IHPnews 622: Crunchtime? - International Health Policies

IHP news 622 : Crunch time ?
( 21 May 2021)

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 an evidence-based believer in synchronicity, I doubt it was just a coincidence that I got my (first)
jab on World Hypertension Day . I didn’t have a bittersweet feeling, like dr. Tedros last week
when he got his, I just hope all 7 billion people (or at least the adults among them) get this jab (x2)
sooner rather than later.

From that angle, it’s good to see that the pressure on G7 countries to share excess doses is at last
steadily increasing, both from UNICEF & WHO this week. Sharing doses is long overdue and nowhere
near enough, though. Tedros said the world has now effectively reached a stage of ‘vaccine
apartheid’, while calling on vaccine makers to make up the (Covax) gap. Not for the first time, he
didn’t mince words: “trickle down vaccination is not an effective strategy for fighting a deadly
respiratory virus". Neither is the trickle down “global solidarity” we’ve mostly seen so far. Worse, our
wonderful “winner takes all” global economic system has sparked a bunch of new vaccine
billionaires, as the People’s Vaccine Coalition flagged, ahead of the G20 Global Health Summit in
Rome: “Pharma monopoly logic: can create billionaires, can't vaccinate billions of people.”

Today’s Global Health summit should at least bring some progress (although our hopes shouldn’t be
too high, it appears), while a full-blown multilateral effort led by the Biden administration can
probably be expected in the coming weeks, by the G7 summit in the UK in June. (let’s hope it won’t
be ‘for “democracies” only’). At least on the need for (boosting) manufacturing (capacity) in all
regions, everybody increasingly agrees - if not for this pandemic, then for the next.

On Tuesday, Emmanuel Macron chaired a summit on post-pandemic recovery in sub-Saharan
Africa, launching a multibillion-dollar “New Deal” for the continent. You don’t have to teach Jupiter
how to communicate. Accelerating vaccination on the continent was also high on the agenda, as
you can imagine.

On the conceptual & paradigmatic front, we’d like to flag the concept Health Systems for Health
Security, increasingly in vogue. A WHO/University of Leeds workshop was dedicated to it on
Thursday. A number of possible paradigm shifts could also be looming on the horizon in the
slipstream of the Covid pandemic, at least if we dare to hope.

For the first one, see Gregg Gonsalves’ tweets of last weekend, commenting on increasingly critical
coverage on Bill Gates in a number of areas (among others, re IP/global vaccine equity & Bill’s
oversized role in global health governance) : “So many people, institutions in global health are in
hock to industry or Gates or both. They have constrained the possibilities in global health along the
contours of the market, so that private gain takes precedence over public good. May #COVID19 crack
open a new world of hope.” “….The philanthropy-capitalist model of public health/global health

hems in policies and programs along the contours of the market, puts private gain over public good.
Always. It's time for a change. ” Agree .

A FT op-ed, by Ayoade Alakija, co-chair of the Africa Vaccine Delivery Alliance, pointed to another
paradigm shift - Pandemic gives Africa a chance to free itself from aid dependency. Hope so too
 .

Finally, in an “Inside Geneva” podcast, looking ahead to the 74th World Health Assembly, Suerie
Moon (Graduate Institute) indicated that IP waivers could, and probably should, be the foundation
for a new “social contract” during global health crises, especially when, as with Covid- 19,
governments ( and thus taxpayers) have shouldered the financial risk of developing the vaccines. She
considered the changed US position as a signal of a shifting social contract in this respect, that needs
to be renegotiated. Do inform Ursula, Charles, Boris & Angela, Suerie!

More in general, top of the agenda at the WHA will be learning lessons from the pandemic (if not
now, then when ?) or as Suerie put it: “What do we need to do to fix a broken system? That Covid
has shown over and over again is not functioning?”. She called the Covid pandemic ‘a reckoning’ at
both national and global levels. Among others, the ‘pandemic treaty’ discussions might get a fair
amount of attention. As well as a zillion other issues.

PS: as for Saturday evening’s Eurovision 2021 ’s “reckoning”, let’s wait & see. I’ll make sure I have
some crunch food .

Enjoy your reading.

Kristof Decoster

Featured Article

Failing humanity: looking back on the week, remembering
the past
Werner Soors (former ITM staff member)

What a week this was. In case I wouldn’t have noticed, on Friday 14th the mayor of the privileged
town I live in (Antwerp) warned against “the identification of young Muslims, 14-15-16 years old,
with a certain frustration - youngsters who now receive those images, unfiltered through social
media and with one-sided interpretation”. I didn’t feel addressed. After all, I’m 65. He was referring
of course to what was happening in the Gaza strip, and the possibility that the conflict would be
exported to the banks of the river Scheldt.
Saturday 15th. No need to be a Muslim to have a good morning coffee at Lari Chikh in my Antwerp-
North neighbourhood. No usual Berber jokes about King Mohammed VI today. This is Nakba day,

day of Palestinian mourning since 1948. We’re all watching the Israeli bombing of the Gaza strip on
TV, mouth open, in painful silence.
Sunday 16th. My favourite procrastination day. After contemplating missed deadlines, I dwell
through the weekend edition of this country’s self-declared quality newspaper. On the last page, a
reflection on the Palestine-Israel crisis under the heading ‘The echo of Hannah Arendt’. Poor
Hannah. She once really believed in utopian Zionism, then became overtly critical, and has since
been vilified by her kindred (with the exception of Albert Einstein, of course, who also wisely enough
refused to become president of Israel).
Monday 17th. In the Netherlands, Queen Máxima turns 50 and there is no way to escape that in the
Low Countries. These days, anything goes to distract from the real news, even the daughter of a man
actively involved in the ‘dirty war’ of the Argentinean military junta. And oh yes, Máxima gave a
reading of a poem by Pablo Neruda. Aw.
Tuesday 18th. Kristof asks me if my editorial will be ready by tomorrow. I say yes (another deadline).
Good Latin American friends write me not to forget that Tupac Amaru and Micaela Bastidas were
gruesomely executed by the Spanish occupants of their homeland, 240 years ago. Long dead, they
have inspired indigenous resistance and anti-colonial movements ever since. Maybe I could write
something about colonialism?
Wednesday 19th. Quote from an opinion piece in ‘De Standaard’ by 100 Belgian doctors (I co-signed,
no cause for congratulation): “a conflict in which the vast majority of victims fall on one side is not
an operation of war. It is slaughter”. The killing in Gaza goes on. The European Union, minus
Hungary, calls in vain for a ceasefire. I am on Facebook, reading a post from Gaza-born friend and
colleague Majdi Ashour: “This time, from now on, our voices must rise above the voice of battle (…)
Salute to the voices that rise above the sound of the battle, and to end this battle that targets the
bodies, the right to self-determination and the resistance of our people”. Majdi worked many years
for the United Nations Relief and Work Agency (UNRWA) in Gaza City. Is he safe? I haven’t seen him
for a long time, so I call him. He’s in the UK, as a political refugee, yearning to be home. His voice is
soft and gentle as he explains to me that even ‘battle’ is not the correct term for what is going on:
“it’s a battering, with the intent to exterminate”. I’m afraid he’s right.
In 1944, Hannah Arendt concluded her essay ‘A hidden tradition’ with this sentence: “only when a
people lives and functions in consort with other peoples can it contribute to the establishment upon
earth of a commonly conditioned and commonly controlled humanity”. What we witness now –
something that comes dangerously close to ethnic cleansing - is failing humanity, and we all have
blood on our hands. We should raise our voice too.

Highlights of the week

World Hypertension Day (17 May)

Via the Respond newsletter :

“This day has been initiated by The World Hypertension League (WHL), a non-profit, non-
governmental organisation with 80 national hypertension societies as members, to increase the
awareness of hypertension and non-communicable diseases (NCDs). This year’s theme is "Measure

Your Blood Pressure Accurately, Control It, Live Longer", with a particular focus on increasing
awareness of hypertension, especially in low- and middle-income countries.
This date coincides with May Measurement Month (MMM) another initiative led by
the International Society of Hypertension (ISH) and endorsed by the World Hypertension League
(WHL), which consists of the global blood pressure (BP) screening campaign, which in 2019 saw 1.5m
people participating….”

G20 Global Health Summit (Rome, 21 May)
Today’s summit [will] include G-20 members along with Spain, Singapore and the Netherlands as
guests; leaders of WHO and other related UN agencies, as well as global health actors such as Gavi,
The Vaccine Alliance, the Global Fund and CEPI, which has been investing in key aspects of COVID
vaccine R&D.

Expectations aren’t too high (see the analyses ahead of the meeting, below), given that they aim for
a “Rome Declaration of Principles”. Also some advocacy below.

HPW - Draft ‘Rome Declaration’ by G-20 Global Health Summit – Sidesteps Hard
Commitments to New Finance and Vaccine Donations
https://healthpolicy-watch.news/draft-g-20-health-summit-declaration-sidesteps-hard-
commitments-to-new-finance-and-vaccine-donations/

Analysis ahead of the Global Health summit from late last week didn’t sound too promising...

“A draft “Rome Declaration” to be issued at next Friday’s G-20’s Global Health Summit, co-hosted by
Italy and the European Commission (21 May), makes a series of 10 sweeping commitments to
ensure equitable access to vaccines; expand medicines manufacturing capacity; assure WHO
access to sites posing an outbreak risk; and invest in global health systems. But the draft
manifesto seen by Health Policy Watch, framed as a “statement of principles,” also lacks any
concrete targets for COVID vaccine dose-sharing, or medicines and vaccines finance. “

“… WHO and other global health officials have repeatedly said that COVAX and the other ACT-
Accelerator initiatives urgently need some US$18.5 billion from the world’s most industrialised
nations to fund purchases of medicines and tests, as well as vaccines. WHO and other global health
officials have also begged for more vaccine donations. That means that if any such concrete
commitments are to be made, they will have to be negotiated up until, and on, the day of the
meeting of G-20 leaders. …”

… The draft declaration so far also sidesteps mention of another thorny issue – the proposed World
Trade Organization (WTO) waiver on intellectual property rights for COVID products, that the
United States recently said it would support, in the case of vaccine IP. A placeholder text, however,
leaves open “{…possible references to ACT-A, WTO activity, WHO, the MPP, C-TAP, and through
bilateral arrangements}.”

The draft also stops short… of calling for a new Pandemic Treaty. “Finally, the draft Rome
declaration also calls for a stronger global health architecture with a “fully funded, independent
and effective WHO at its centre”. … … The Rome Declaration is being pitched primarily as
a general statement of principles, according to the summit’s advance statement…”

See also Reuters – G20 snubs COVID patent waiver, waters down pledge on WHO’s funding

“Leaders of the world’s largest economies back “voluntary licensing” of COVID-19 vaccine patents,
the draft conclusions of a summit show, watering down a U.S. push for waivers and earlier
commitments to supply more funds to the World Health Organization….”

“The health summit's draft conclusions reflect these differing views and make no mention of patent
waivers. G20 leaders are to commit instead to "patent-pooling" which is a less radical measure to
encourage the sharing of patents. It is still an "unfriendly" move for pharmaceutical companies, an
industry expert said, but far less extreme than a patent waiver.”

“… The conclusions may also deal a blow to the WHO and its scheme to accelerate the distribution
of COVID-19 vaccines, drugs and tests across the world. Global leaders reaffirm their support for the
scheme, known as ACT Accelerator, but refrain from clearly committing to fully funding it. They
"underline the necessity to close its funding gap with fair burden sharing", the draft document
reads, and they call for the scheme's "strategic review". This represents a major watering down of
the initial draft in which leaders explicitly committed for the first time to "fair and full financing"
of the scheme. The original draft, also seen by Reuters, was more influenced by the European
Commission which is one of the hosts of the summit, together with the Italian government which
holds the G20 presidency this year…”

FT - EU to back expansion of vaccine production capacity in Africa
https://www.ft.com/content/d2a47c7e-0b00-4e31-92ab-cd3ff0b9070b

From Monday. “The EU plans to throw its weight behind a push to expand vaccine manufacturing
in Africa after the coronavirus pandemic has underscored a need to broaden the production of life
saving jabs. Ursula von der Leyen, European Commission president, is expected to back proposals to
establish strategic manufacturing hubs in African countries at a global health summit in Rome on
Friday, officials said. … … The bloc is also keen to promote initiatives to increase international
vaccine production, which it argues is a better way to improve poor nations’ access to Covid-19
vaccines than the patent waivers proposed by the US this month. The EU’s contribution could
include both direct EU aid and funding from national development agencies and the European
Investment Bank, European officials said. Alongside the funding, which could extend into the
hundreds of millions of euros, Brussels wants to help build up regulatory capacity, including the
establishment of the African Medicines Agency — a continent wide drug regulator that was
conceived in 2014 but has yet to get off the ground….”

“The European efforts are designed to mesh with an African Union goal set in April for up to 60 per
cent of Africa’s routine vaccine needs to be supplied from within the continent by 2040, up from
just 1 per cent now. Given the long timeframes involved in creating manufacturing capacity, the
changes would be aimed at dealing with possible future pandemics and perennial threats such as
yellow fever. …”

The People’s Vaccine - COVID vaccines create 9 new billionaires with combined
wealth greater than cost of vaccinating world’s poorest countries
https://app.box.com/s/c487wmiyquh9q1glpbatzf5sukls7ph2

“At least nine people have become new billionaires since the beginning of the COVID pandemic,
thanks to the excessive profits pharmaceutical corporations with monopolies on COVID vaccines are
making, The People’s Vaccine Alliance revealed today ahead of a G20 leaders Global Health
Summit. …. Between them, the nine new billionaires have a combined net wealth of $19.3 billion,
enough to fully vaccinate all people in low-income countries 1.3 times. … … In addition, eight
existing billionaires–who have extensive portfolios in the COVID-19 vaccine pharma corporations -
have seen their combined wealth increase by $32.2 billion, enough to fully vaccinate everyone in
India….

Reuters – Invest in health or face credit ratings 'stick' -WHO's expert panel
Reuters;

“States that invest too little in public health could have their credit ratings cut, according to the
chair of a World Health Organization panel that wants a new global body set up to spell out the
risks to financial stability from healthcare failures. The comments by Mario Monti come before a
global health summit on Friday in Rome at which leaders of the Group of 20 richest economies will
discuss the coronavirus emergency and how to prevent major health crises in future. "A pandemic
like this one poses huge threats not just to financial stability but to the whole economic and financial
system," Monti told Reuters. … The former Italian prime minister chairs the WHO's Pan-European
Commission on Health and Sustainable Development, set up last September by the world health
body's chief for Europe, Hans Kluge. It has recommended the G20 establish a Global Health Board
which would work to prevent future pandemics by identifying risks, setting global benchmarks for
preparedness and promoting investment in health infrastructure….”

And via Politico: “…the European Union might announce vaccine donations. The European
Commission asked EU members to donate 100 million doses, but countries are reluctant to commit
to a number just yet…”

74th World Health Assembly coming up (24 May – 1 June)

https://www.who.int/about/governance/world-health-assembly/seventy-fourth-world-health-
assembly

With preliminary docs & agenda.

Some reads & analyses ahead of the WHA, related to some key issues on the agenda.

As Suerie Moon put it at the Graduate Institute introduction for new delegates (on Thursday), “for
Covid to become a game changer, we need at all levels: political leadership, political courage,
political wisdom, and political mobilization. “

HPW - Pandemic Treaty & Other New COVID Initiatives Grab Center Stage At
World Health Assembly
https://healthpolicy-watch.news/pandemic-covid-world-health-assembly/

Must-read analysis ahead of the WHA. “Conquering the COVID-19 pandemic will inevitably be the
main topic for discussion at the impending 74th session of the World Health Assembly, which begins
Monday, 24 May. Global health experts weighed in this week at a series of briefings on what to
expect from at the upcoming event. …”

“The annual World Health Assembly will open online on Monday, with ministers of health from the
World Health Organization’s 194 member states tasked with wading through a heavy agenda
dominated by how to fix the COVID-ridden global health system and step up global response to
future crises. …”

Among others, focal points at the WHA will be: Pushing for Legally Binding Instruments to Fight
Pandemics; Cementing the Power of the WHO to Fight Off Future Health Crises and Eradicate the
Current Pandemic; WHO’s political independence; governance and funding without strings
attached; the question of vaccine equity.”

And this quote: “In the absence of strong action by wealthy donor countries at the G-20 and the
WHA, the trajectory of COVID risks the disease becoming a “pandemic of the poor”, Joanne Liu
warns. For Liu, if the opportunity is not seized at this year’s WHA to adequately address the WHA, by
taking bold decisions and committing to actions then she believes COVID will become an endemic
disease, mostly but will be limited to low and middle income countries, whilst high income countries
leave the rest of the world behind.

Geneva Observer – What does the WHO need? Public health experts are
unanimous: More power, more independence, and more transparency.
https://www.thegenevaobserver.com/

Some more pre-analysis by Jamil Chade. Based on the three reports presented and debated during
the WHA.

Plus: “…Debating and accepting the reports’ conclusions might be the easy part. Agreeing to transfer
power to the organization and fund it adequately might prove to be more difficult and require some
serious diplomatic jostling. It is expected that a resolution calling for the strengthening of the
organization will be approved by consensus—the draft is circulating—but after that things will
proceed incrementally once the low-hanging fruits are dealt with….” The draft has been watered
down substantially already….

HPW – Far-reaching Proposals For Reform On Table at World Health Assembly –
But Will Member States Heed The Call?
https://healthpolicy-watch.news/far-reaching-proposals-for-reform-on-table-at-world-health-
assembly-but-will-member-states-heed-the-call/

Coverage of the “Introduction to WHA 74 session,” by the Global Health Centre of the Geneva
Graduate Institute.

“…some far-reaching recommendations for reform that will be on the table this year could make a
big difference, said a group of high-level global health voices … They referred to proposals by The
Independent Panel for a Pandemic Treaty; limiting the Director General’s term to one five-seven
year stint to remove the position from political influences; and the granting of stronger investigative
powers to visit countries and publish data on outbreak threats, said Julio Frenk, former minister of
health for Mexico and president of the University of Miami, speaking at the event. …”

“However, in the realpolitik of WHA negotiations, passage of most of these key reform measures
remains doubtful to dim, people close to the organisation also told Health Policy Watch….”

“…That has led to two versions of a draft WHA resolution circulating. According to one version,
WHA member states would explicitly agree to begin negotiations towards a legal treaty or
convention on pandemics. But the other version would merely agree upon the creation of a working
group to take forward the recommendations of the Independent Panel as well as two other
investigative committees, which explored the functionality of the International Health Regulations as
well as WHO’s own emergency response team during the pandemic….”

Geneva Health Files - Tied Funds To WHO, But Flexible Funds To Its Partners:
Sustainable Financing Working Group Confronts Challenges
P Patnaik; Geneva Health Files;

Last week Friday’s GHF issue, with focus on the discussions in WHO’s Sustainable Financing Working
group.

“As WHO’s working group on sustainable financing gets down to work, it is bringing to light the
extent to which its financing is tied – this includes even those funds coming from partner agencies.
The inter-governmental working group on sustainable financing met late last month (April 29-30) for
its second meeting and set off discussions on the potential ways to prioritize essential functions of
the WHO given the limited access to “sustainable funds” that the organization currently has.
Geneva Health Files spoke to diplomatic sources who were present at the meeting, to get an
understanding on the discussions evolving within the working group. The emergency preparedness
resolution currently being discussed among WHO member states is expected to come up with a set of
recommendations for this working group. …”

A few excerpts:

“… Member states were informed at the meeting that while donor countries provided flexible funds
to WHO partners including Gavi – The Vaccine Alliance and The Global Fund, those donors
however provided earmarked funding to WHO. … In addition, it also emerged that the funds from
these WHO partners come to WHO in a tied manner. … … … When these agencies were created, it
was decided that they would only accept unearmarked funding and long-term funding, the source
said. (This is in the form of replenishments.) Representatives from Gavi and The Global Fund were
invited to the meeting to discuss these issues. … One of the reasons for member states’ preference
to give flexible funds to other global health agencies include the governance structure….” … “…

Officials at the meeting discussed the various options that the working group can consider in order
to prioritise essential functions of WHO… during these preliminary discussions, it appears that
member states have not been able to prioritise essential functions within the programme budget,
an official said. …”

And a final remark: “… Clearly, the narratives around WHO financing are unfolding in complex
times with deep geopolitical changes underway, and in the context of a disruptive pandemic which
has transformed international health policy-making in definitive terms including in the creation and
endorsement of super structures such as the ACT Accelerator. Inevitably these will have implications
for financing which helps set policy priorities for WHO. “Essentially, the other global health players
do not want to enter the intricacies of emergencies’ preparedness and response, and that is why
the financing of WHO shall now be increasingly geared towards emergencies. We are observing
this Davos ‘reset language’ in the context of redefining roles and financial strategies for the WHO,”
Nicoletta Dentico, a global health governance expert said at a recent event discussing sustainable
financing. “

See also WHO - Sustainable financing Report of the first and second meeting of the Working Group
on Sustainable Financing Report by the Director-General

(14 May) Report of the two meetings so far by this Working Group on sustainable financing.

HPW - Top Scientists Call For Further Investigation Into Virus Origins Ahead Of
World Health Assembly
https://healthpolicy-watch.news/86225-2/

“A group of 18 prominent scientists, primarily based in the United States, have called for further
investigations into the origins of the SARS-CoV2 virus, including that it could have been created in the
Wuhan Institute of Virology lab, in a letter published on Thursday in the journal Science. …”

AP - Diplomats, donors concerned about sex abuse reports at WHO
https://apnews.com/article/united-nations-europe-ebola-virus-health-
edfde9bd5d8b251488f3174f6585868f

“British, European and American diplomats and donors have voiced serious concerns about how
the World Health Organization handled sex abuse allegations involving its own staff during an
outbreak of Ebola in Congo, as reported this week by The Associated Press….”

See also Thomson Reuters - Rocked by new sex claims, World Health Organization appeals for
information

“ Facing scrutiny over new claims of sexual abuse by its workers, the World Health Organization
(WHO) on Wednesday urged anyone with information to come forward so that action can be
taken….”

Nature Editorial - Universal health care must be a priority — even amid COVID
https://www.nature.com/articles/d41586-021-01313-3

“A focus on specific diseases has derailed efforts to achieve health care for all before. The world
must not repeat that mistake with COVID-19.”

“The WHO has placed ‘health for all’ high on the agenda of next week’s meeting, hoping to drive
political and financial commitments from governments. Perhaps mindful of the vagueness that
doomed past efforts, Tedros has created a new council of economists, health and development
experts to advise on the economics of providing everyone with basic health care, including ways to
quantify its value.”

“Universal health care might seem a lofty goal amid a crisis, but if we do not push for change now,
we will regret it. The pandemic has increased the number of people living in extreme poverty,
making them more vulnerable to disease. It’s infected, killed and traumatized health-care workers
everywhere, most devastatingly in places that had too few already. “Our failure to invest in health
systems doesn’t only leave individuals, families and communities at risk, it also leaves the world
vulnerable to outbreaks and other health emergencies,” Tedros said in October 2019. “A pandemic
could bring economies and nations to their knees.” A few months later, it did. We must not let that
happen again.”

Devex – Will the World Health Assembly adopt a pandemic treaty?
https://www.devex.com/news/will-the-world-health-assembly-adopt-a-pandemic-treaty-99952

The “ crystal ball “ question as somebody put it.

“A pandemic treaty can take months to years to draft and negotiate, and it’s unlikely one would be
adopted at next week’s 74th World Health Assembly. But some experts are hoping member states
would endorse a resolution for the formation of an intergovernmental task force to draft and
negotiate a treaty….”

Related link: Politico - US and Russia seek to squash talks for pandemic treaty

“… Washington and Moscow are cool to talks on the creation of a pandemic treaty and are stalling
efforts to bring forward a decision at the World Health Assembly starting May 24, according to
several officials in Geneva, Switzerland, with knowledge of the discussions. This resistance has
brought conversations on the decision down to the wire. Negotiations are further complicated by
push back from several other countries that argue there isn’t sufficient time to discuss a treaty as
long as they battle the ongoing pandemic. …”

“…The U.S. remains skeptical, saying more time is needed to consider recommendations from
international panels examining what went wrong with this pandemic response. The focus, a senior
U.S. health official said, should be on building global consensus on how to strengthen WHO….”

Quote: “… “Our current collective efforts should be focused on achievable near-term goals, which
can lay the groundwork for any potential instrument in the future,” the U.S. official added. But one

of the Geneva officials who spoke to POLITICO suggested that the real U.S. concern may lie
elsewhere: Getting enough support to pass the treaty in the U.S. Senate, which would require a
two-thirds majority — in other words, Republican support.”

BMJ Analysis - Post-covid reforms: can we avoid fighting the last war?
https://www.bmj.com/content/373/bmj.n1184

One of the reads of the week. “Anna Bezruki and Suerie Moon explain why post-pandemic reforms
are unlikely to leave the world fully prepared for the next emergency and argue for a focus on strong
monitoring systems and flexible arrangements”

The authors discuss the difference post-Ebola reforms made for covid-19, the remaining gaps and
blind spots, and implications for the future.

Key messages: “The global response to covid-19 has benefited from reforms implemented after the
west African Ebola crisis; These include national preparedness, increased data sharing, international
investment in vaccine research, and a stronger WHO; However, gaps and blind spots in that reform
process left the world unprepared for the magnitude, breadth, and severity of the covid-19
pandemic; Wide ranging reforms are needed, but only a few are likely to be implemented,
particularly those most relevant to covid-19; Post-covid reforms should prioritise continuous
monitoring of the global system and flexible arrangements to adapt governance as new possible
pandemics emerge.”

Graduate institute (report) - Envisioning an international normative framework
for pandemic preparedness and response issues, instruments and options
G L Burci, S Moon et al; https://repository.graduateinstitute.ch/record/299175

19 p. Commissioned by and prepared for the Global Preparedness Monitoring Board.

“…Calls for a “pandemic treaty”, first proposed by the president of the European Council and since
endorsed by 26 heads of state and the Director-General of the WHO, have added some specificity
and urgency to this question. This paper offers a concise analysis of the global systemic weaknesses
to be addressed, the range of options of international normative instruments for doing so, and the
strengths and weaknesses of each. We then turn to the suitability of WHO as the host
intergovernmental organization for such an instrument. The paper concludes with three “menus”
of options for possible paths forward.”

With a ‘basic menu’, ‘deluxe menu’, and ‘business menu’ for such a possible pandemic treaty.

 • Another link related to the pandemic treaty:

South Centre - The Proposed Pandemic Treaty and the Challenge of the South for a Robust
Diplomacy “…. he proposal nonetheless raises some structural and procedural conundrums for the
Global South. The negotiation of a pandemic treaty should, as a matter of necessity, take into
account the asymmetries of World Health Organization member-states and the interests of the
Global South….”

WHO - Stronger collaboration for an equitable and resilient recovery towards the
health-related sustainable development goals: 2021 progress report on the global
action plan for healthy lives and well-being for all
https://www.who.int/publications/i/item/9789240026209#.YKaAaFv8vBk.twitter

“This second, annual Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP)
progress report illustrates how the SDG3 GAP is providing an important, long-term improvement
platform for collaboration among 13 agencies in the multilateral system as they support countries on
the path towards an equitable and resilient recovery from the COVID-19 pandemic and further
progress towards the health-related SDGs.” With 8 case studies.

Think Global Health – Six Things to Watch at The World Health Assembly
https://www.thinkglobalhealth.org/article/six-things-watch-world-health-assembly

Pre-analysis by David Fidler. The 6 things are: global vaccine access; preparing for the next
pandemic; strengthening WHO and global health governance; the geopolitical factor; what
developing countries want; the pandemic’s collateral damage.

Gates & “winds of change” in the US press ?

NYT - Long Before Divorce, Bill Gates Had Reputation for Questionable Behavior
https://www.nytimes.com/2021/05/16/business/bill-melinda-gates-divorce-epstein.html

Some evidence of clumsy behaviour, and perhaps a bit more in the light of MeToo (cfr this pertinent
tweet Angela Rasmussen – “Don’t know who needs to hear this but “sought to initiate an intimate
relationship” with a subordinate is not “an affair,” which implies a relationship between two
mutually consenting people outside of a spectacularly lopsided workplace power dynamic.” But no
smoking gun re the Epstein connection – the only thing that would be a ‘game changer’ (at least in
my (European middle-aged male) opinion).

On the latter, the Daily Beast reported, “The billionaire met Epstein dozens of times starting in 2011
and continuing through to 2014 mostly at the financier’s Manhattan home—a substantially higher
number than has been previously reported.” “…a former Gates Foundation employee told The Daily
Beast that Gates wanted to get in the good graces of some of Epstein’s professional connections.
“My understanding was he wasn’t hanging out with Epstein to get women,” the employee said….”

See also FT - Bill Gates says investigation into affair ‘in no way related’ to leaving Microsoft board

“Bill Gates has denied that Microsoft’s investigation into an “intimate relationship” with an employee
two decades ago had any impact on his decision to leave the software company’s board last year.”

(Investigative journalist) Tim Schwab in a Twitter thread, putting some things in
perspective
https://twitter.com/TimothyWSchwab/status/1394398555863928835

“The rapidly evolving investigation into #BillGates & #MeToo creates serious contradictions w/
#GatesFoundation's woman-forward, equity-focused brand/PR. I don't underestimate Bill Gates,
but this is a major existential crisis that could end the #GatesFoundation as we know it. ”

“The real threat to the #GatesFoundation right now is not the rule of law or institutional dynamics
within a private foundation, but rather the court of public opinion. And by that I mean the news
media turning against Bill Gates. The fact that NYT, WSJ et al. are doing some hard (tho maybe still
restrained) reporting on #BillGates & #MeToo means he's losing perhaps his most important and
long-standing ally.”

“Over the last decade the news media has been incredibly kind to Bill Gates, dead focused on his
good deeds and very rarely interrogating his or his foundation's power (or flaws/failures/abuses). I
had enormous difficulty trying to get this published…” “ For years, the news media coverage of the
#GatesFoundation has traded in fiction and mythology: presenting Gates as a warm and virtuous
sweater-wearing saint of a man, unimpeachable in his devotion to fixing the world, and highly
effective in these efforts.”

For more, see The Nation - The Fall of the House of Gates? (by Tim Schwab)

ACT-A (including Covax donations & other Covax news)
As mentioned above, a key issue today is whether ACT-A will be fully financed at the G20 summit (or
not). It doesn’t seem likely, for the moment.

The Accelerator – News from ACT-A
https://spark.adobe.com/page/78pUl1wI9CfuT/

ACT-A has started a newsletter. Among others, this could imply ACT-A will become a global health
stakeholder beyond this pandemic as well, not just for this one.

Some excerpts:

“In March, WHO, Coalition for Epidemic Preparedness Innovations (CEPI) and partners created a
special COVAX task force to identify manufacturing plants that could be quickly adapted to carry
out some of the steps of vaccine production—a prelude to the group’s longer-term goal of building a
widely dispersed, sustainable network of vaccine makers. … “

PS: Germany and South Africa are co-chairs of this new working group.

For more info on this taskforce, see also GAVI - COVAX Manufacturing Task Force to tackle vaccine
supply challenges

… At a virtual summit in mid-April, the Africa Centres for Disease Control and Prevention and the
African Union launched their Partnership for African Vaccine Manufacturing, with plans to create
an ecosystem of sustainable vaccine development that would provide for 60 percent of the
continent’s routine immunization needs by 2040. That number stands at 1 percent today. … … The
Partnership plans to set up five vaccine production hubs on the continent over the next 10 to 15
years. The first three hubs, in Rwanda, Senegal and South Africa, would produce mRNA vaccines.
These cutting-edge vaccines have only just come into use, developed in response to COVID-19
pandemic. … With the right support, factories in Egypt, Morocco, Senegal, South Africa and Tunisia
that are now packaging and labeling vaccines, and occasionally filling vials, could broaden their
roles….”

“… fundraising for diagnostics has been tough. ACT-A’s diagnostics pillar needs US$ 8.7 billion for
2021 to keep pace with the demands of the pandemic. Diagnostics is the least funded of the four
ACT-Accelerator pillars; contributions have been running eightfold behind the contributions for
vaccines….”

“In its sixth meeting, the ACT-Accelerator Facilitation Council on Wednesday focused on helping
countries build stronger health systems to fight COVID-19 and prepare for future emergencies. … …
The Council also discussed COVAX's new task force on expanding vaccine production, and hosted a
session on raising US$ 18.5 billion to finance the global pandemic response through the end of 2021.”

And some ACT-A related global health events coming up:

“21 MAY: Global Health Summit, Rome… present an urgent case for burden-sharing among
countries to fast-track equitable access to COVID-19 tools. Vaccine sharing, scaling up vaccine
production, and reaching full funding for ACT-A will be discussed. 2 June: COVAX AMC summit,
hosted by Japan for Gavi, the Vaccine Alliance. 11-13 June, 47th G7 summit, in Cornwall, UK.
Funding for ACT-A is expected to be a focal point for discussion.”

GAVI - Japan to host Gavi's COVAX Advance Market Commitment (AMC) Summit
https://www.gavi.org/news/media-room/japan-host-gavis-covax-advance-market-commitment-
amc-summit

“ The Government of Japan yesterday announced that it will host the virtual Gavi COVAX Advance
Market Commitment (AMC) Summit on June 2nd 2021. The event, co-hosted by Japanese Prime
Minister H.E. Yoshihide Suga and José Manuel Barroso, Chair of the Gavi Board, will aim to secure at
least US $8.3 billion for 2020-21 in order to accelerate access to 1.8 billion COVID-19 vaccine doses
for lower-income economies via the Gavi COVAX Advance Market Commitment by raising an
additional US$ 2 billion from donors and the private sector in addition to US$ 6.3 billion raised
before the campaign was launched at the “One World Protected” event on April 15th. … Securing
1.8 billion doses would enable the AMC to protect nearly 30% of the population in all AMC
countries, or roughly half the entire adult population. Currently, the AMC has funds in place to
protect approximately 20% of populations, equivalent to all health and social care workers, elderly
and those with underlying health conditions….”

FT - Indian vaccine maker to hold off exporting Covid jabs
https://www.ft.com/content/63fbbb79-f657-4e6c-b190-cffd0d630593

Another setback for Covax.

“The Serum Institute of India, the world’s largest vaccine manufacturer, plans to hold off exporting
Covid-19 jabs again until the end of the year in a blow to countries depending on its shipments to
start their campaigns. “We continue to scale up manufacturing and prioritise India,” chief executive
Adar Poonawalla said on Tuesday. “We also hope to start delivering to Covax and other countries
by the end of this year,” he added, referring to the multilateral global vaccine programme….”

Meanwhile, GAVI hopes COVID-19 vaccine exports from India can resume in Q3 (Reuters).

But for now, “As India confronts a truly dreadful wave of the pandemic, Indian vaccine production,
including the 140m vaccine doses initially destined for Covax, have been committed to protecting
its own citizens,” a Gavi spokesperson told Reuters.”

Via AP - “Zain Rizvi, a law and policy researcher at the advocacy group, Public Citizen, called the
new delay announced by the Serum Institute “a nightmare” for global vaccine access. “COVAX has
no plausible path to meeting its modest goals unless rich countries share doses and technology
immediately,” he said.”

In SSA (and other parts of the world counting on Covax), they’re very worried, clearly. See Reuters -
… India's halt to vaccine exports 'very problematic' for Africa

“…. An extended halt to exports of COVID-19 vaccines from India, where authorities are battling a
wave of domestic infections, risks derailing vaccination efforts already underway in Africa, one of
the continent's top health officials said on Tuesday.” “…. Africa has lagged far behind other regions
due to supply issues and meagre financial resources but had planned to vaccinate 30-35% of its
population by the end of the year and 60% within the next two to three years. …. "This is very
problematic as it means unpredictability of our vaccination programmes and a serious risk of not
achieving our stated target... on time," the director of the Africa Centers for Disease Control and
Prevention, John Nkengasong, wrote to Reuters. “

HPW - WHO Appeals For Vaccine Donations To Cover Huge COVAX Shortfall
https://healthpolicy-watch.news/who-appeals-for-dose-donations-to-cover-huge-covax-shortfall/

“COVAX has a shortfall of 190 million COVID-19 vaccine doses, and the few manufacturers that
have reached agreements with the facility will only deliver later in the year or even in 2022, World
Health Organization (WHO) Director Dr Tedros Adhanom Ghebreyesus said on Monday.”

“Pfizer has committed to providing 40 million doses of vaccines to COVAX this year, but the majority
of these would be [delivered] in the second half of 2021. We need those right now and call on them
to bring forward deliveries, as soon as possible,” Tedros told the body’s biweekly pandemic briefing.
“Moderna has signed a deal for 500 million doses with COVAX but the majority has been promised
only for 2022. We need Moderna to bring hundreds of millions of this forward into 2021 due to the

acute moment of this pandemic.” Meanwhile, COVAX discussions with Johnson & Johnson about
getting its vaccine had not been finalised, he added….”

“… Tedros added that manufacturers needed to give the right of first refusal to COVAX for any
additional dose capacity and also enter into their deals with manufacturers such as Inceptor, Biolyse,
Teva and others that are willing to use their facilities to produce COVID-19 vaccines. … … Bruce
Aylward, WHO’s lead at COVAX, stressed that the vaccine platform’s aim to ensure that 20% of
the world’s population was vaccinated by the end of the year was “at risk” because of supply
shortages. However, he said that COVAX was in talks with a number of countries and was hopeful
about “the possibility of larger-scale donations over the coming days, hopefully weeks at the
longest”. “I’d like to emphasise that, in speaking to everyone, no one has surplus doses”, but would
be donating from what they had,” said Aylward. … Norway and Sweden have already made
donations, while France, New Zealand, Belgium, the United Arab Emirates (UAE), Spain, Portugal and
US have all indicated that they want to donate. …”

See also Reuters - WHO chief urges COVID-19 vaccine makers to advance doses for COVAX

“The head of the World Health Organization called on manufacturers to make COVID-19 vaccine
doses available to the COVAX vaccine-sharing facility earlier than planned due to a supply shortfall
left by Indian export disruptions. … Specifically, he asked Pfizer (PFE.N)to bring forward deliveries
of some 40 million doses in the second half of the year and asked Moderna(MRNA.O)to make
doses pledged for 2022 available this year.”

WSJ - Biden Commits to Exporting Covid-19 Vaccines by End of June
https://www.wsj.com/articles/biden-to-commit-to-exporting-covid-19-vaccines-by-end-of-june-
11621269053?mod=hp_lead_pos7

“The U.S. plans to share 20 million doses of Covid-19 vaccines produced
by Moderna Inc., Pfizer Inc. and Johnson & Johnson with the rest of the world, President Biden
said, on top of the 60 million AstraZeneca doses it had already promised to export.
Mr. Biden said Monday that 80 million vaccine doses are expected to be exported by the end of
June. The AstraZeneca doses will be delivered once federal authorities sign off. … Mr. Biden said Jeff
Zients, the White House Covid-19 coordinator, will lead the administration’s global vaccination
efforts. Gayle Smith, a State Department official who is coordinating the U.S.’s role in the global
coronavirus response, will also be a key part of the effort, Mr. Biden said. “

And via Reuters – U.S. will donate substantial portion of vaccines through COVAX -U.S. official |
Reuters

“The United States will donate a significant number of COVID-19 vaccines through the World
Health Organization's COVAX scheme for distributing doses to poorer countries, the U.S. global
coordinator on COVID Gayle Smith told a news conference. … Smith said that the United States was
also planning to increase its funding for COVAX, in addition to $2 billion which she said it had
already donated to the facility in past months….”

Geneva Health Files - At Risk: COVAX Plans to Vaccinate 20% of the People in
LMICs
Geneva Health Files;

See also above. “A top WHO official admitted this week, that initial plans to vaccinate 20% of the
populations in LMICs might be at risk. Bruce Aylward, who leads the ACT Accelerator efforts at
WHO, said at a briefing that the Facility faces a gap of 150 million by the end of May and that gap
will increase in June. This could put at risk, the goal of vaccinating 20% of the people in the AMC
countries, he said. … … The calls for more transparency in the supply forecasts from The COVAX
Facility has gone louder in recent days, with even the International Chamber of Commerce calling
for greater transparency on “when countries can expect shipments – and, if there are bottlenecks or
issues getting orders to some countries, how these can be addressed.”…”

GAVI - Go Give One campaign gives public the opportunity to support access to
COVID-19 vaccines for lower-income countries
https://www.gavi.org/news/media-room/go-give-one-campaign-gives-public-opportunity-support-
access-covid-19-vaccines

“The Go Give One campaign launches today, giving everyone everywhere a chance to play their part
in helping to vaccinate the world. Created by the WHO Foundation, the campaign asks individuals
to donate US$ 7 for a COVID-19 vaccine dose, with the aim of getting 50 million people to take
part in the campaign. The money raised goes to the COVAX Advanced Market Commitment (AMC)
… Part of the new campaign is a matching feature that allows companies around the world to
contribute through a simple fundraising mechanism that puts the campaign in front of their
employees or customers….”

Trips waiver & tech transfer
The debate (and momentum?) on a temporary waiver continues, even if Team Europe doesn’t want
to have much to do with it. They rather want to focus on removing obstacles to commercial trade of
vaccines.

Reuters - Backers of WTO vaccine waiver ask opponents to join talks - document
Backers of WTO vaccine waiver ask opponents to join talks - document

“Supporters of a proposal to waive patent rights on COVID-19 vaccines at the World Trade
Organization are set to call on opponents to join the negotiations, stressing the gravity of the
pandemic, a draft document showed on Monday.”

"The cosponsors call on all delegations who have not yet indicated that they will join text-based
discussions, to do so as soon as possible," the 62 proponents of the waiver, including India and South
Africa that initially floated the proposal, said in a co-authored draft statement. "Continuous
mutations and emergence of new variants of SARS-COV-2 highlight the significant uncertainties and
complexities of controlling SARS-COV-2 and underscore the urgency of this proposal," they said. "A
failure to respond in a timely manner on the waiver proposal undermines the legitimacy and

credibility of the WTO." That call was echoed by the WTO's chief on Monday. "We need to sit down
at the negotiating table and actually look at a text. People are dying, and the faster we can sit down
and look at a text the better," said Ngozi Okonjo-Iweala at a virtual meeting of the Paris Peace
Forum.”

“… The next formal TRIPS council meeting at the WTO is scheduled for June 8.”

See also TWN - Co-sponsors of TRIPS waiver proposal call for solidarity at WTO (19 May)

Reuters – Vaccine patent waiver will not be enough -WTO chief
https://www.reuters.com/business/healthcare-pharmaceuticals/vaccine-patent-waiver-will-not-be-
enough-wto-chief-2021-05-20/

“Waiving intellectual property rights for COVID-19 vaccines will not be enough to narrow the huge
supply gap between rich and poor countries, the head of the World Trade Organization said on
Thursday. …. Speaking to the European Parliament on Thursday, WTO director-general Ngozi
Okonjo-Iweala said it was clear that an IP waiver alone would not be enough. "To have solved the
unacceptable problem of inequity of access to vaccines, we have to be holistic. It's not one or the
other," she said, adding this could not drag out for years….”

FT - Biden urged to oblige US vaccine makers to share technology
https://www.ft.com/content/9408223f-0a6c-43b7-9f67-c7e4697005c2

“Activists say president should build on patent waiver with transfer of knowhow as part of global
Covid fight.”

“Many of the scientists and campaigners who helped persuade Joe Biden to back an intellectual
property waiver for Covid vaccines are urging the US president to go further and force vaccine
makers to hand over their technology. … … many experts say that even if the WTO waiver proposal
secures the necessary support of every member, production will not rise quickly enough. Instead they
want companies to hand over instructions for how to make their vaccines to other companies
around the world, even if that ends up undercutting their own revenues. They say it is especially
important to do so with mRNA vaccines such as those made by BioNTech/Pfizer and Moderna,
given they can be modified more quickly to deal with potential emerging variants.”

“One possibility is that the president could use his powers under the Korean war-era Defense
Production Act to seize companies’ technology on the government’s behalf and then share that with
other countries. Another is that the government could use its own patents to force vaccine makers’
hands. Moderna in particular has used a patent in its vaccine without a licence from the National
Institutes of Health, which invented that piece of technology. … … Alternatively, the administration
could set up an organisation to act as a third-party broker negotiating technology transfer deals on
behalf of US manufacturers. The Clinton Foundation plays this role with HIV drugs, and says it has
helped bring down costs by 100 times in certain parts of the world. The WHO has already launched a
Covid-19 patent pool for companies to share their IP, and experts say this could also prove a global
technology broker if needed….”

FT - Brussels seeks to regain initiative on Covid vaccine patent debate
https://www.ft.com/content/e84e927c-b99f-4113-ab46-280930f74f74

“EU calls for countries to use flexibility in current WTO system before waiving IP rights”

“Valdis Dombrovskis, executive vice-president of the European Commission, said World Trade
Organization members should use existing rules to make it easier to share intellectual property (IP)
for coronavirus jabs, rather than expand the ability of governments to override patents, as
proposed by the US. Given the pandemic represents a national emergency, the requirement to
negotiate with rights holders to license the production of Covid vaccines could be waived, he said in
prepared remarks to the European Parliament. The intervention was a plea for countries to increase
access to vaccine technology under the existing WTO agreement known as Trips, rather than create a
major new loophole in the IP regime by waiving patents. But experts questioned whether the EU’s
more cautious approach to patents would have a significant impact on the debate….”

“… Dombrovskis said the EU was also willing to engage in discussions for a “targeted and time-
limited” patent waiver, but he said WTO members still needed to have full details of what the US
was proposing. EU member states have given the US suggestion a frosty reception. Dombrovskis also
confirmed that the EU would shortly be launching an initiative to boost vaccine manufacturing in
Africa. …”

See also Bloomberg:

“The European Union’s executive arm will present a proposal to the World Trade Organization
calling on other countries to help boost vaccine production capacity in developing countries and
export more shots while they explore a possible waiver on patents….” “…Specifically this would
mean limiting the application of export restrictions in order to keep supply chains open, and applying
no restrictions to exports toward developing countries included in the Covax aid program….”

“The EU’s proposal to the WTO will be based on three components: boosting trade in vaccines and
limiting restrictions on exports; expanding production, with the help of current vaccine
manufacturers; a review of intellectual property rights, including potential compulsory licensing. “

But see also this tweet on the European parliament:

“@Europarl_EN passes a resolution to urge the European commission to support the proposal to
suspend patents on Covid19 vaccines and treatments. Lets keep up the pressure and get the EU and
UK to stop blocking progress on negotiations. #PeoplesVaccine.”

Guardian – Britain in talks to waive Covid vaccine patents to improve global
access to jabs
https://www.theguardian.com/global-development/2021/may/20/britain-in-talks-to-waive-covid-
vaccine-patents-to-improve-global-access-to-jabs

“The UK government is in talks about a plan to waive Covid-19 vaccine patents to boost the
production of shots in low and middle-income countries, the Guardian can reveal. The discussions