Health is one of the fundamental rights of every human being. These words adopted almost 70 years ago in the Constitution of the World Health Organization have been particularly relevant since the outbreak of COVID-19 because the only way out of pandemics, but also out of local or regional infection outbreaks in general, is to have access to vaccinations for everyone. That is why the worldwide initiative COVID-19 Vaccines Global Access (COVAX) was established in April 2020 with the goal to guarantee fair and equitable access of COVID-19 vaccines for every country in the world.
But as early as 2021, the UN Committee on Economic, Social and Cultural Rights criticized that COVAX did not solve the problem of insufficient production of vaccines; other measures would be urgently needed, particularly with regard to intellectual property, in order to achieve universal access to vaccines. This criticism is shared by many civil society actors. Therefore, Bread for the World talks with Richard Neci, Executive Director of the Ecumenical Pharmaceutical Network (EPN) from Kenia, about his perspective.
Thank you very much for sharing your thoughts. From your perspective, why did COVAX fail?
Richard Neci: The COVAX failure to meet its target of vaccinating 70% of humanity by mid-2022 is, in my perspective, due to a number of factors. First, there was a vaccines nationalism of high-income governments, reflecting the lack of fairness and equity. COVAX was the largest and encouraging global vaccine-sharing initiative ever developed in times of emergency. Although some experts would say the goal of vaccinating 70% of humanity by mid-2022 was very ambitious, I have a different perspective. The G20 Rome Leaders’ Declaration of 2021 demonstrated that developed countries believed it is possible and by end of June 2022, they had reached the target – while Africa was still at 16% of people fully vaccinated. The high-income countries had full control over the constraint in production, supply and the financing of COVID-19 vaccines. They knew the only one way to make everyone safe was to expand and diversify global production of vaccines at local and regional levels. What was lacking is translating their willingness to action toward fairness. I also think it was not realistic to commit to fairness, equity and affordability without strong consideration of the Intellectual Property (IP) rights and temporary TRIPS waiver. Voluntary licensing was a good step ahead, but not enough to reduce the inequalities and vaccines nationalism. All this reflect the failure of COVAX.
What are the general obstacles to medicines, vaccines and other medical supplies not being distributed fairly?
Neci: In my opinion, the lack of LMICs capacities to produce locally as well as the lack of coordinated manufacturing initiatives in developing countries is the first obstacle. Africa carries 25 % of the global disease burden, consumes nearly 25 % of global produced vaccines, however it imports 99 % of its vaccines and 90 % of medicines needed for its population. The pandemic demonstrated clearly that reducing dependency on importation is key to address supply disruptions. In addition, the transfer of technology is not focused on the entire production value chain: a successful local production in LMICs requires not only TRIPS waiver, but most importantly transfer of technology in the entire value chain. Finally, we have a lack of flexibility of IP system and incentives of IP rights’ holders to invest more in LMICs.
What needs to be changed so that medicines and vaccines can be distributed equally around the world?
Neci: In my view, not only things need to be changed, but the change should start early. The African Union has set up a goal to produce 60 % of Africa’s needed vaccines by 2040. We should not wait for the next pandemic to take action. First, we need a strong political will translated into action. The access to vaccines for all is a fundamental human right, especially during pandemics. Second, we need to scale up and expand the production in LMICs in the perspective of affordability and efficiency. This requires the preparation of the continent to compete with low price medicines and vaccines imported from other developing countries. Thirdly, we need more capacity in monitoring of medicines quality and post-marketing surveillance because availability took precedence over quality during the COVID-19-pandemic.
What can the German goverment do to support your call?
Neci: The German government should push technology transfer and mandatory investments of IP rights’ holders in LMICs in research and development and local production value chain. Africa needs its own local production of vaccines for the African population. This is why we also need the softening of IP rights, especially during health crisis. Therefore, it is of vital importance that the German government changes its position regarding IP rights. Furthermore, the German government should catalyze the enhancement of healthcare systems in low-resource settings to improve the distribution and administration of vaccines and medical products. Germany can also promote in-country equity through the BMZ development cooperation strategies. In LMICs countries, the faith health systems which count for up to 40% of healthcare provision in Sub-Saharan Africa is often left behind.
If you are interested in reading more about this topic, please download our publication “A pandemic of voluntarism” published by Bread for the World, Global Policy Forum Europe and Misereor (German version "Pandemie der Freiwilligkeit")