how through voluntary licensing agreements to increase quickly the manufacturing productions “.

In other words: a patent surrender was not the way to go.

Gaps

Despite the deadlock at the WTO, observers insist that the World Health Assembly resolution is important because it recognizes the importance of improving local production to achieve other development goals, as well as to deal with the immediate health emergency.

It is also seen as a step in the right direction towards price transparency, which has been a source of disagreement over the past decades between the private sector and governments.

That is why the resolution does not only consider the pandemic scenario. In 2018, despite tremendous progress, nine million people living with HIV still lacked access to treatment and Africa still imports 80% of its essential medicines and 90% of its vaccines come from abroad.

Main points

In order to overcome this situation, the resolution calls on governments to “strengthen their leadership, commitment and support in promoting quality and sustainable local production of medicines and other health technologies”, and to develop holistic national policies, strategies and action plans.

This would include North-South and South-South development cooperation, partnerships and networks to build and improve health technology transfer.

The resolution also calls for the creation of a global platform to promote technology transfer and local production as needed.

Gaps

Médecins Sans Frontières (MSF) welcomed the resolution but said it did not go far enough. “Given the recent positions of the United States and other countries committing to engage in formal negotiations supporting the World Trade Organization’s proposed TRIPS waiver, the final text of the draft resolution should reflect this historic development, ”he said.

But industries, represented by the International Federation of Pharmaceutical Manufacturers and Associations, have used the debate at WHO to argue that poor public systems are the biggest barrier to accessing health care.

“Waiving COVID-19 vaccine patents will not increase production and provide the practical solutions needed to tackle this global health crisis,” he said.

“On the contrary, it is likely to cause disruption; while avoiding meeting the real challenges of scaling up production and distribution of COVID-19 vaccines globally: namely removing trade barriers, resolving bottlenecks in supply chains ‘supply and scarcity of raw materials and ingredients in the supply chain, and a willingness of rich countries to start sharing doses with poor countries,’ concluded the industry body.

The United States insisted that the current crisis shows the need to strengthen supply chains around the world. “The United States strongly believes in intellectual property protections, but in the service of an end to this pandemic, supports the waiver of these protections for COVID-19 vaccines,” the US delegation said.

Portugal, for the EU, welcomed the resolution, saying the current crisis shows production capacity needs to expand globally. According to the EU, the bloc considers “fair access” as a “global public good” and supports the idea of ​​establishing production poles in emerging countries, particularly in Africa.

In a statement, the 46 African nations also applauded the decision. “The pandemic has demonstrated the vulnerability of developing countries,” they said. Their hope is that the document strengthens WHO’s mandate to provide technical assistance to countries to increase production. But they insisted that the patent waiver will be essential and suggested that Africa would not give up on the idea.

Almost a year and a half after the outbreak of the pandemic, meetings in Geneva reveal how far the international community is still from a deal that can boost access to vaccines and treatment.

For negotiators, however, the next four weeks could be crucial in determining whether the world will have a new structure for distributing the doses, or whether it will see a widening disparity between regions.