IHP news 599 : "There should be no monopolies in a pandemic"

IHP news 599 : “There should be no
monopolies in a pandemic”
( 27 November 2020)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the
Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

As is often the case, I’ll just offer here some issues that caught my attention this week, without
paying too much attention to ‘intro coherence’ : )

The week started with a rather disappointing informal WTO meeting, and then an equally
underwhelming G20 leaders’ summit. A tweet related to the former meeting perhaps: “So now
wealthy countries are pitching ACT-A against India/South Africa TRIPS waiver request. Isn't it
obvious developing countries would prefer to have power to manufacture on their own over receiving
charity from wealthier nations?” To which I would add, linking it to the G20 summit outcome: if
“rich” countries are pitching it like this, the least they could do is to properly fund ACT-A. Sadly, that
also seems too much asked, at least for now. Let’s hope change comes when the Biden
administration takes over. But I have to say, after the rather desperate ACT-A fundraising effort by
dr. Tedros et al, for months and months now, and also taking into account all the hoarding of
vaccines by rich countries and other “Team Europe” ‘s, I’m increasingly on the side of the ones who
argue “Poorer countries can’t wait until 2022. The WTO should suspend COVID vaccine patents now”.
It’s probably also time to take the mantra ‘there should be no monopolies in a pandemic’ to the
streets.

Early this week, the New York Times came up with a (somewhat sycophantic) analysis piece of Bill
Gates’ (huge) role in the Covid-19 ecosystem. It is remarkable how smoothly Bill has made the
transition from the MDG to the SDG (and now Covid-19) era, unlike many others in global health. I
have my doubts, though, whether this global health “Perkamentus/Voldemort” hybrid (with a good
dose more of Perkamentus, in my opinion) will also survive the Decolonize Global Health movement,
clearly being one of the ‘elephants in the room’ in that respect.

As you know, from billionaires to global tax justice, is just a small step for this newsletter . End of
last week, The State of Tax Justice Network confirmed that “the axis of tax avoidance” (featuring
also the Dutch, among others, always in for an extra buck (make that “billion”) or two ) is collectively
responsible for over 47.6 per cent of global tax loss incurred from corporate tax abuse. Let that sink
in. It’s more than time to do something about these ‘tax haven powers’. But we’ll have to push
them, collectively, if not they’ll continue to rob health systems and societies of much needed public
resources. With all the political backlash that entails.

Over to our (still miserable) Covid lives then. Huh. Some people have even likened our current Covid
lives to ‘pre-retirement’, given how little that actually makes life fun is still allowed, among others a
“night life” worth its name. By now, most of us are rooting for the vaccines to get back a bit of our
lives from before, the night owls and youngsters first of all. I don’t blame them.

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Madhukar Pai wrote a great piece on the need for men in global health (especially privileged ones
from elite institutions in the North) to Lean Out. I’m all in favour of that agenda, and his
suggestions are very relevant. I’m less fond of the ‘Leaning in, Leaning out’ terminology, though.
Feels like the yoga version of ‘breathing in, breathing out’ to me. Being middle-aged, I even feel less
enthusiastic about it, not exactly able anymore to ‘bend it like Beckham’ without some serious back
consequences. But feel free to ignore me on this one (as I’m also white and work at a Northern
institute, though not exactly as a ‘top dog’!) .

Finally, on Wednesday the world also had to say goodbye to Maradona. That was just utterly sad. By
the way, I think Diego would also have supported a “People’s Vaccine”. Passionately.

Enjoy your reading.

Kristof Decoster

Featured Article

Global Health is still the “Master’s House”: how brave are we
to decolonise and dismantle it?

Lance Louskieter (EV 2020) & Shehnaz Munshi (EV 2018)

Decolonisation is not a metaphor and decoloniality is not an end. Rather, it is a means, a segue, a
process, a lens with multiple ends. To advance socially just health systems, we argue for global health
scholars (and especially us located in postcolonial contexts) to take a political stance on the side of
justice. We need to recognise that we have the agency to read, engage with, and apply decolonial
theory, methodology and praxis for justice and equity. Decoloniality requires us to be brave at
chipping away, disrupting and dismantling but we also need to be realigning, building, reimagining and
transforming in very real and concrete ways. At the African Health Systems Africa Convening 2020,
Pascale Allotey asked: “how brave are we in the quest for the disruption of coloniality? How disruptive
are we prepared to be?” It’s a vital question.

The predecessors of “global health” (among others, “tropical medicine”) were an instrument of
colonisation, and global health has never fully shed this past. Through the systems and structures put
in place by the colonisers, tropical medicine was instrumentalized to support the colonists’ overall aim
to dominate, steal, loot, destroy, occupy, manipulate and oppress. More significantly, the colonisers'
oppression extended to destroying and changing our ways of being, doing, thinking. Their rule
fundamentally changed and controlled our spirituality, bodies, politics, economics and connection to
land. They re-oriented our systems to serve white supremacy, the project of modernity, capitalism
and industrialisation. These created conditions of hegemony, structural violence, and oppression that
are infused in institutions such as universities (schools of tropical medicine, anthropology, geography,
architecture, philosophy and economics, amongst others), health care systems, policy structures,
social welfare systems, arts, religion and language. These models - Ramón Grosfoguel calls them
Westernised Universities - have been replicated in all countries that were colonised. Most of us are
“products” of these Westernised Universities and are part of the legacy of colonisation. In other

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words, we ourselves are “colonised” – we have undergone processes of alienation, othering, and
dehumanization. Many of us have been categorised and othered, racialized and gendered. The
knowledge and lessons from our ancestors have been demonised and destroyed, affecting our identity
and humanity in the process. To some extent, things changed for the better under tropical medicine’s
successors, ‘international’ and ‘global health’, but as the current Decolonize global health movement
rightly argues, not nearly enough. Indeed, by and large the same patterns continued after colonisation,
though framed more euphemistically. Decolonial scholar, Nelson Maldonado-Torres refers to this as
“coloniality”.

Meanwhile, in the current Anthropocene, our biosocial relations are markedly structured by a
‘capitalist world-ecology, joining power, capital, and nature as an entwined whole’. Under global
capitalism, modernist paradigms of technological utopianism and economic growth have come to
represent the ‘natural order of things’ . Placing this concept of “biosocial relations” in a wider context,
we (humans) are responsible for the destruction and alteration of the earth's atmospheric, geologic,
hydrologic, biospheric and other earth system processes, from which we are also alienated. We human
beings have thus also “colonized” the planet, with deep implications for our health. Put differently:
we need to “decolonize the Anthropocene” as well. Soon.

Many would argue that the Global Health community (including many researchers and practitioners)
has made significant progress in recent decades in improving health outcomes, reducing infant and
child mortality rates across the world and raising life expectancy. In crude terms, the epidemiological
transition is testament to these global health successes. Furthermore, fields like HPSR have advanced
thinking in health systems strengthening. However, when we examine the entrenched inequalities
using an intersectionality and decolonial lens, the evidence of coloniality soon starts to emerge.

Using an intersectionality and decolonial lens to analyse entrenched inequalities reveals how
coloniality still permeates the systems and structures that global health is nested in. Feminist scholar
and activist Audre Lorde called Global Health, the ‘Master’s House,’ given the power it yields in
deciding who gets to live, and who must die. This should compel us to assess how Global Health still
upholds the colonial footprint. And then deal with it. At the already mentioned African HSG convening,
Professor Faisal Garba raised our awareness of the dangers of commodified health, while Professor
Elewani Ramugondo descibed racism (which continues to operate within global health categories,
implicitly or explicitly), as genocidal. Many scholars have linked capitalism, profit-driven
pharmaceutical companies, burgeoning private health care, dependency on philanthrocapitalism, aid,
donor funds, and vertical programs and selective primary health care. Although many Global Health
interventions appear “helpful”, saving the lives of African children, the real commitments usually fall
short of the lofty rhetoric, and fail to address deeper structural inequities. This reaffirms the political
nature of health systems and policies (with ideology never far away). Dominant tools and methods of
research and practices of global health are more often than not, neo-colonial, neo-liberal and
complicit in reinforcing hegemonic systems of power. It remains thus imperative to interrogate the
‘master’s tools’.

Audre Lorde offered a powerful word of caution when she stated, ‘for the Master's Tools will never
dismantle the Master's House. They may allow us temporarily to beat him at his own game, but they
will never enable us to bring about genuine change’ (1984, 110–11). The dismantling of the
‘master’s house’ - that is, colonial ideologies and traditions that are imbued within our psyche and
entrenched in our systems - only threatens those who still define the Master's house as their only
source of possibilities, solutions, or support. For Lorde, the tools of resistance and building formed
within prevailing practices, structures, and institutions are ultimately unusable for the task of
overturning the hegemonic conditions that prevail. The re-imagining project requires different sets
of tools. Therefore, Global Health scholars cannot continue using the master’s tools and be confident
that they are dismantling the master’s house.

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To truly decolonize, global health scholars must seek genuine measures of resistance and liberation.
For Lorde, this must come from somewhere else, somewhere “outside,” whether outside of “the
western canon,” outside of mainstream academia, outside of modern political institutions,
structures, and social processes, or perhaps outside of history altogether. And we would argue,
probably outside of “global health” as well.

For African scholars situated in “global health”, we thus propose an African consciousness project
that centres the wealth of African philosophies, knowledge, cosmologies, praxis, ways of being and
doing from the multiplicity of contexts on the continent as worthy of inquiry and as valid and
important for our own healing, wellbeing and health.

Decolonisation requires application. We need to reconfigure the master’s tools to transform the
master’s house. We need to be intentional about examining the tools we use in our theory, praxis, but
also in our ways of being and doing. Global health needs to find a language in which we can describe
how we are resisting and challenging hegemonic practices and forms of power. This language needs
to translate into the discovering and development of tools for overturning the hegemonic conditions
that still prevail in global health. We need to look to archives outside the Western canon that will help
us liberate and rehumanise ourselves. Using this new lens, we can then begin reimagining health,
outside of profits, outside of “outcomes” and ‘’deliverables”, but rather, as a way to celebrate our
humanity in all its diversity. The language of radical love, care, collective reliance, compassion,
reciprocity, justice and equity should become the cornerstone of how we approach global health.

Pascale Allotey asked us to be brave, and ready for a slow, difficult process. However, she emphasized,
if this is done with integrity, it can lead to transformation. And, as we would add, to a real “Re-
imagining of our health systems”.

Highlights of the week

Global Tax Justice

Tax Justice Network - The State of Tax Justice 2020
https://taxjustice.net/reports/the-state-of-tax-justice-2020/

Launched at the end of last week.

“Countries are losing over $427 billion in tax each year to international corporate tax abuse and
private tax evasion. That’s nearly 34 million nurses’ yearly salaries lost every year, or one nurse’s
yearly salary every second. More tax is lost to tax havens ever year due to corporate tax abuse by
multinational corporations then due to private tax evasion by individuals. Multinational
corporations short-change countries out of $245 billion in tax every year while people who mover
their wealth offshore short-change their governments out $182 billion less in tax every year. Almost
all responsibility for global tax losses falls on higher income countries. Higher income countries
were responsible for 98 per cent of all the tax loss countries around the world lost, whereas lower

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income countries were responsible for just 2 per cent. The world’s biggest tax havens are OECD
member countries: the UK (with its network of Overseas Territories and Crown Dependencies), the
Netherlands and Luxembourg….”

With 3 key recommendations.

Guardian - How can we pay off the global coronavirus debts? Tackle the powerful
Ben Tippet; https://www.theguardian.com/commentisfree/2020/nov/23/pay-off-global-covid-19-
debts-tackle-powerful-tax-havens-pandemic

“Shutting down tax havens and cancelling debts could pay for the pandemic and more – if countries
work together.”

Excerpt: “…Arguing for progressive taxation will be key to winning this debate. … …. . But this
approach should not be limited to the UK. If implemented across the globe, an excess profit tax could
raise $104bn annually and a new wealth tax $4.4tn annually – theoretically, enough to pay for all
the Covid-19 spending in just a couple of years. Global coordination can also help ensure that
corporations and the wealthy do not hide their wealth in tax havens. According to the IMF, shutting
down tax havens (and taxing corporate profits and hidden individual wealth at current rates in the
countries where they live and sell their products) would raise $200-$600bn a year…..”

Looming debt tsunami in SSA ?

Guardian - Zambia's default fuels fears of African 'debt tsunami' as Covid impact
bites
https://www.theguardian.com/global-development/2020/nov/25/zambias-default-fuels-fears-of-
african-debt-tsunami-as-covid-impact-bites

“Aid agencies say debts should be restructured or cancelled due to the pandemic and warn other
countries could follow.”

“… Neighbouring governments are rattled: if Zambia has had to default, they could too.”

“Ghana looks very risky to me,” said Tim Jones, head of policy at the Jubilee Debt Campaign. He said
Angola, Chad and Congo-Brazzaville were also at risk. … … A separate study by the Institute of
International Finance warned of a “debt tsunami” as global indebtedness topped $277tn in the
third quarter of this year. In emerging markets, which are more likely to default, debt has risen by
more than a quarter. This potential wave of defaults could have catastrophic effects on already
fragile healthcare systems, aid agencies warned.”

“At a time when hospitals and healthcare systems are buckling under the strain of Covid-19, it is
perverse that poor countries are having to pay $3bn a month in debt repayments to rich banks,
investment funds or the World Bank, while their populations fall further into poverty and
destitution,” said Chema Vera, Oxfam International’s interim executive director. “Debt needs to be

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cancelled, postponing it is futile.” “The UN security council could pass a resolution to compel
private creditors to accept a debt restructuring,” said Jones, who argued that private lenders are
proving the hardest to negotiate with when it comes to debt restructuring deals.”

Coming up: World Aids Day (1 Dec)

UNAIDS - UNAIDS calls on countries to step up global action and proposes bold
new HIV targets for 2025
https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/novemb
er/20201126_bold-new-aids-targets-for-2025

New UNAIDS report. “As COVID-19 pushes the AIDS response even further off track and the 2020
targets are missed, UNAIDS is urging countries to learn from the lessons of underinvesting in health
and to step up global action to end AIDS and other pandemics.”

“In a new report, Prevailing against pandemics by putting people at the centre, UNAIDS is calling on
countries to make far greater investments in global pandemic responses and adopt a new set of bold,
ambitious but achievable HIV targets. If those targets are met, the world will be back on track to
ending AIDS as a public health threat by 2030. The global AIDS response was off track before the
COVID-19 pandemic hit, but the rapid spread of the coronavirus has created additional setbacks.
Modelling of the pandemic’s long-term impact on the HIV response shows that there could be an
estimated 123 000 to 293 000 additional new HIV infections and 69 000 to 148 000 additional
AIDS-related deaths between 2020 and 2022….”

“Although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have done
remarkably well and have achieved or even exceeded the targets set for 2020, many more countries
are falling way behind. The high-performing countries have created a path for others to follow.
UNAIDS has worked with its partners to distil those lessons into a set of proposed targets for 2025
that take a people-centred approach….”

The report also argues that we need to learn from the AIDS battle. Enter a People’s Vaccine.

On the latter, see HPW: UNAIDS Calls For A “People’s” COVID Vaccine – Need To Get Core Public
Health Programmes Back On Track

“In a message at the launch of the annual World AIDS Day report, Prevailing against pandemics by
putting people at the centre, UNAIDS Executive Director Winnie Byanyima also called on the global
pharma industry to unlock the secrets to their COVID-19 vaccine technologies to produce a cheap
and accessible “People’s Vaccine”….”

 • Coverage of the UNAIDS report via the Guardian - Surge of Aids-related deaths feared as
 Covid pandemic puts gains at risk

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“Just a six-month disruption to medical supplies induced by Covid-19 could result in an extra
500,000 Aids-related deaths in sub-Saharan Africa by the end of 2021, according to data modelling in
the annual report from UNAids….”

Byanyima: ““HIV has been slipping down the international agenda for some years. That is why I am
calling on leaders to come forward to support a UN general assembly high level meeting on ending
Aids in 2021 to address with urgency the outstanding issues that are holding us back from ending the
epidemic as a public health threat by 2030.”

 • And HPW - UNAIDS Proposes New HIV 2025 Targets – Calls For Countries To ‘Step Up’
 Pandemic Preparedness Investment

Lancet Editorial – Maintaining the HIV response in a world shaped by Covid-19
Maintaining the HIV response in a world shaped by COVID-19

“…. Against the backdrop of an extraordinary health crisis, this year's campaign calls for global
solidarity and joint responsibility. To health leaders facing many competing priorities, what might
this entail in practice? In 2018, the International AIDS Society-Lancet Commission envisioned a new
era of global solidarity, in which the HIV response would integrate with the broader global health
field. Built on the AIDS movement's commitment to human rights, gender equality, and health equity,
this new era could focus on developing robust, flexible, people-centred health systems, achieving
universal health coverage, and addressing the social and structural determinants of health. The
Global Fund to Fight AIDS, Tuberculosis and Malaria adopted a systems-strengthening approach in
2016. For other institutions that have been instrumental in the AIDS response, this outlook should
mean that fragmented, siloed approaches are replaced with broader health system strengthening
and preparedness that integrate HIV with other health priorities. The integration of HIV with
COVID-19 is already happening. COVID-19 has compelled numerous countries to accelerate the
scale-up of differentiated service delivery for HIV by expediting multi-month dispensing of HIV
medicine, which they otherwise may not have done. COVID-19 is imperilling HIV services and forcing
health systems to adapt. But adaptations need not always be harmful…..”

G20 Leaders’ Summit (virtual, Ryadh, last weekend)
In general, the summit failed to deliver, certainly in terms of global health. Strong in terms of
rhetoric, but few concrete commitments, at least for now. For example in terms of funding for
Covax & the ACT-Accelerator… where huge funding gaps remain.

Also on debt relief, not that much progress was made (apart from what was already in the works).

See below for some reads & analysis :

Leaders’ Declaration
https://www.g20riyadhsummit.org/pressroom/g20-riyadh-summit-leaders-declaration/

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Among others, with this paragraph (3): “We have mobilized resources to address the immediate
financing needs in global health to support the research, development, manufacturing, and
distribution of safe and effective COVID-19 diagnostics, therapeutics and vaccines. We will spare no
effort to ensure their affordable and equitable access for all people, consistent with members’
commitments to incentivize innovation. In this regard, we fully support all collaborative efforts,
especially the Access to COVID-19 Tools Accelerator (ACT-A) initiative and its COVAX facility, and
the voluntary licensing of intellectual property….” “We recognise the role of extensive
immunisation as a global public good.”

Guardian - G20 leaders pledge to distribute Covid vaccines fairly around world
https://www.theguardian.com/world/2020/nov/22/g20-leaders-pledge-to-spare-no-effort-to-
distribute-covid-vaccines-fairly

“G20 leaders meeting remotely pledged on Sunday to “spare no effort” to ensure the fair
distribution of coronavirus vaccines worldwide, but offered no specific new funding to meet that
goal….”

“The EU and the UN say there is a £4.5bn funding shortfall this year that the G20 nations should
fill. Countries have so far invested $10bn in the Access to Covid-19 Tools (ACT) Accelerator and its
vaccine pillar, the Covax Facility. The two schemes are designed to ensure the vaccines do not remain
the preserve of the wealthiest economies.”

PS: another 20+ billion is needed (for 2021) for ACT-A.

“… The summit also discussed how to help stave off possible credit defaults among developing
nations as their debt soars in the economic upheaval the virus has unleashed. The G20 had already
extended a debt service suspension initiative (DSSI) for developing countries until June next year,
but Guterres had pushed for a commitment to extend it until the end of 2021. The draft
communique did not offer a firm commitment, as countries wait to see the scale of the
international debt crisis. G20 finance ministers will instead examine the recommendation when the
IMF and World Bank meet next spring and see “if the economic and financial situation requires”
another six-month extension. Italy will chair the G20 in 2021….”

NYT - G20 Summit Closes With Little Progress and Big Gaps Between Trump and
Allies
https://www.nytimes.com/2020/11/22/us/politics/g20-summit-
trump.html?referringSource=articleShare

“….Over all, the communiqué offered little in terms of any breakthrough announcements beyond
general appeals for more global cooperation and “affordable and equitable access” to
therapeutics and vaccines. The lack of more significant initiatives underscored how difficult it is for
the G20 to carry out an agenda when the United States is indifferent — Mr. Trump skipped part of
the summit to play golf — or even hostile to many of its positions, even during a pandemic that has
killed more than 1.3 million people globally….”

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Devex - Few results from G-20 meeting as decisions await new US administration
https://www.devex.com/news/few-results-from-g-20-meeting-as-decisions-await-new-us-
administration-98619

“The G-20 discussions and resulting communiqué from the leaders’ meeting over the weekend
include some positive language, but more concrete action on a number of issues — from COVID-
19 response to climate — has been delayed until the next U.S. presidential administration is in
place, experts told Devex.”

PS: “… LeCompte said there is an expectation that U.S. President-elect Joe Biden will call for an
emergency G-20 meeting early in his administration, which could be an opportunity to push
forward on a number of issues, including climate and International Monetary Fund Special
Drawing Rights. Some of the issues were seemingly being pushed until next year in anticipation of a
new U.S. administration with different views, Atienza said….”

FT - “State heads skirt the question of how many doses would be released to
Covax scheme”
https://www.ft.com/content/5f5e5a8c-1b94-438f-8f10-212126883e6c

(PS: this was written before the encouraging news on the Astra-Zeneca vaccine.)

Excerpt: “So far the world’s most powerful economies have bought up almost all of the available
doses of the two most promising Covid-19 vaccines from Moderna and the Pfizer-BioNTech
partnership. The companies were the first to release data from phase 3 clinical trials and both shots
have demonstrated an efficacy rate of more than 94 per cent. Pfizer and BioNTech have the capacity
to produce 1.35bn doses of their vaccine by the end of 2021, including 50m doses by the end of the
year. The majority of those doses have been reserved by the US, EU, UK and Japan. The G20 leaders
skirted the question of how many doses they would reserve for their own populations and how
many they would release to the Covax scheme, which aims to ensure the global distribution of 2bn
vaccine doses by the end of 2021….”

Reuters - G20 leaders seek to help poorest nations in post-COVID world
https://www.reuters.com/article/uk-g20-saudi/g20-leaders-seek-to-help-poorest-nations-in-post-
covid-world-idUSKBN2810JD

With the respective stances from EU, China, Russia, …

 • For example, the European one:

“…. the European Union urged G20 leaders quickly to put more money into a global project for
vaccines, tests and therapeutics - called Access to COVID-19 Tools (ACT) Accelerator - and its
COVAX facility to distribute vaccines. “At the G20 Summit I called for $4.5 billion to be invested in
ACT Accelerator by the end of 2020, for procurement & delivery of COVID-19 tests, treatments and
vaccines everywhere,” European Commission head Ursula von der Leyen said on Twitter. … “We need

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to show global solidarity,” she said….” …”… To prepare for future outbreaks, the EU is proposing a
treaty on pandemics.”

 • China: China calls for 'global firewall' to halt spread of COVID-19

“Chinese President Xi Jinping vowed to strengthen his country's cooperation with other countries on
COVID-19, stressing the need for a "global firewall" to reopen trade and to make vaccines available
to all during a virtual summit of leaders from the world's 20 biggest economies…..”

“China has proposed a global mechanism on the mutual recognition of health certificates based on
nucleic acid test results in the form of internationally accepted QR codes…..”

See also Xinhua - Remarks by Chinese President Xi Jinping at 15th G20 Leaders' Summit

NPR - Angela Merkel Raises Concern Over Coronavirus Vaccine Plan For Poorer
Countries
NPR;

“Speaking on Sunday during a two-day virtual G20 global summit, Merkel said progress toward
developing a system for distribution to less wealthy countries has been slow and that she would
raise the issue with the global vaccine alliance, GAVI. "We will now speak with GAVI about when
these negotiations will begin because I am somewhat worried that nothing has been done on that
yet," she said.

“… Duke University researchers suggested earlier this month that poor countries may have to wait
up to four years to get a vaccine, while wealthy nations claim the lion share of the world's future
doses, leaving billions of people without immunizations. …. … COVAX recently announced more than
$2 billion had been raised from the European Commission, Spain, France, Korea, and others, to aid in
this effort, but that there is still a $5 billion shortfall for 2021….”

G20 Research group - G20 Ryadh Summit
https://edition.pagesuite.com/html5/reader/production/default.aspx?pubname=&pubid=62533094
-737e-486d-8290-df1a414dc4a5

Interesting read, ahead of the G20 Ryadh Summit. With pieces from many global health leaders
(including dr Tedros, Winnie Byanyima, Seth Berkley, …) and analyses, including one by Ilona
Kickbusch, among others.

Do check out certainly, Health is Wealth (by Winnie Byanyima).

Tweet Ilona Kickbusch (ahead of the G20 summit): “Minimum expectations for #G20 summit also in
my view: Equitable and affordable access to vaccines ( fully funding #COVAX) and expanding the
scope of debt relief programme for the poorer countries. #COVID19. “

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That didn’t quite materialize. Hopefully early 2021.

Global Health Governance

Gavi and IOM join forces to improve immunisation coverage for migrants
https://www.gavi.org/news/media-room/gavi-and-iom-join-forces-improve-immunisation-coverage-
migrants

“Today, Gavi the Vaccine Alliance and the International Organization for Migration (IOM) signed a
memorandum of understanding to strengthen their collaboration on vaccination efforts and
related health services for migrants and forcibly displaced persons across the world, both regarding
routine immunisations as well as in response to outbreaks….” The agreement focuses on reaching
missed communities in humanitarian and emergency settings with vaccination.

GAVI - COVAX Facility convenes first meeting of COVAX AMC engagement group
https://www.gavi.org/news/media-room/covax-facility-convenes-first-meeting-covax-amc-
engagement-group

(20 Nov) “The COVAX AMC Engagement Group, composed of Gavi COVAX AMC participants, donors,
and other stakeholders, forms a key component of Facility governance. Together with the COVAX
Shareholders Council comprised of self-financing participants, all 187 economies participating in the
COVAX Facility are represented in the Facility’s governance structure. …” On its first meeting on
Monday. “The AMC Engagement Group, which is comprised of all AMC-eligible participants and
donor governments and will be self-organising, is a key component of COVAX Facility governance.
More than 500 participants, including high-level representatives from 101 economies, participated in
the half-day virtual meeting….

NYT - An ‘Electrifying’ Economist’s Guide to the Recovery
https://www.nytimes.com/2020/11/19/us/economist-covid-recovery-mariana-mazzucato.html

“Mariana Mazzucato, a professor who has the ears of world leaders and chief executives, envisions
a post-pandemic world that redefines what is valued.” Well worth a read, certainly also with a view
on her new role for WHO.

For more on Mazzucato’s views, see also Foreign Affairs - Capitalism After the Pandemic.
“Getting the Recovery Right.”

BMJ blog - Strengthening pandemic preparedness and response begins with
answering the question: where are the women?
C Wenham et al; https://blogs.bmj.com/bmj/2020/11/20/strengthening-pandemic-preparedness-
and-response-begins-with-answering-the-question-where-are-the-women/

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“…to tackle the downstream effects of disease outbreaks on women and other excluded genders, we
must examine the policies that are created to prevent, detect, and respond to health emergencies,
and assess potential revisions to these policies to mitigate against some of these avoidable harms.
The Independent Panel for Pandemic Preparedness and Response (IPPPR) and the IHR Review
Committee can be starting points for taking action on gender. We identify critical changes to
the International Health Regulations (IHR) and the Health Emergencies Programme at the World
Health Organization (WHO). As the key normative framework and international legally-binding
mechanism for global health security, amendments to the IHR and as a result, WHO’s efforts in
health emergencies, would set precedent for meaningful gender mainstreaming in global disease
control efforts. This commitment would encourage the cascade of needed gender awareness and
inclusion efforts by everyone in the global health landscape, especially member states….”

Beijing-based development bank AIIB to target healthcare in Asia
https://www.ft.com/content/5c593a14-a4f2-4ae7-ac07-b63a40a21e36

“New unit to consider loans for areas such as improving wet markets and sewage monitoring.”

“The Beijing-based Asian Infrastructure Investment Bank is setting up a department focused on
healthcare and education infrastructure after the coronavirus pandemic exposed the region’s
weaknesses in the area. The AIIB had long been considering a healthcare unit but Covid-19
accelerated its plans, said Erik Berglöf the bank’s chief economist, who is working on the new
department’s launch. “Definitely, Covid has shown the importance of the primary healthcare
system in offering resilience to pandemics,” Mr Berglöf told the Financial Times. “We saw that in
many countries in Asia, the basic healthcare system didn’t hold up very well. That’s clearly something
that needs to be addressed.” Adding ‘soft’ infrastructure projects to its portfolio opens the
possibility of the AIIB becoming a ‘one-stop shop’ for regional development Ayse Kaya, Swarthmore
College The new department is a shift for the development bank, which in the four years since its
establishment has focused on financing infrastructure projects in sectors such as energy, transport
and water. In April, the AIIB extended a $355m emergency loan to China supporting the public health
response to Covid-19 in Beijing and Chongqing, the institution’s first foray into the sector. The bank,
which is hiring a director-general to head the new “social infrastructure” unit, is aiming to appoint
vital staff before the end of the year. Mr Berglöf said it was too early to disclose the new
department’s financing target. But the AIIB would initially co-finance healthcare and education
projects and consider standalone projects in the longer term as it built experience. “

“… “Adding ‘soft’ infrastructure projects to its portfolio opens the possibility of the AIIB becoming a
‘one-stop shop’ for regional development,” said Ayşe Kaya, associate professor of political science at
Swarthmore College. “This will increase the institution’s competitiveness and help distance it from
China’s contentious Belt and Road Initiative.”

And a few links:

 • USAID - USAID participates in GHS agenda ministerial, calls on the governments of member
 countries to make new commitments.

 “From November 18 to 20, 2020, the United States Agency for International Development (USAID)
participat[ed] in the official United States Delegation to the Sixth Global Health Security Agenda

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(GHSA) Ministerial, hosted this year by the Government of the Kingdom of Thailand in a live virtual
format. USAID [came] together with interagency colleagues from across the U.S. Government —
including representatives from the Departments of State, Health and Human Services, and Defense,
and others — as well as delegations from the governments of dozens of partner countries, non-
governmental organizations, and international agencies, to discuss critical issues related to global
health security…”.

 • Wemos – More engagement and inclusivity in the GFF Strategy – A Lobby success ( blog by
 M Koutsoumpa)

Coming up: UNGA special session (on Covid response) (3-4
Dec )

Concept note: Special Session of the General Assembly in response to the Coronavirus disease
(COVID-19) Pandemic.

As a reminder: “…The United Nations system-wide response to COVID-192 is based on three pillars:
a largescale, coordinated, comprehensive health response; a wide-ranging effort to safeguard lives
and livelihoods; and a transformative recovery process….”

Meanwhile, do join the movement calling on world leaders meeting Dec 3-4 at #UN General
Assembly Special Session on #COVID19 to adopt more comprehensive public health approaches.
See last week’s IHP’s Featured article (by Kent Buse & Anthony Zwi), and also RCPHcall@gmail.com.

Or this tweet: “*LAUNCHING 1 DEC* Call to #ReclaimPublicHealth. Landing just before @UN
General Assembly Special Session on #Covid19 the Call outlines 10 principles based on co-creation,
#humanrights & trust that put #communities at centre of #publichealth.”

Covid key news

Cidrap News – Pace of global COVID-19 rise slows, but deaths still climbing
https://www.cidrap.umn.edu/news-perspective/2020/11/pace-global-covid-19-rise-slows-deaths-
still-climbing

(Nov 25) “The global surge in COVID-19 cases slowed a bit last week for the first time in months,
though deaths from the virus continued a steady rise, the World Health Organization (WHO) said
yesterday in its latest weekly situation report. Led mainly by continued levels in the Americas and
Europe, the pandemic total topped 60 million cases today. Though acceleration slowed, the world
still added about 4 million cases last week, and officials recorded 67,000 more deaths, the WHO said.
The decline in cases came many from Europe and Southeast Asia, though Europe still reported the
largest portion of cases and deaths over the past week. … As cases and deaths continue to climb in
the Americas, especially in the United States, Africa reported the highest jump in cases and deaths
over the past week, 15% and 30%, respectively. The Mediterranean and Western Pacific regions
also reported increases…”

 13

UN News - ‘Real hope’ surrounding COVID vaccines ‘cannot be overstated’ – WHO
chief
https://news.un.org/en/story/2020/11/1078372

“Along with other tried and tested public health measures, the head of the World Health
Organization (WHO) told journalists on Monday that “there is now real hope” that vaccines will
play an essential part in helping end the COVID pandemic. “With the latest positive news from
vaccine trials, the light at the end of this long, dark tunnel is growing brighter”, said Director-General
Tedros Adhanom Ghebreyesus. “The significance of this scientific achievement cannot be
overstated”. … … Noting that no vaccine in history has been developed as rapidly, the WHO chief
remarked that the scientific community had set “a new standard for vaccine development” and
now the international community must set “a new standard for access”. “The urgency with which
vaccines have been developed must be matched by the same urgency to distribute them fairly”, he
spelled out, warning of a real risk that the poorest, and most vulnerable will be “trampled in the
stampede” to get innoculated. …”

SCMP - WHO names line-up for international team looking into coronavirus
origins
https://www.scmp.com/news/china/science/article/3111314/who-names-line-international-team-
looking-coronavirus-origins

“Ten public health experts, animal health specialists and virus hunters will work alongside Chinese
scientists. World Health Organization says it has been reassured by Beijing that they will be on the
ground in China ‘as soon as possible’.”

“The 10-person team includes public health experts, animal health specialists and virus hunters
from Japan, Qatar, Germany, Vietnam, Russia, Australia, Denmark, the Netherlands, Britain and the
United States. They will work alongside Chinese scientists on a set of investigations into how the
virus that causes Covid-19 emerged and spilled over into humans, triggering a pandemic that has
now claimed over 1.4 million lives. WHO on Monday said the names of the international team
members had been shared with member states and released online, despite concerns about
harassment given that the virus origins have become a highly contentious subject. …. Members of
the international team were selected by the WHO and finalised in consultation with Beijing, Ryan
said last month. The Chinese and international teams held their first virtual meeting on October
30 and continue to meet online…. … One hanging question is when the international team will join
field studies on the ground in China, considered a critical part of the mission, which was called for by
over 130 nations at a May meeting of the WHO’s governing body. Ryan on Monday said they “fully
expect” the international team will be on the ground for this work, and they would like the scientists
to be “deployed as soon as possible”. …. …. The scientific mission’s phase one work centres around
Wuhan, the city where the first cluster of cases was identified. ….”

Guardian - Tech giants join with governments to fight Covid misinformation
https://www.theguardian.com/technology/2020/nov/20/tech-giants-join-governments-fight-covid-
misinformation-facebook-twitter-google

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“Facebook, Twitter and Google are working with a coalition of governments including the UK and
Canada to fight misinformation and conspiracy theories around Covid vaccinations. Formed by the
British fact-checking charity Full Fact, the new working group will aim to set cross-platform standards
for tackling misinformation – as well as how to hold organisations accountable for their failure to do
so. … …. As well as the three technology companies, the partnership includes the UK’s Department for
Digital, Culture, Media and Sport and Canada’s Privy Council Office, fact-checkers from South Africa,
India, Argentina and Spain, the Reuters Institute for the Study of Journalism, and the journalism non-
profit First Draft….”

And some links:

AP - Mexico becomes 4th country to hit 100,000 COVID-19 deaths

“Mexico passed the 100,000 mark in COVID-19 deaths Thursday, becoming only the fourth country —
behind the United States, Brazil and India — to do so.”

The Telegraph - Fears of Covid-19 second wave in India as daily cases increase again

“A lack of testing gives a false impression that Covid-19 is on the decline in the world's second-most
populous country.”

Covid access to vaccines, medicines, …
On the (disappointing) WTO (Trips waiver) meeting from end of last week, the potentially
‘gamechanger’ vaccine from Astra Zeneca (still with some caveats, though), and more.

Reuters - Wealthy countries block COVID-19 drugs rights waiver at WTO - sources
https://www.reuters.com/article/us-health-coronavirus-wto/wealthy-countries-block-covid-19-
drugs-rights-waiver-at-wto-sources-idUSKBN280211?il=0

No “white smoke” from WTO so far. In fact, anything but.

“Wealthy nations on Friday reiterated their opposition to a proposal to waive intellectual property
rules for COVID-19 drugs, three trade sources said, despite pressure to make an exception to improve
access to drugs for poorer countries. Supporters of the waiver say existing intellectual property (IP)
rules create barriers on access to affordable medicines and vaccines and they want restrictions to be
eased, as they were during the AIDS epidemic. But opposition from the European Union, the United
States and some other wealthy nations at a meeting on Friday, means the proposal set to go
before the World Trade Organization’s (WTO) General Council next month is likely to fail….”

And a link: India seeks support from China, Russia at WTO to exempt Covid-19 drugs, vaccines from
patent protection

 15

LSE (blog) - Poorer countries can’t wait until 2022. The WTO should suspend
COVID vaccine patents now
S Memon; https://blogs.lse.ac.uk/covid19/2020/11/23/poorer-countries-cant-wait-until-2022-the-
wto-should-suspend-covid-vaccine-patents-now/

Spot on. “Wealthy countries are first in line in the queue for vaccines, and the WTO is refusing to
suspend patent enforcement so that poorer countries can manufacture generic versions. Most
people will have to wait until 2022. This is unconscionable, say Shaz Memon and Akber Ali. India in
particular is in an excellent position to roll out its own versions.”

Geneva Health Files – TRIPS waiver discussions: moving the needle
Geneva Health Files;

Geneva Health Files follows the TRIPS waiver discussions closely.

This week’s Feat article: The needle has moved, but the fight is on. “EU bloc and others, push for
TRIPS flexibilities, a defining departure from the past.”

“This story tries to capture prevailing dynamics shaping the discussions on this proposal, it also
reviews key statements from certain countries and presents the possible course the proposal could
run in the coming weeks.”

“The chair Ambassador Xolelwa Mlumbi-Peter, has said a formal TRIPS Council will be convened on
10 December with the aim of adopting a report that can be submitted to the next General Council,
scheduled for 16-17 December….”

Guardian - Oxford AstraZeneca vaccine to be sold to developing countries at cost
price
https://www.theguardian.com/global-development/2020/nov/23/oxford-astrazeneca-results-covid-
vaccine-developing-countries?CMP=share_btn_tw

“The coronavirus vaccine produced by Oxford University and AstraZeneca will be available on a
non-profit basis “in perpetuity” to low- and middle-income countries in the developing world.”

“The details of arrangements to supply poorer countries came as AstraZeneca revealed the interim
results of a phase 3 trial of the vaccine, which is being heralded as the first to meet the more
challenging requirements of the developing world. … …. Unlike the vaccine produced by Pfizer-
BioNTech, which requires ultra-cold storage, the AstraZeneca vaccine can be kept in the kind of
conventional fridge used to store vaccines around the world, with a shelf life of up to six months.
Also unlike the Pfizer-BioNTech vaccine, AstraZeneca’s experimental vaccine is already a part
of Covax, the global initiative that is hoping to distribute about 2bn doses to 92 low- and middle-
income countries at a maximum cost of $3 a dose. As global justice campaigners demanded more
transparency from Oxford and AstraZeneca over details of the deal to supply doses to people in the
developing world, the partnership confirmed in a statement that lower-income countries would
receive the vaccine on a not-for-profit basis. “A key element of Oxford’s partnership with

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AstraZeneca is the joint commitment to provide the vaccine on a not-for-profit basis for the
duration of the pandemic across the world, and in perpetuity to low- and middle-income
countries,” it said. As part of the initiative, AstraZeneca announced during the summer it would make
1.3bn doses of its then untried vaccine available at cost to ensure that any vaccine was not hoarded
by the world’s wealthiest countries….”

Later in the week, due to increasing commotion about the results (communication), the CEO (see
HPW) announced a new international trial will be done to validate the results (and test a more
efficient dose).

For more analysis on this potential ‘gamechanger’ for vaccine access in LMICs, including the growing
scrutiny about the vaccine results, as the week progressed, see:

 • FT - Doubts raised over AstraZeneca-Oxford vaccine data

“Disquiet is growing over the way that Oxford university and AstraZeneca have handled the early
readout from trials of their coronavirus vaccine, which much of the developing world may rely on to
emerge from the pandemic. The results were hailed a success for showing an average efficacy of 70
per cent — a figure reached by pooling the results from cohorts on two different dosing regimens. ….
But on Tuesday, Moncef Slaoui, the head of Operation Warp Speed, the US government’s funding
programme for vaccine development, disclosed that second subgroup was limited to people aged 55
or below, a demographic with lower risk of developing severe Covid-19. Oxford and AstraZeneca did
not disclose the age breakdown on Monday, when results were released. “There are a number of
variables that we need to understand,” Mr Slaoui said. It is still possible the difference in efficacy was
“random”, he added. Markets have taken notice. London-listed shares in AstraZeneca have lost more
than 6 per cent after the announcement. …”. …. “Much of the confusion stems from Oxford and
AstraZeneca not being fully forthcoming on the reason for the two different dosing regimens —
which changed unexpectedly as trials progressed. In a statement late on Wednesday, Oxford
acknowledged a difference in manufacturing and measurement processes meant later phases of its
clinical studies resulted in half a dose being administered instead of a full one….. Prof Dean
contrasted the AstraZeneca disclosures with those from other trials. “We had this precedent set by
the other vaccines with Moderna and Pfizer/BioNTech and these were single trials, with a protocol
released in advance,” she said. “We had a chance to look through it . . . It was fairly
straightforward.”…” See also Science - After dosing mix-up, latest COVID-19 vaccine success
comes with big question mark

 • NYT - What We Know About AstraZeneca’s Head-Scratching Vaccine Results

 “AstraZeneca’s new clinical trial results are positive but confusing, leaving many experts
 wanting to see more data before passing final judgment on how well the vaccine will work.”

 • HPW - AstraZeneca Breakthrough Heightens Competition Between Two Different World
 Views On Vaccine Procurement & Distribution

“… it’s increasingly clear that the funds available to support the ambitious worldwide COVAX
vaccine procurement and distribution facility planned by WHO and its partners through its ACT
Accelerator initiative, is, at present, woefully inadequate. …”

 17

“… Any deadlocked funding also threatens to pit two long standing world views against each other
– in much more direct competition than what has been seen in decades. One, led by the G20
economies, is hugely invested in their pharma industries, and a donor-driven regime of massive
vaccine purchases at reduced prices, and distribution for poorer countries. They argue that the
private sector confidence that they will reap as a reward for their efforts is necessary to incentivize
the expensive investments required for any vaccine R&D, let alone the COVID research effort that has
taken place at unprecedented scale and speed. Another vision, led by South Africa and India, is
challenging that more fundamentally. They are pressing ahead for an IP “waiver” in the World
Trade Organization (WTO) – so that countries would have the discretion to waive, for the period of
the pandemic, not only COVID-related patents, but also trade secrets, industrial designs and
copyrights associated with prized vaccines, tests or treatment technologies. This, South Africa,
India and its partners say, would greatly expand countries’ own ability to produce, as well as to
export and import desperately needed vaccines, tests, and treatments quickly, and at much reduced
prices – while bolstering the greater self-sufficiency that has become so important in the
pandemic….”

 • A good COVID-19 vaccine is one that works for rich and poor alike (by H Slim)

“There are seven key elements to a pro-poor vaccine, and the Oxford-AstraZeneca vaccine seems to
score five out of seven so far ….”

 • BBC - Covid-19: Oxford University vaccine shows 70% protection Or 90 % ‘under the right
 circumstances’.

 • Bloomberg - Astra-Oxford Shot Is Key to Escaping Pandemic for Many Nations

UN News - UNICEF planning ‘mammoth operation’ to deliver COVID-19 vaccines
https://news.un.org/en/story/2020/11/1078302

“The UN Children’s Fund (UNICEF) is working with more than 350 partners, including major airlines,
shipping lines and logistics associations from around the world, to deliver COVID-19 vaccines to over
92 countries, as soon as doses become available, the agency said on Monday. “ “ Meanwhile, nearly
2bn doses of Covid-19 vaccines will be shipped and flown to developing countries next year in a
“mammoth operation”, the UN children’s agency Unicef said on Monday, as world leaders vowed
to ensure the fair distribution of vaccines.” As part of Covax.

See also Devex - COVID-19 vaccine work for UNICEF is about to become more intense. Here's why.

“UNICEF’s ongoing urgent work to help countries prepare for a COVID-19 vaccine is about to
become “even more intense,” according to Benjamin Schreiber, deputy chief for UNICEF's global
immunization program. … …. All 92 low- and middle-income countries that are slated to receive
vaccines as part of the COVAX Facility will soon release their country-specific COVID-19 deployment
vaccination plans. UNICEF, which is partnering with Gavi, the Vaccine Alliance, and the World Health
Organization in the monumental task of readying for the deployment of vaccines and vaccine
supplies, will want to ensure that countries can carry out their strategies….”

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“…. UNICEF is working with 350 global airlines and freight providers to facilitate COVID-19 vaccine
transport and delivery. The agency announced in October that it is planning to stockpile 520
million syringes in strategically located warehouses — from Copenhagen to Dubai — so it can
quickly deliver the items to countries once approved COVID-19 vaccines become available. “… By way
of example: “ … When it comes to cold chain capacity, in particular, countries in South and
Southeast Asia, for example, might be “a bit better prepared than a lot of the other countries we
work with,” explained UNICEF’s cold chain expert Michelle Seidel….”

NYT - Bill Gates, the Virus and the Quest to Vaccinate the World
https://www.nytimes.com/2020/11/23/world/bill-gates-vaccine-coronavirus.html

Well worth a read. With some interesting, though somewhat sycophantic, quotes. Baffling ones,
actually.

Guardian - Wealthy nations urged to give portion of Covid vaccine as
'humanitarian buffer'
https://www.theguardian.com/global-development/2020/nov/20/wealthy-nations-urged-to-give-
portion-of-covid-vaccine-as-humanitarian-buffer

“…. The French government is understood to be taking the lead on rallying contributions to the
buffer, with president Emmanuel Macron saying in a speech on Friday he hoped France and its
European partners would donate a part of their doses to healthcare workers and others “who need it
most, in the most fragile countries”. Sources involved in the negotiations said French officials have
flagged that giving between 1% and 5% of their doses on a rolling basis to the humanitarian
stockpile would be politically realistic, though no figure has been finalised. … … The intention to
create the buffer was announced by the WHO, but it is yet to give details of the size of the stockpile
and how it would operate…..”

Quartz – The countries that have already ordered enough vaccines for their entire
population
https://qz.com/1937072/the-countries-that-have-already-ordered-enough-covid-19-vaccines/

Based on the Duke data. “…Should all three of these candidates (i.e. Moderna, Pfizer & Astra Zeneca)
gain regulatory clearance, four countries—Canada, Japan, the UK, and the US—could vaccinate
more than 100% of their entire populations based on the number of these three vaccines they’ve
already pre-ordered….”

FT - Vaccine contracts shrouded in secrecy despite massive public funding
https://www.ft.com/content/95c49b5a-f2c7-49a3-9ac5-3e7a66e3ad6b

“Campaign groups and some politicians argue more information should be disclosed.”

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