Tuesday’s Weekly Primer: Curated Global Health News

Originally published on March 2nd, 2021 on Geneva Health Files

POLICY UPDATES

• WTO GENERAL COUNCIL MEETING
• WTO’s new boss Ngozi Okonjo-Iweala began her first day at work speaking at the General Council meeting that began this week.
• The WTO’s highest-level decision-making body is meeting March 1st-3rd. The Council is currently chaired by Ambassador David Walker (New Zealand). At WTO, the Council has the authority to act on behalf of the ministerial conference which only meets about every two years.

Image credit: ©WTO/Bryan Lehmann

• There are a number of agenda items for this meeting, one of the most watched has been the update from the TRIPS Council on the discussions on the TRIPS Waiver proposal.
• As many as 31 delegations took to the floor and a majority of the countries spoke in favor of the proposal, a WTO official said. Discussions on the waiver proposal will continue at the TRIPS Council in the coming weeks and it will return as an agenda item at the General Council, the official said.
• Although the proponents have got support from an increasing number of WTO members, the official said that since WTO is a consensus-based organization no decision can be taken unless everyone agrees to it. It is understood that some countries cautioned against the use of the TRIPS waiver as an approach to address the pandemic, and wanted to examine further the role of intellectual property being a barrier to access to medical products during this pandemic.
• Interestingly, the US and the EU, opponents to the proposal did not intervene at the meeting on March 1, on this matter. Nearly six countries are understood to have spoken against the waiver proposal at the meeting.
• A number of countries did not articulate a clear position on the proposal at the meeting, a source said. The next General Council meeting is in May 2021.

Here is an excerpt from South Africa’s statement made at the General Council meeting yesterday:

Excerpt:

“What we are proposing is a limited scope and a temporary Waiver that would provide countries with the policy space needed to collaborate in research and development (R&D), manufacturing, scaling up, and supplying COVID-19 tools which are currently in short-supply. The Waiver is an instrument that is provided for in the WTO legal framework in exceptional circumstances. No one can dispute that COVID-19 is an unprecedented crisis facing the global economy today. We have indicated our flexibility to engage on the scope and timeframe for the application of the Waiver and we are ready to engage in constructive text-based discussions with Members towards a solution. The world cannot afford anymore delays. This should be the most urgent priority for the WTO. History will judge us harshly should we fail to provide a credible response to this crisis. The time to act is now.”

The new WTO chief has alluded to “The Third Way” in driving towards a solution to meet the acute demand for vaccines in the current pandemic. While details on what this third way is yet to emerge, but loosely translates into voluntary licensing approaches.

(Last week we analysed how the third way could potentially open up negotiations on the waiver proposal. Check it out.)

See DG Ngozi’s speech here on assuming office on March 1. An excerpt from her speech on COVID-19 response:

“Permit me Ladies and Gentlemen to spend just a little time on COVID-19. We have a demand for a TRIPS waiver by a growing number of developing countries and the dialogue is intensifying. Whilst this is happening, I propose that we “walk and chew gum” by also focusing on the immediate needs of dozens of poor countries that have yet to vaccinate a single person. People are dying in poor countries. We just had our first COVAX shipment to Ghana last week and others will follow but it will not be enough. There is serious supply scarcity and some countries are out bidding COVAX and diverting supplies. The world has a normal capacity of production of 3.5 billion doses of vaccines and we now seek to manufacture 10 billion doses. This is just very difficult, so we must focus on working with companies to open up and license more viable manufacturing sites now in emerging markets and developing countries. We must get them to work with us on know how and technology transfer now. There will soon be a world manufacturing convention where we can seek to build this partnership. I also hope we can initiate a dialogue and information exchange between us and representatives of manufacturers associations from developing and developed countries. Excellencies, this should happen soon so we can save lives. As I said at the beginning, this will be an interim solution whilst we continue the dialogue on the TRIPS waiver.”

It remains to be seen how much traction the third way gets from WTO members. Going by the responses to her first speech as DG, it is obvious she has a “style of her own” as one observer remarked.

A long-time source of Geneva Health Files, has called ‘The Third Way’, as “COVAX on steroids”. We will decipher this in the days to come!

WHAT WE FOUND INTERESTING

• WHO: Human infection with avian influenza A (H5N8) — the Russian Federation Disease Outbreak News, 26 February 2021

“On 18 February 2021, the National IHR Focal Point for the Russian Federation notified WHO of detection of avian influenza A(H5N8) in seven human clinical specimens. These are the first reported detection of avian influenza A(H5N8) in humans.”

WHO

NEWS:

Donors bet a U.S. firm could transform disease testing in Africa. Then COVID-19 hit: Reuters Investigates

A must-read story on the implications of monopolies in healthcare, in this case diagnostics.

“Test samples had to be sent more than 1,500 kilometres from remote hospitals to the capital Kinshasa. Results took weeks to come back. Some of the infected returned home, spreading the virus. In Bukavu, the capital of South Kivu province, bodies piled up in the morgue. Senior doctors described total confusion. Five doctors and 10 nurses were among those who died, according to one medic who spoke on condition of anonymity.”

It needn’t have been this way. Bukavu’s Provincial General Reference Hospital, like dozens of others across Congo, had access to a machine that could have processed around 100 COVID-19 tests a day, if only it had the right chemical kits, doctors there told Reuters.

Reuters Investigates

Finland Had a Patent-Free COVID-19 Vaccine Nine Months Ago — But Still Went With Big Pharma: Jacobin Mag

A story of our times, from Finland.

“A team of leading Finnish researchers had a patent-free COVID-19 vaccine ready last May, which could have allowed countries all over the world to inoculate their populations without paying top dollar. Yet rather than help the initiative, Finland’s government sided with Big Pharma — showing how a patent-based funding model puts profit over public health….

…In the mainstream narrative, the first-generation COVID-19 vaccines from Pfizer, Moderna, and AstraZeneca are typically presented as an illustration of how markets incentivize and accelerate vital innovation. In reality, the fact that the profit motive is the overriding force shaping medical research has been devastating — particularly in a global pandemic. The Finnish vaccine provides a striking case study of the many ways in which the contemporary patent-based funding model has slowed down vaccine development, and how it currently hampers the possibility of conducting effective mass-inoculation campaigns.”

Jacobin Mag

Brazil Is Brilliant at Vaccinations. So What Went Wrong This Time? New York Times

It is heart-breaking to read this opinion piece on the political response to the pandemic in Brazil.

“Vaccinating over 210 million people may sound daunting, but for Brazil it really shouldn’t be. With one of the largest universal, free-of-charge public health systems in the world, the country has a distinguished track record of vaccinations and disease control. The National Immunization Program, founded in 1973, helped to eradicate polio and rubella in the country and currently offers more than 20 vaccines free in every municipality.

…We take immunization so seriously here that we even have a mascot for vaccination campaigns, an adorable six-foot smiling white blob named “Zé Gotinha,” Joe Droplet. (This glorious national hero apparently refused to shake hands with President Jair Bolsonaro during an official event in December.)…”

New York Times Opinion

Africa will pay more for Russian Covid vaccine than ‘western’ jabs: Financial Times

Cheaper Russian vaccines, the rhetoric falls apart.

“The African Union will pay three times more for Russia’s Sputnik V jab than it is paying for the Oxford/AstraZeneca and Novavax vaccines, according to people familiar with the procurement process.

The $9.75 price per dose for 300m shots of the Russian vaccine, developed by the state-run Gamaleya Institute, undermines Moscow’s argument that it is offering affordable jabs to countries priced out of deals with western pharmaceutical groups.”

Financial Times

Gavi’s Seth Berkeley on BBC HARDtalk: BBC

What can we learn from Africa’s experience of Covid? The Guardian

A comprehensive read with voices from across Africa.

“For now, then, the African paradox persists. “We don’t have an explanation for why the impact has been lower,” says Karim. “It remains for me an unanswered question.” Nkengasong says that answers may not be forthcoming for years, and until then most theories remain on the table. One early prediction has already been disproved, however: that many Africans whose immune systems were weakened by HIV/Aids infection would die of Covid-19. Thankfully it didn’t happen, says Karim, for a reason that, in hindsight, appears obvious. The two diseases don’t affect the same age groups, since HIV is mainly a disease of the young in Africa. There is, however, some evidence that when those infected with HIV do catch Covid-19, their Covid-19 can be more severe.”

Fluid dynamics of COVID-19 airborne infection suggests urgent data for a scientific design of social distancing: via The Brief AMR-COVID-19

Very interesting conclusions:

“In the present paper we discussed the scientific foundation of these ‘social distancing’ measures, which touches several billion individuals globally. Our simulations demonstrate that currently available information is inadequate to design social distancing recommendations on a solid scientific basis….

…Our findings call for novel experimental efforts to address two key issues that cause uncertainty in predictions: the determination of droplet size distributions at emission and the infection potential of viral load carried on dry versus wet nuclei..”

Has Covid changed the price of a life? The Gurdian

A clinical analysis of a brutal question. Economists, epidemiologists, physicists, ethicists and philosophers weigh in on this.

“..There are two broad approaches to valuing a human life. The first is known as the value of a prevented fatality (VPF), and it’s the one applied in the first scenario above. How much would you pay for, say, improving road safety to reduce the risk of premature deaths? It’s an average measure applied across the population as a whole.

The second approach applies when you have more information about the individuals concerned, as in the lifeboat example above, and it’s called the quality-adjusted life year (QALY). A QALY is one year in full health, whatever that means for the individual in question. That’s an important detail, because the value of a QALY is the same for a person born deaf as one born hearing, but less for a “sickly old” man than for a “healthy young” child. Age and health are taken into account, but that’s all. “This is nothing to do with economic importance,” Jessop explains. “A rich person’s QALY is the same as a poor person’s.”

The Guardian

FROM THE JOURNALS / REPORTS:

• Preparing for the Next Pandemic: the International Health Regulations and World Health Organization during COVID-19: Forthcoming in Yearbook of International Disaster Law, vol. 2(1) (2020) [Gian Luca Burci & Mark Eccleston-Turner]
• Looking back at a year that changed the world: WHO’s response to COVID-19: WHO

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