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Commodifying Life-Saving Medical Products Undermines Global Health Response © Álex Cámara/NurPhoto via AP)

Leaders at a virtual Covid-19 summit on the sidelines of the United Nations General Assembly on September 22, 2021, pledged to mobilize millions of doses of Covid-19 vaccines and billions of dollars to “build back better,” but these promises failed to address issues central to meeting global need, Human Rights Watch said today.

By focusing more on redistributing existing supplies rather than on how to swiftly enable factories around the world to make more desperately needed Covid-19 vaccine and related products, governments at the summit missed an opportunity to take transformative action urgently needed to beat the pandemic and prepare for future threats.

“Dose sharing is helpful, but rich countries cannot donate their way out of this crisis as there simply aren’t enough shots to go around,” said Akshaya Kumar, crisis advocacy director at Human Rights Watch. “Without fixing the supply side of this problem, we’ll be stuck pushing this boulder up a hill only to watch it come crashing down once again.”

The US sought to rally support at the summit for a set of concrete targets that it developed alongside the Multilateral Leaders Taskforce on Covid-19. But it excluded technology transfer hubs, technology access pools, and sharing intellectual property from the list of actions it is promoting as needed to address the pandemic.

The Biden administration has promised to organize additional multilateral meetings, later this year and in early 2022, to follow up on implementation of the targets themselves. Follow up is important since, according to the World Health Organization (WHO), only 15 percent of the vaccine donations pledged to date have actually “materialized.” With the announcement at the summit that the US government would donate 500 million more vaccine doses to lower income countries, the Biden administration has pledged to donate 1.1 billion doses of Covid-19 vaccines by September 2022, with the bulk of those donations scheduled for next year. So far, the US government reports it has shipped 160 million vaccine doses abroad.

In his remarks at the summit, Biden spotlighted US financial support for vaccine manufacturing in India and South Africa, a theme that is included among the summit targets. A factsheet issued following the summit recalled the financial support already invested by the US International Development Finance Corporation in manufacturers in “Africa and India, which it stated would enable those facilities to produce up to 2 billion vaccine doses for developing countries in 2022.”

In June, the WHO and COVAX announced a COVID mRNA vaccine technology transfer hub, to be set up in South Africa. In 2020, the WHO created a Covid-19 Technology Access Pool. Both efforts, which seek to enable greater vaccine manufacturing globally, remain hobbled by lack of participation from wealthy governments and companies that hold the intellectual property needed to make Covid-19 vaccine and related products, Human Rights Watch said. However, the document laying out the global targets did not identify technology access pools or transfer hubs like these as key operational objectives to achieve this greater and more distributed manufacturing.

In the coming weeks, as they work to operationalize their commitments to the targets agreed at the summit, wealthy governments, especially the US, Germany, Australia, Japan, UK, and European Union should immediately boost funding for efforts to scale up global manufacturing and distribution of Covid-19 health products. Following the summit, the US and European Commission made public a statement to launch a “taskforce” on Covid-19 manufacturing and supply chains, which includes a commitment to coordinate initiatives to boost global production of vaccines and therapeutics. They should urgently pursue negotiations at the World Trade Organization (WTO) to waive some intellectual property rules, which are handcuffing potential producers from contributing to global efforts to increase supplies, Human Rights Watch said.

The WHO is calling for governments to mobilize to ensure that at least 40 percent of the world’s population is vaccinated by year end, with a goal of 10 percent by the end of September. More than 70 percent of the world’s high-income countries have reached the 40 percent target and almost 90 percent have reached the 10 percent target. In contrast, at the beginning of September, not a single low-income country had reached either target. According to the UN Development Program, high income countries have covered approximately 60 percent of their populations, while the world’s poorest countries have covered just 3 percent, a coverage gap of a factor of 20.  

COVAX is largely supplied by AstraZeneca, which in turn has relied on only one manufacturing partner in India, the Serum Institute. As India struggled with a huge surge in deaths and infections with the second wave of Covid-19, the Indian government halted all exports of vaccines to be able to meet the growing public health crisis in the country. Human Rights Watch and others have urged COVAX to enhance transparency and publish procurement contracts and prices. While COVAX has said it is “working with manufacturers committed to minimal profit pricing,” it has not yet published details about procurement pricing and profits in its agreements with vaccine developers and manufacturers. On September 20, India announced that it would resume exports of vaccines produced there in October, which Dr Tedros Adhanom Ghebreyesus, the head of the WHO, called an “important development in support of reaching the 40 percent vaccination target in all countries by the end of the year.” This does not displace the responsibility of other countries that have funded the research and development of vaccines to oversee more widespread licensing and manufacturing.

In May, the United States signaled that it would support negotiations on the text of a proposal to waive some intellectual property rights at the WTO’s TRIPS Council. But the European Commission, representing the European Union member states, Switzerland, and several other high-income governments have consistently stalled and blocked efforts to adopt the waiver. Negotiations resumed in Geneva on September 14 but have yet to progress to text-based negotiations.

At the Summit, South African President Cyril Ramaphosa and Indian Prime Minister Narendra Modi referred to their governments’ efforts to secure a TRIPS waiver, Canadian Prime Minister Justin Trudeau mentioned the importance of resolving intellectual property issues at the WTO, and New Zealand Prime Minister Jacinda Ardern expressed her government’s support of the waiver, but President Biden did not mention the issue. A statement issued by the White House following the summit stated the “United States supports a waiver of intellectual property protections in the WTO TRIPS Agreement for COVID-19 vaccines in service of ending this pandemic.” The waiver proposal currently being advanced by India and South Africa would cover a variety of Covid-19 medical products, not just vaccines.

The General Assembly itself has been marked by wrangling around inequitable global access to Covid-19 vaccines, as New York City sought to mandate vaccination for all those in the main General Assembly Hall, which it treats as a convention center. In practice enforcement of the mandate was left to an “honor system.” The city of New York offered free Covid-19 tests and a single dose Covid-19 vaccine to all delegates through a mobile clinic outside the main General Assembly building.

“While world leaders and their delegations had a chance to benefit from the abundant supply of Covid-19 vaccines in the US, the summit organized by the Biden administration missed the opportunity to offer the same to their populations back home,” Kumar said. “Leaders should have used this moment to invest in developing a pandemic-resilient future for everyone.”


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