Everything we do during and after this crisis must be with a strong focus on building more equal, inclusive and sustainable economies and societies that are more resilient in the face of pandemics, climate change, and the many other global challenges we face.
UN Secretary-General António Guterres
by Daniele Dionisio
PEAH – Policies for Equitable Access to Health
Damn Covid Pandemic, Let’s Begin Exploiting You For Fairer World
The Case For Health
In today’s planetary arena there’s stringent need of an array of inter-sectorial policies the governments should embrace to achieve equitable global health goals while ending the misalignment among the right to health, trade rules, and the patent system.
This would require non-stop multi-sector engagement worldwide to pressure governments into making “U-turn” changes, implementing common measures on shared agenda. Really hard bet in these times of neoliberal globalization underpinning unfettered trade liberalization, whereby collusion of national-transnational corporations with their political counterparts comes as no surprise.
As reported, ‘In the contemporary policy environment, one element in particular connects health inequalities around the world: Neoliberalism as a set of norms that guide and justify policy, ultimately equating financial worth with moral worth. The connections are not only conceptual of course; they are also material and institutional, operating through such channels as campaign money, capital flight and the networks of power and privilege epitomised by the World Economic Forum, where the global super-elite meet to worry about the threat posed to their fortunes by the rest of us’.
Just a couple of examples:
– Unbridled TRIPS-plus measures still enforce intellectual property (IP) protection beyond what is required by the WTO TRIPS agreement. These measures encompass making it easier to patent new forms of old medicines that offer no added therapeutic benefit for patients (the so-called ‘ever-greening’); restricting ‘pre-grant opposition’, which allows a patent to be challenged before it is being granted; allowing customs officials to impound shipments of drugs on mere suspicion of IP infringement, including ‘in transit’ products that are legal in origin and destination countries; expanding data exclusivity beyond WTO’s request for data protection against unfair commercial use only; extending patent lengths beyond 20-year TRIPS requirements; and preventing drug regulatory authorities from approving new drugs if they might infringe existing patents.
– Investor state dispute settlement (ISDS) provisions are in the crosshairs now that most currently being negotiated or finalized trade agreements are charged with introducing ISDS clauses whereby many forms of government regulations, including TRIPS-compliant price cuts of medicines, could be sued by the patent owners for making pointless or eroding their expectations.
As maintained: ‘..the exigencies of market competition and enormous corporate power mean that governments privilege economic priorities and corporate interests over social and environmental needs, even in settings where democratic institutions and decision-making processes are marked by integrity and representativeness….’
As such, no wonder that the safeguarding principles for equitable access to medicines embraced by the WHO and the UN system as a whole are under attack and quite watered down now that the stranglehold of neoliberal policies is mushrooming worldwide. In this context, some WHO Member States disappointingly run contrary to WHO directions while placing corporate interests and for-profit policies before people right to the equitable access to health.
These circumstances are a bad omen at a time when the US administration is lobbied by the pharmaceutical corporations, European authorities are doing so little to check the tide of ‘me-too’ drugs, and the European Medicines Agency keeps testing new medicines only in terms of safety and efficacy compared with a ‘pretend’ drug.
And this occurs even as a WHO strapped for public financing sees its role thwarted by a number of international bodies and private donors, meaning overlapping/duplication of initiatives risk and undue pressure towards earmarked programs.
Under this scenario, which is plagued by misalignment, litigations and frictions among the parties, governments are seemingly not ready to embark on what advocated at the opening of this editorial as an opportunity to advance public health over political and commercial interests.
Conversely, ‘Rome wasn’t built in a day’, and any concerted efforts to break the wall will trustily pave the way for access to quality assured, affordable drugs and vaccines on non-discriminatory basis in the near future. Indeed, while hinted points above remain challenging issues to be addressed, they can be however. As the old saying goes ‘where there’s a will, there’s a way’.
These insights align with PEAH core messages, including leitmotif whereby governments around the world should tackle neoliberal globalization in an efficient manner to ensure that citizens enjoy equal health benefits on an equitable basis, while advancing public health over political and commercial interests.
Actually, non-stop tips for administrations worldwide emerge from PEAH vision and contributors’ takes. These entail, besides other measures:
-Ensuring that leading institutions and organizations enhance working with health ministries to boost needs-driven rather than market-driven rules.
-Pushing for a coordinated response to fight corruption, while refraining from being caught with corporate holdings in a circle of mutually reinforcing political and commercial interests over public health concerns.
-Rejecting pressures towards adopting heightened IP rights while banning TRIPS-plus clauses and ISDS provisions.
-Pushing for open knowledge and new approaches to pharmaceutical innovation that do not rely on the patent system and de-link the costs of R&D from the end price of medicines and vaccines.
-Backing generic competition as the most effective way to lower medicine prices in a sustainable way.
That said, is there a way, against all odds, to actually move good intentions into practice? Astonishingly (but not that much), ill-fated Covid pandemic may definitely serve as an opportunity to move the envelope further as long as stakeholders get their act together.
Reportedly, ‘By accepting that new health technologies were determined by Big Pharma’s economic interest at the expense of millions of people’s lives, we’ve naturalized our lives pricing and the understanding of health as a commodity – and an expensive one!… The good news is that the COVID-19 pandemic, exactly by collecting our debts from the past, is also giving us the opportunity to stop, think, catch up on our obligations and put our house in order. Giving visibility to the reality of people affected by NTDs during the current crisis doesn’t mean to establish a hierarchy among the diseases. It’s quite the opposite. It’s the strong statement that we won’t be able to overcome this challenge if we continue to accept a system that ignores the suffering of millions of people as if they were less valuable and their needs were less urgent. Epidemics and diseases, regardless of our will, will continue to emerge. What we can change is how we look at those affected by all of them and how we face them. It’s precisely at this moment when humanity is called to fight an invisible enemy that we have the unique opportunity to notice the silenced reality of those who have waited, for a long time, to be seen’.
This entails, first and foremost, answering the concern by people in resource-constrained countries and discriminated settings: Now that Covid vaccines are on the market, will my family and I have access to them? Will our health systems be able to buy them?
To the point ‘…In early 2021, a total of 12.8 billion doses of vaccine had been reserved, the largest number committed to the EU, the US and COVAX. The unequal distribution of confirmed purchases was clear, with 7.8 billion doses bought by high-income countries, 4.2 billion doses to upper-middle-income, 1.2 billion doses to lower-middle-income and 582 million to low-income countries. In an already unequal world, in which the Covid-19 pandemic further accentuated inequality last year, it seems morally and politically unacceptable that a heavily slanted vaccine rollout should let it deteriorate even more.’
That’s the gap the COVAX initiative is currently trying to fill in, though presently it seemingly falls far short of expectations.
Disappointingly, even worse performances on fair access to vaccines are being registered as for other initiatives, including the continued obstruction by rich countries to a proposal from South Africa and India to waive intellectual property protections on Covid-19 drugs and vaccines.
In this connection, several strategies to improve vaccine distribution equity were just highlighted by Iris Borowy in her exhaustive analysis, whereby the pros and cons are weighted as regards:
-Strengthening COVAX
-Suspending patents / providing free licenses
-Donating extra doses when domestic need has been (partially) satisfied
-Donating/selling unilaterally.
These issues add, under an overarching perspective towards fairer world, to Judith Richter’s reflection Defending and Reclaiming WHO’s Capacity to Fulfil its Mandate focused on WHO’s role in the international health arena, whereby a number of possibilities are brought up relating to language, propaganda even, and power, which could contribute to reclaiming WHO’s capacity to unequivocally work for peoples’ health during and after Covid-19 pandemic.
Meanwhile, Africa looks like it would take its own momentum from Covid-19 scourge. Examples include the Africa Medical Supplies Platform (AMSP) as a non-profit continental online procurement platform designed to resolve Africa’s COVID-19 medical supply predicament. Besides strengthening Africa’s supply management system and bolstering local production of pharmaceuticals, the main objective of the platform is to provide equitable access to medicines and medical supplies for all participating countries.
All in all, which lessons have we learnt from Covid pandemic? Certainly, that how countries cope and invest for their future during and after Covid-19 will determine the recovering and coming back to what we used to know as “our normal lives”. Meaning that the present time is the opportunity countries’ governments have to take and move forward social support to fairly sustain their vulnerable groups, as well as to support the productive sector with financial incentives and equitable measures. As inalienable pre-condition, this ties to awareness that ‘In the current pandemic scenario, public health experts need to look at the establishment of animal health care and the strengthening of an ecosystem where human and animal will live congruently to protect human health. This integrated, holistic and harmonious approach to protecting human health is referred to as one world one health, a name coined by the wildlife conservation society. A better understanding of the ecosystem is needed to protect public health’.
In a nutshell, to achieve Covid-19 far reaching recovery humankind is required, at government, corporate and civil society levels, to set green economy in motion first, while managing to curb inequalities and inequities throughout poor and rich nations. Echoing George Lueddeke’s words, ‘The greatest challenge in our path to building more equal, inclusive and sustainable economies and societies, underscored in Survival: One Health, One Planet, One Future, lies with making a fundamental paradigm or mindshift from seeing the world through a strictly human-centric lens to taking a wider more inclusive eco-centric view – ensuring the needs of humans are compatible with the needs of our ecosystems.’