Publications

Marije Versteeg, Senior Global Health Advocate at Wemos,  @Marije_Versteeg 

Since the onset of the pandemic, a multitude of access initiatives and proposals have been initiated by public and multilateral institutions worldwide, ranging from COVAX, the COVID19-technology access pool (C-TAP), HERA, the TRIPS Waiver proposal and EU counter proposal, to the mRNA Hub and ofcourse the Pandemic Treaty deliberations. As it can be difficult to keep track of developments, Wemos launched the website www.covid19response.org where we critically review access initiatives for COVID-19 medical innovations. As a Dutch NGO focusing on global health, we analyse initiatives that are either spearheaded, supported or influenced by Dutch, European and/or global public institutions.

Learning from the past

Vaccine inequity remains a harsh reality today. While wrongs of the past two years, such as vaccine nationalism and over-priced vaccines, cannot be undone, decisions we make today as a global community should bring us closer to social justice and health equity in the future. What has been known to access to medicines activists, experts and communities worldwide for decades, has now become visible to the global community: the current system of innovation, manufacturing and allocation does not result in health for all. And it is deeply unjust.

Five principles

Our analysis is informed by the right to health, as stipulated in the Constitution of the WHO and recognised in the Universal Declaration of Human Rights. The Declaration has relevance to the European Union and finds expression in Sustainable Development Goal 3, which aims to ‘ensure healthy lives and promote well-being for all at all ages.  In the review of initiatives, we applied a health equity lens and looked at five criteria:

• Sufficiency– to what extent could this initiative help meet the global demand for Covid-19 innovations?
• Urgency– to what extent could this initiative increase global access to Covid-19 innovations urgently?
• Sustainability– to what extent could this initiative improve resilience to future public health emergencies of international concern?
• Power balance– to what extent could this initiative contribute to equal power relations between high-income countries and lower-income countries?
• Public first– to what extent does this initiative put public interest above commercial interest?

Together, these five principles point at the importance of structural solutions that are needs-based and contribute to self-reliance and sovereignty in regions that have been left behind.

Structural solutions

While COVAX, for instance, plays an important role in facilitating access to COVID-19 vaccines, it does not address the underlying causes of inequitable access that many countries face. The mRNA hub in South Africa, on the contrary, offers a structural solution to vaccine inequity. Other initiatives hold a promise for structural change for health equity, like the Global Pandemic Treaty. Yet this would depend on whether and on what terms health equity is actually included in its final text.

All eyes on local production capacity expansion

We believe investments in expanding manufacturing capacity of COVID-19 vaccines and other local health priorities, are necessary and urgent. Various initiatives that we discuss on our website, such as Team Europe and the Global Health Threats Fund, commit billions of euros and dollars to local production capacity expansion on the African continent. It is important, however, that these initiatives reduce local and global reliance on a few leading manufacturers and that they shift the power balance towards the host countries and region.

Attaching conditions to investments

The recent lack of conditioned financing of vaccine R&D by high income countries, with taxpayers funds, allowed commercial interests to prevail over public interests. Pro-public conditions should be attached to public investments, including requirements for local production capacity, such as sharing of know-how and technology, contract transparency, affordable pricing and need-based allocation.
Going forward it remains critical to keep carefully scrutinising current and new initiatives. If we understand their characteristics and possible contribution to an equitable and effective COVID-19 response, we can call upon and support our governments to make the right choices next time.