IHP news 616 : Taking on the "Capitalism in our heads"

IHP news 616 : Taking on the “Capitalism in
our heads”
( 9 April 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,

The Covid version of your kid saying, “Later when I’m a grow-up, I will…” is probably, “When this
whole Covid thing is over (whatever that means), I will .. (+ bucket list)”. I certainly look forward to
post-Covid life, the monk life has lasted long enough. While it is said that top politicians and leaders
of international organisations live on the rhythm of their agendas, at IHP we’ve basically been living
on the rhythm of Outlook emails, zzz-Zoom webinars & Twitter feeds over the past year. (Will check
with Tedros & von der Leyen which rythm feels most dystopian ). A few neoliberal capitalist ‘guilty
pleasures’ kept me going, meanwhile, such as watching Kevin de Bruyne in the Champions League,
or Fargo episodes on Netflix. I also happen to be real good at ultra-slow jogging. Still, it would be
unfair to just blame the pandemic for our current “Covid way of life”. In a magazine last weekend, an
essay on work ethic zoomed in on the ‘capitalism in our heads’ (i.e. our inner focus on ever more
productivity). I quite agree with that analysis, certainly for many of us ‘knowledge workers’ who
presumably have more autonomy than the average Amazon employee. The pseudo-shrink in me also
tells me that what one hates the most is “the enemy within” (at last, Bill Gates gets a hunch why this
newsletter tends to be a bit, ahum, ‘biased’ ). It’s no doubt for a reason that a terribly annoying
Cranberries song goes like this: “in your he-e-ad, in your he-a-ad….”. Followed by: “Zombie”.

Enough post-Easter musings, over to global health land. BMJ Global Health celebrated its 5th
anniversary with another hard-hitting editorial; this week was World Health Worker week (April 5-
9), and on World Health Day (nicely timed this year, just a few days after Easter’s chocolate
bonanza), WHO urged all of us to build a fairer, healthier world post-COVID-19. There are some
hopeful signs in that respect. On global tax justice, the “race to the bottom” might at last be
finished, female economists are driving the intellectual revolution towards making the global
economy “more human, sustainable and less abstract” (we couldn’t count on Larry Summers for
that one ), and some observers even argue that the global narrative on post-pandemic safety
nets and welfare states is changing for the better, mostly. So, if for once we make abstraction of the
massive global socio-economic Covid shock and the ecological emergency, you’d almost say mankind
seems at last on track to “build a fairer, healthier world”. The fact that we’re lining up in droves to
“see a giant ape and a dinosaur going at it for 15 rounds” shows that we’re still not all enlightened
women, though. And unfortunately, the climate emergency also remains all too real. To do
something about the latter, I’m afraid we’ll have to kill capitalism. Including in our own heads. Might
take 15 rounds as well, though.

Enjoy your reading.

Kristof Decoster

 1

Featured Article

“Critically Examining Decolonization: The Field of Global
Health”: some conference reflections
Divya Santhanam, Gopika Punchhi, Yotakahron Jonathan, Shehnaz Munshi, Amadene Woolsey,
Anamika Mishra

We are writing from the following places: Azania, The traditional lands of the Three Fires
Confederacy of First Nations, which includes the Ojibwa, the Odawa, and the Potawatomie, the
traditional lands of the Anishinaabek, Haudenosaunee, Lūnaapéewak and Attawandaron peoples, on
lands connected with the London Township and Sombra Treaties of 1796 and the Dish with One
Spoon Covenant Wampum.

The conference “Critically Examining Decolonization: The Field of Global Health” (February 20, 2021)
was born out of a desire to interrogate current discourses of decolonization. Many similar
conferences in North America have not yet situated the land on which they have taken place by
examining the settler-colonial dynamics of power. As Hurwitz & Bourque write on settler
colonialism, “land, not labor, is key. In this system, Indigenous Peoples are literally replaced by
settlers.” Through a keynote, two panels, a workshop and a Q&A session, we sought to examine the
ways in which colonial power has shaped global health discourse and the interaction between settler
and global colonialism. Furthermore, we hoped to imagine how medical learners and professionals
can disrupt these power structures.

In many ways, this conference resembled writing a story. We started with a few medical students
living in Canada seeking to deepen and question dominant narratives surrounding global health in
medical education. If the planning of the conference was analogous to structuring a plot, the
audience and panelists were the writers, filling the pages with rich discourse. In accordance with the
importance of collective storytelling in decolonial work, we brought together perspectives of
organizers and speakers to reflect on the major points of discourse in the conference and to
highlight ongoing questions of what it means to decolonize, specifically in the field of global health.

Decolonization is a revolutionary term tied to struggle, resistance and sacrifice

 “Until stolen land is relinquished, critical consciousness does not translate into action that disrupts
settler colonialism.” Tuck and Yang, Decolonization is Not a Metaphor

In the past year, calls to decolonize fields and educational institutions have entered mainstream
conversation. However, we risk forgetting the most essential component of decolonization – the
land and returning it to Indigenous Peoples, as noted by Dr. Rick Monture, an Associate Professor at
McMaster University’s Indigenous Studies Program and panelist at our conference. Post-conference,
some of the co-authors of this piece weighed in. On the spiritual pain associated with the
dispossession of land, Shehnaz Munshi reflected, “When combined with sophisticated epistemic
violence and colonisation of our minds, colonisation has devastating implications for physical,
spiritual, emotional, social, and community health and well-being.” Additionally, Yotakahron
Jonathan noted that “Settlers of Turtle Island need to recognize that personal sacrifices will need to
be made and lived experiences need to be prioritized… we need to ensure that whoever’s land we
are on, we are uplifting their voice.”

 2

So, what does it mean to decolonize? Decolonization is a revolutionary term, as highlighted
throughout our conference, and requires us to be willing to give up privilege, self-interest, land and
control. This revolution is rooted in resistance, struggle, justice and mutual care; It requires an
understanding of colonial history and a critical reflection of what purpose and who decolonization
serves. It lies beyond conference discussions and academic circles and requires tangible action at
individual, interpersonal, and structural levels.

Global vs. Public Health – Saviourism vs solidarity?

Panelists from the global South spoke about perceiving their work as public health work rather than
global health work. If public health is located within and ‘done’ by local communities, is the term
‘global health’ inextricably associated with the “imperialist complex”? Yotakahron Jonathan
reflected, “instead of being responsible for the health of the public in settler colonial societies, for
example the health of Indigenous Peoples in Canada, this distinction is a way to avoid accountability
through true reconciliation.” In the context of the settler-colonial nation state Canada, the
difference in terminology is a settler move to innocence. By portraying global health as an
‘elsewhere’ rather than ‘right here’ problem, institutions and individuals in the global North absolve
themselves of the crucial discomfort created by the nature of decolonization and exacerbate white
saviorism. Perhaps a new interpretation of global health is one that would be diametrically opposed
to its persistent coloniality and lies in movements of shared solidarity against colonial powers, such
as those of migrants and Indigenous Peoples in Canada, and “sharing of strategies of resistance”
against ongoing occupations and colonial projects around the world.

Accountability is rooted in positionality and reflexivity – who are you, what is your relationship to
the land and to whom are you accountable?

“It shouldn’t be on Indigenous people to do the work...it should be on settlers. Doing the work is
part of the unsettlement that is needed. And asking this of Indigenous people or expecting us to
keep them accountable, is another settler move to innocence. Reading lists, like the ones provided
by this conference, should be seen only as an introduction to this work, not “the work” itself.” -
Yotakahron Jonathan, Mohawk, Bear Clan from Six Nations of the Grand River Territory

“I am reminded of the tension within my own identity. My parents moved to North America from
Tamil Nadu nearly fifty years after India gained independence from the British. Now an uninvited
guest on Turtle Island, I think about the ways in which I am complicit in the settler colonial project,
how my existence is used to justify diversity and the “Canadian mosaic” and downplay the ongoing
settler colonial violence that persists to this day.” - Divya Santhanam, second-generation Tamil
immigrant settler

“To believe that any work is unbiased is naive. Colonialism is rooted into every aspect of my life and
it is hard to conceptualize how much it influences my thoughts, emotions and actions. Reflexivity is
the key to analyzing these influences to deconstruct its influence on me. This is not an easy task or
one that is done quickly.”- Amadene Woolsey, third generation Caucasian settler from Austria and
the United Kingdom

“Ultimately, we are accountable to communities and people. This must be centered in all of our
work, be it local or global. We are moving beyond acknowledging our positionality alone, but
towards a critical understanding of the dynamics of power and privilege in everything and how we
are complicit in upholding these imbalances if we are not actively resisting them.” - Gopika Punchhi,
second-generation immigrant settler from Mumbai

 3

“Our speakers discussed the notion of radicality as a purposefully uncomfortable and unsettling idea.
I felt tension between being a medical student being indoctrinated into a system with minimal
power with the expectation to be complicit, and being radical and disputing the dominant narrative.
We are expected to internalize the science and culture of medicine, but to critically assess the
structures we exist in, is to antagonize them. I wondered, how can we as students stay radical in the
ways in which learn and practice medicine?" - Anamika Mishra, first generation immigrant settler
from Gujarat

If the process of this conference was likened to writing a story, it is certainly not sufficient;
decolonization is not a linear process that can be achieved through checkboxes, but necessitates
reflexivity, resistance and revolution. To truly decolonize, one must leap off the pages, into action.

Authors:

Divya Santhanam (she/her), a second-generation Tamil immigrant settler and second-year medical student at
Western University, Ontario

Gopika Punchhi, a second-generation immigrant settler from Mumbai and first-year medical student at
Western University

Yotakahron Jonathan (she/her), Mohawk, Bear Clan from Six Nations of the Grand River Territory, third-year
medical student at McMaster University, Ontario.

Shehnaz Munshi, HPSR researcher, currently Project Manager for the Sheiham Family/Wits program on social
determinants of health and health equity, University of the Witwatersrand, South Africa.

Amadene Woolsey (she/her), a third-generation Caucasian settler from Austria and the United Kingdom and
first-year medical student at Western University

Anamika Mishra, a first-generation immigrant settler from Gujurat and third-year medical student at Western
University.

Highlights of the week

World Health Day (7 April)

UN News -COVID-19 lays bare social inequality says UN chief, as COVAX doses top
36 million
https://news.un.org/en/story/2021/04/1089042

“The COVID crisis "has revealed how unequal our societies are” said the UN chief in his message
for World Health Day released on Monday. Highlighting the inequalities and injustices that have been

 4

apparent throughout the pandemic, Secretary-General António Guterres said in his message for the
day to be marked on Wednesday, that the vast majority of vaccine doses administered so far, have
been confined to “a few wealthy countries” or those producing the shots cleared for distribution. …
… To date, COVAX has shipped more than 36 million doses to 86 countries, the UN
Spokesperson Stéphane Dujarric told correspondents at UN Headquarters on Monday….”

WHO urges countries to build a fairer, healthier world post-COVID-19
https://www.who.int/news/item/06-04-2021-who-urges-countries-to-build-a-fairer-healthier-world-
post-covid-19

For World Health Day, 7 April 2021, WHO is therefore issuing five calls for urgent action to improve
health for all people. (see below for more detail on these)

HPW - As Countries Worldwide Face Shortages – Appeal for Equitable COVID-19
Vaccine Access on World Health Day
https://healthpolicy-watch.news/equitable-vaccine-access-appeal/

“Some of the world’s smallest countries joined the World Health Organization (WHO) to appeal for
equitable access to COVID-19 vaccines on the eve of World Health Day – as the pipeline of global
vaccine supplies to low- and middle-income countries risk drying up for the coming few months. “

… WHO Director-General Dr Tedros Adhanom Ghebreyesus made a five-point global call to action
ahead of World Health Day on Wednesday, calling for: Accelerated equitable access to COVID-19
technologies between and within countries; Investment in primary health care; Prioritizing health
and social protection; Building safe, healthy and inclusive neighbourhoods; Strengthening data
and health information systems. “At the start of the year, I made a call for every country to start
vaccinating health workers and older people in the first 100 days of 2021. This week [10 April] will
mark the 100th day, and 190 countries and economies have now started vaccinations.”

Global Health 50/50 (& ICRW & APHRC) - Gender equality commitments absent
from health sector policy responses to pandemic
https://globalhealth5050.org/the-sex-gender-and-covid-19-project/policy-portal/

A new policy portal launched on 7 April (World Health Day) finds that countries have failed to
account for an essential aspect of equity - gender - across all areas of their COVID-19 health
policies, including vaccination. Despite repeated calls from the World Health Organization for
gender-responsive COVID-19 health policies, the portal finds that 91% of policies from across 76
countries have no mention of gender. The figure is one of a number of metrics presented on the
Sex, Gender and COVID-19 Health Policy Portal, launchedg on Wednesday 7 April 2021.

Portal: The Sex, Gender and COVID-19 Health Policy Portal

Executive summary: https://globalhealth5050.org/wp-content/uploads/Executive-summary-the-
Sex-Gender-COVID-19-policy-portal.pdf

 5

The findings by the three research organisations - Global Health 50/50, housed at University College
London (UCL), the African Population and Health Research Center, and the International Center for
Research on Women in India - are published in the new Sex, Gender and COVID-19 Health Policy
Portal.

… 91% of policies found to have no mention of gender. Among over 450 policies from 76 countries
reviewed, one-third make specific commitments to ensuring equity while just one in seven reference
human rights. … “

See also the Lancet GH - Recorded but not revealed: exploring the relationship between sex and
gender, country income level, and COVID-19 (by Sarah Hawkes et al)

Cfr Tweet Kent Buse: “Globally in 2020, we found that around 4 in 10 cases of #COVID19 and 3 in 10
deaths were reported with no mention of whether individuals were male or female.”

IHP - World Health Day 2021: did I miss something?
W Soors; https://www.internationalhealthpolicies.org/blogs/world-health-day-2021-did-i-miss-
something/

Werner Soors wasn’t impressed too much by WHO’s webinar on Wednesday, and the
(accompanying) brief WHO sent out ahead of the webinar. Read why.

Global Tax Justice

NYT -Yellen calls for a global minimum corporate tax rate.
https://www.nytimes.com/2021/04/05/business/yellen-global-minimum-corporate-tax-
rate.html?smid=tw-share

Promising early signs of an end to the race to the bottom, I hope. “Ms. Yellen, in a speech to the
Chicago Council on Global Affairs, called for global coordination on an international tax rate that
would apply to multinational corporations regardless of where they locate their headquarters.
Such a global tax could help prevent the type of “race to the bottom” that has been underway, Ms.
Yellen said, referring to countries trying to outdo one another by lowering tax rates in order to
attract business … … Overhauling the international tax system is a big part of that. Corporate tax
rates have been falling around the world in recent years. Under the Trump administration, the rate in
the United States was cut from 35 percent to 21 percent. Mr. Biden wants to raise that rate to 28
percent and increase the international minimum tax rate that American companies pay on their
foreign profits to 21 percent….”

See also U.S. Treasury Secretary Janet Yellen says she is working with G-20 countries to agree on a
global corporate minimum tax rate to end a "30-year race to the bottom on corporate tax rates."

 6

The IMF also supports it. See the Guardian - Gopinath said the IMF backed the call by the US
treasury secretary, Janet Yellen, for a global minimum corporate tax rate to make it more difficult for
big corporations to shift their profits between jurisdictions.

And via FT - Global corporate tax deal edges closer after US backs minimum rate

“The world’s leading economies are close to agreeing a set of principles that would revolutionise the
taxation of multinationals after France and Germany threw their support behind a new US
approach to the issue. Talks on how to make it difficult for international companies to shift profits
round the world to minimise tax have been stuck at the OECD for years, but are now progressing
rapidly according to several governments. On Monday the US set out plans for a global minimum
corporation tax; on Tuesday European countries backed the proposal but made it clear this
ambition of Joe Biden’s administration would need to be accompanied with a deal to enable them
to tax an element of technology giants’ global profits….”

As for the G20, see the Guardian - G20 takes step towards global minimum corporate tax rate “ G20
finance ministers are exploring a global minimum tax on corporate profits, amid growing
international consensus on tackling avoidance after the pandemic….” (in the margins of the IMF/WB
Spring meetings). For the full G20 Communiqué, see Second G20 Finance Ministers and Central
Bank Governors meeting - Communiqué.

 • Some tweets:

Tweet Jayati Ghosh: “What a difference a few months can make! With the US govt on board, the
@icrict proposal for 25% global minimum tax rate gets some traction, with huge benefits for govts
and people across the world. Yellen calls for a global minimum corporate tax rate.”

Tweet Gabriel Zucman: “Great read by @ryanlcooper on why Janet Yellen's push for a high global
minimum corporate tax is so important If this becomes reality, the development model of tax
havens collapses — a new form of globalization begins.”

 • The Economist’s take: Janet Yellen calls for a global minimum tax on companies. Could it
 happen? | The Economist

“Many countries want to link a deal to the trickier issue of taxing rights on profits.”

 • Analysis by Alex Cobham ( Tax Justice Network) - US Treasury Secretary Yellen confirms: It’s
 time to end the race to the bottom on corporate tax (linking the ‘new narrative’ also to the
 OECD process, and looking ahead to the coming months).

World Bank/IMF Spring meetings (April 5-11)

For some overall analysis we’ll probably have to wait till next week. Here some snippets (see also
above, ‘Global Tax Justice’):

 7

Devex Newswire: The World Bank meets team Biden
https://www.devex.com/news/devex-newswire-the-world-bank-meets-team-biden-99576

The World Bank hosts its first big get-together since the institution’s largest shareholder traded
Trump for Biden. On the agenda, among others: Covid-19; debt; climate change.

FT - IMF proposes ‘solidarity’ tax on pandemic winners and wealthy
https://www.ft.com/content/5dad2390-8a32-4908-8c96-6d23cd037c38

“High earners and companies that prospered in the coronavirus crisis should pay additional tax to
show solidarity with those who were hit hardest by the pandemic, according to IMF. A temporary
tax would help to reduce social inequalities that have been exacerbated by the economic and health
crisis of the past year, the fund said in its twice-yearly fiscal monitor on Wednesday. It would also
reassure those worst affected that the fight against Covid-19 is a collective endeavour within
societies. Vitor Gaspar, IMF’s head of fiscal affairs, told the Financial Times that a symbolic rise in
taxation from those who have prospered over the past year would strengthen social cohesion even
if there was not a pressing need to repair the public finances. Countries should consider this policy
as it would help boost their citizens’ perception “that everybody contributes to the effort necessary
for recovery from Covid-19”, he said. …”

See also the Guardian - IMF calls for wealth tax to help cover cost of Covid pandemic.

Devex – African nations expect $33.6B in Special Drawing Rights
https://www.devex.com/news/african-nations-expect-33-6b-in-special-drawing-rights-99611

“African nations expect to receive $33.6 billion from a new issuance of Special Drawing Rights,
according to Vera Songwe, executive secretary of the United Nations Economic Commission for
Africa. On Wednesday, G-20 finance ministers and central bank governors reaffirmed calls for
the International Monetary Fund to make a proposal for a new allocation of $650 billion in SDRs
— an international reserve asset — that will provide countries around the world with liquidity. The
last SDR allocation was issued in 2009 following the global financial crisis. The African Union has
advocated for a global issuance of SDRs over the past year in hopes that countries can use these
funds for the purchase of COVID-19 vaccines, and other parts of national pandemic recoveries.

… When allocated, countries will receive SDRs based on their IMF quotas, which roughly reflects a
country’s position in the global economy. This means wealthier countries will receive more than low-
income countries. Because of this, the five largest economies on the African continent — South
Africa, Nigeria, Egypt, Morocco, and Algeria — will receive much of the funding, Songwe said. To
counter this, she is calling for a system where high-income countries, which don’t need the SDRs,
can transfer them to countries that do. IMF is expected to present a plan on the new issuance and
a system for reallocating SDRs in June. Countries could then receive SDRs in August….”

Link:

Euractiv - G20 agrees ‘final extension’ to $10 billion debt service suspension scheme

 8

“Developing countries stand to benefit from up to $10 billion in savings after the G20 group of
wealthy nations announced on Wednesday (7 April) that it would extend its debt service suspension
initiative (DSSI) which launched last May until the end of this year….”

Devex - In Brief: World Bank's Malpass calls for more COVID-19 vaccines,
vaccinators
https://www.devex.com/news/in-brief-world-bank-s-malpass-calls-for-more-covid-19-vaccines-
vaccinators-99582

“World Bank President David Malpass is pushing for lower-income countries to begin COVID-
19 vaccination campaigns as soon as possible, due to his concern that rolling out vaccines could
take longer in resource-constrained settings. … When vaccines do start to become available in
greater numbers for more countries, many of them will have to make significant and rapid
investments to ensure they have sufficient workforces to deploy them. … … According to the bank’s
own capacity assessments in more than 100 countries, only 30% had plans in place to scale up the
workforces that will be needed to deliver vaccines. The same assessments found that countries’
experiences delivering childhood vaccinations were not good indicators of their readiness for adult
vaccination campaigns against COVID-19.”

“… The World Bank’s board of directors approved a $12 billion package to support COVID-19
vaccination in its client countries. Malpass said Monday that by the middle of this year, the bank
plans to have supported 50 countries with projects totaling $4 billion. …”

Telegraph - Africa needs £9bn to buy enough vaccines to stop Covid-19 spread,
say World Bank and IMF
Telegraph;

“ Africa needs around £9bn ($12bn) to buy and distribute Covid-19 vaccines to reach enough people
to stop the coronavirus spreading, according to a new paper by the World Bank and the
International Monetary Fund. The world's rich G20 countries should also extend a debt
moratorium until the end of the year to help the poorest countries through the pandemic, the paper
said….”

FT (op-ed) - IMF’s spring meetings lack ambition for a world in crisis
M Ahmed; https://www.ft.com/content/5e6a02e2-c3e4-4fd6-aa08-910bf3186f5b

Analysis. “At the spring meetings of the IMF and World Bank this week, we can expect measures to
support low- and middle-income countries’ pandemic recovery that are laudable but fall well short of
what is required. One likely outcome will be an allocation of up to $650bn in IMF special drawing
rights, the fund’s reserve currency that is used to supplement members’ official reserves. An
extended pause on debt service payments for the poorest countries and a commitment from wealthy
nations to help finance the global distribution of Covid vaccines will probably also be agreed. All
these measures will be welcome. But they will be only marginally helpful for countries where the
end of the pandemic remains far off. They certainly will not prevent IMF managing director

 9

Kristalina Georgieva’s warning of a “dangerous divergence” between economies from becoming a
reality. …”

And some (vital) advocacy & reports in the margins of the Spring Meeting:

Oxfam (report) Failure to vaccinate globally could cost up to $2,000 per person
this year in rich nations
https://www.oxfam.org/en/press-releases/failure-vaccinate-globally-could-cost-2000-person-year-
rich-nations

(6 April) “Rich countries must open the way to cheaper mass-produced COVID-19 vaccines in order
to protect every person in the world and avert a $9 trillion “worst case” global economic
catastrophe, said Oxfam today. They should also agree this week to inject $650 billion more into
the global economy to help developing countries cope with the pandemic’s already devasting effects.
The two issues —one around tackling the chronic global scarcity of vaccines that is now sparking
trade disputes between and economic shocks among countries, and the other in agreeing a new
allocation of Special Drawing Rights (SDRs)— will feature at the World Bank and International
Monetary Fund’s (IMF) Spring Meetings April 5-11….”

Reuters -New IMF reserves could fund vaccinations for low-, middle-income
countries: report
Reuters;

“Moves to bolster the IMF’s emergency reserves could provide the $44 billion needed to vaccinate
70% of the population in lower- and middle-income countries by the end of 2022, at no added cost
to rich countries, a new Rockefeller Foundation report finds. … … The Rockefeller report, to be
released Tuesday, said rich countries could reallocate their new SDRs to quickly close the funding
gap and get more people vaccinated around the world, preventing virus mutations that could stall a
global recovery. … The World Bank estimates that Africa alone would need about $12 billion for
COVID-19 vaccines to attain sufficient levels of inoculations to interrupt virus transmission, according
to a new paper by the bank and the IMF….”

CGD (blog) A New IMF Pandemic Window Could Provide $30 Billion to Finance
Vaccines for Developing Countries
https://www.cgdev.org/blog/new-imf-pandemic-window-could-provide-30-billion-finance-vaccines-
developing-countries

Linked to a new CGD policy note.

“More urgently and practically, we propose tapping into the underutilized financial firepower of
the International Monetary Fund—an institution with a $1 trillion lending capacity that was set up
precisely to deal with global financial crises. By introducing a Vaccine Financing window in its
existing rapid financing facility, the IMF could provide fast access to $30 billion—only 3 percent of
its lending capacity—an amount that, at $10 person, would cover the total cost of vaccines for the

 10

entire population of most developing countries (excluding India and China, which are both able to
produce and finance the vaccines they would need for any pandemic).

… The traditionalists in the finance world will protest that the IMF is there to deal with financial
crises not pandemics or vaccines. But the obstacle to early access to vaccines is very much an
economic and finance concern. As the IMF’s own analysis shows, delay in vaccinating the world
will slow global growth and increase financial vulnerabilities; a study by NBER authors finds the
global economy could experience losses of over $9 trillion if poorer countries are left behind. As
the IMF Managing Director Kristalina Georgieva has said when trying to limit the fiscal and
financial consequences of a pandemic, “vaccine policy is economic policy.”…”

Global Health Governance & Financing

With first plenty of analyses related to the concept of a ‘pandemic treaty’.

Geneva Health Files -Pathogens-Sharing & The Pandemic Treaty: The Commercial
Link
P Patnaik; https://genevahealthfiles.substack.com/p/pathogens-sharing-and-the-pandemic

Analysis of “the potential commercial implications of a pandemic treaty by connecting the dots
between various policy developments”.

“The rules on how information on pathogens and genetic sequences will be shared could be
determined under a proposed pandemic treaty. This is important because even though countries
may share physical samples of pathogens and genetic sequence data, they could be excluded from
having access to vaccines and diagnostics developed based on this information without binding
commitments on benefits sharing. COVID-19 shows us, this has happened. “

A few quotes: “… what also lies underneath, is a call for a legal mechanism that would make it
binding for countries to share information, data and genomic sequences in the event of outbreaks.
This is where the money is. This could potentially also risk seeding new inequalities that could result if
mechanisms are not put in place to compensate countries who share information on pathogens. …
The on-going discussions on pathogens-sharing in the backdrop of the COVID-19 pandemic,
overwhelming focusses on sharing information, and rarely on benefits-sharing, critics say. …”

“… In the event that a new treaty such as the pandemic treaty, prescribes new obligations or rules
on these matters, they will take precedence over the older treaties, legal experts suggested….”

Thomas Cueni and his many IFPMA bigwig friends are certainly already watching this pandemic
treaty debate closely.

 11

Telegraph - Guardian - Countries unlikely to face sanctions if they fail to comply
with new pandemic treaty
Telegraph;

“World leaders called for a new pact governing disease outbreaks but carrots, rather than sticks, are
most likely to encourage compliance… … Carrots to encourage compliance could include funding
from the World Bank or the International Monetary Fund - although whether this would make
much difference to superpowers such as China or the United States is questionable. …”

Foreign Policy - The World Needs a Post-Pandemic Health Treaty With Teeth
L Gostin et al ; https://foreignpolicy.com/2021/04/05/who-un-pandemic-treaty-health-regulations/

“WHO has no power to demand openness or independently confirm data at present.”

Nature Editorial –The world must learn from COVID before diving into a
pandemic treaty
https://www.nature.com/articles/d41586-021-00866-7

Recommended. “A treaty might help countries to prepare for the next pandemic — but first they
must study what went wrong during this one.”

“A pandemic treaty needs to meet at least four conditions. … “

CGD - A Global Pandemic Needs A Global Response: US Contributions to COVID
Relief
E Collinson et al ; https://www.cgdev.org/blog/global-pandemic-needs-global-response-us-
contributions-covid-relief

“The American Rescue Plan—the massive COVID-19 relief package recently signed into law—has
featured in plenty of headlines. While the vast majority of the nearly $1.9 trillion package is allocated
to domestic relief and response, the legislation provides nearly $11 billion in supplemental
international affairs spending. We dug in to see how this new injection of funding compares to
emergency foreign assistance provided under previous pandemic-related legislation and share
some areas we hope to see USAID and the State Department prioritize as they work to put the new
money to good use….”

Global Health Action - Tracking sectoral allocation of official development
assistance: a comparative study of the 29 Development Assistance Committee
countries, 2011–2018
S Nomura et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1903222

 12

“This study estimated the sectoral allocation of gross disbursements of ODA of the 29
Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-
operation and Development (OECD) for the duration of 2011 to 2018, by aid type (bilateral,
multilateral, and both aids). …. … For all 29 countries, during the period of 2014–2018 where data
were available for all the countries, the sector with the highest average annual ODA contribution
was health at 20.34 billion USD (13.21%), followed by humanitarian aid at 18.04 billion (11.72%).
Humanitarian aid has increased in the sectoral share rankings in both bilateral and multilateral aid,
and the sectoral share for refugees in donor countries has increased in bilateral aid. While the 29
countries show relatively similar trends for sectoral shares, some countries and sectors display
unique trends. For instance, infrastructure and energy sectors in bilateral aid of Japan are
particularly high accounts for 48.48% of the total bilateral ODA of the country in 2018.”

Lancet Viewpoint - US–China health exchange and collaboration following COVID-
19
Liming Li et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00734-
0/fulltext

“Strong US–China collaboration on health and medicine is a crucial element of the global effort
against COVID-19. We review the history of health collaboration and exchanges between the public
and private sectors in the USA and China, including the long-lasting collaboration between
governmental public health agencies of the two countries. Academic and scientific exchanges
should be reinvigorated and the increasing valuable role of non-profit foundations acknowledged.
The shared interests of the two countries and the magnitude of the pandemic necessitate both
countries to collaborate and cooperate. We provide recommendations to the two governments and
the global health community to control the ongoing COVID-19 pandemic and prepare for future
threats.”

See also a related Lancet Editorial - China's response to COVID-19: a chance for collaboration
(which zooms in a bit more on the current (tense) international environment).

Covid key news

Key trends, WHO messages, new initiatives, …

Cidrap News - Global COVID-19 cases climb for 6th straight week
https://www.cidrap.umn.edu/news-perspective/2021/04/global-covid-19-cases-climb-6th-straight-
week

“The world's number of new COVID-19 cases rose for the sixth week in a row… In its weekly
snapshot of COVID-19 activity, the World Health Organization (WHO) said 4 million new cases were
reported last week, with deaths on the rise for the third week in a row. The five countries reporting
the highest case numbers shifted last week, with India reporting the most, followed by Brazil, the
United States, Turkey, and France. … The part of the world that felt the biggest case increase was

 13

the WHO's South-East Asia region, which includes India, followed by the Western Pacific region,
which includes the Philippines, another current COVID-19 hot spot….”

See also FT - Coronavirus tracker: the latest figures as countries fight the Covid-19 resurgence (for
some of the main trends).

Reuters - Global COVID-19 death toll surpasses 3 million amid new infections
resurgence
Reuters;

“ Coronavirus-related deaths worldwide crossed 3 million on Tuesday, according to a Reuters tally,
as the latest global resurgence of COVID-19 infections is challenging vaccination efforts across the
globe….”

“Worldwide COVID-19 deaths are rising once again, especially in Brazil and India. Health officials
blame more infectious variants that were first detected in the United Kingdom and South Africa,
along with public fatigue with lockdowns and other restrictions….”

Link: Washington Post - Brazil has become South America’s superspreader event

“There is mounting anxiety in parts of South America that P.1 could quickly become the dominant
variant, transporting Brazil’s humanitarian disaster — patients languishing without care, a
skyrocketing death toll — into their countries….”

And Reuters - 'A biological Fukushima': Brazil COVID-19 deaths on track to pass worst of U.S. wave

“ Brazil’s brutal surge in COVID-19 deaths will soon surpass the worst of a record January wave in the
United States, scientists forecast, with fatalities climbing for the first time above 4,000 in a day on
Tuesday as the outbreak overwhelms hospitals….”

Cidrap News - India, other COVID hot spots set more daily case records
https://www.cidrap.umn.edu/news-perspective/2021/04/india-other-covid-hot-spots-set-more-
daily-case-records

“Over the weekend, new daily infections in India crossed 100,000 cases for the first time, with cases
soaring higher in other places, such as the Philippines and Ukraine. Meanwhile, upticks in activity
have other countries worrying about the start of fourth surges….”

See also BBC News - Coronavirus update: India is facing a 'severe, intensive' second wave.

 14

WEF (blog) - 'Travesty' that some nations unable to start COVID-19 vaccinations:
WHO
“…It's a 'travesty' that some countries are still unable to begin vaccinating health workers and the
most vulnerable against COVID-19, the Director-General of the World Health Organization said
yesterday….”

Reuters - WHO does not back vaccination passports for now - spokeswoman
Reuters;

“The World Health Organization does not back requiring vaccination passports for travel due to
uncertainty over whether inoculation prevents transmission of the virus, as well as equity
concerns, a spokeswoman said on Tuesday. “We as WHO are saying at this stage we would not like
to see the vaccination passport as a requirement for entry or exit because we are not certain at this
stage that the vaccine prevents transmission,” WHO spokeswoman Margaret Harris said. “There
are all those other questions, apart from the question of discrimination against the people who are
not able to have the vaccine for one reason or another,” she told a U.N. news briefing….”

“The WHO now expects to review China’s COVID-19 vaccines Sinopharm and Sinovac for possible
emergency use listing around the end of April…”

The same goes for Africa CDC & WHO Afro. See HPW: “ …The Africa CDC and WHO further
expressed concerns regarding the growing calls for vaccine passports which they said could be
discriminating against Africans who would have received the vaccines if enough doses were available
in their countries….”

NYT –With Virus Origins Still Obscure, W.H.O. and Critics Look to Next Steps
https://www.nytimes.com/2021/04/07/health/coronavirus-lab-leak-who.html

Recommended analysis. “A scientific mission to China proposed further study for a number of topics.
Critics and the director of the W.H.O. have weighed in as well.”

Link: HPW - International Scientists Call On WHO To Conduct “Full” Investigation Into Origins of
COVID-19

And Lancet World Report - Calls for transparency after SARS-CoV-2 origins report

“As focus shifts to the next phase of research on the origins of SARS-CoV-2, calls for data sharing and
more rigorous studies intensify. John Zarocostas reports.”

UN News - Migrants left stranded and without assistance by COVID-19 lockdowns
https://news.un.org/en/story/2021/04/1089302

 15

“Travel restrictions during the COVID pandemic have been particularly hard on refugees and
migrants who move out of necessity, stranding millions from home, the UN migration agency,
IOM, said on Thursday. According to the International Organization for Migration (IOM), the first
year of the pandemic saw more than 111,000 travel restrictions and border closures around the
world at their peak in December. …”

Covid Science

Guardian - Global rollout of vaccines is no longer a guarantee of victory over
Covid-19
S Michie et al ; https://www.theguardian.com/world/2021/apr/06/global-rollout-of-vaccines-is-no-
longer-a-guarantee-of-victory-over-covid-19

Must-read. “New variants of concern have changed the game, spreading worldwide and threatening
to derail pandemic control efforts.”

“…As members of the Lancet Covid-19 Commission Taskforce on Public Health, we call for urgent
action in response to the new variants. These new variants mean we cannot rely on the vaccines
alone to provide protection but must maintain strong public health measures to reduce the risk
from these variants. At the same time, we need to accelerate the vaccine program in all countries in
an equitable way. … … Together, these strategies will deliver “maximum suppression” of the
virus….”

Science News - Side effect worry grows for AstraZeneca vaccine
https://science.sciencemag.org/content/372/6537/14

Good overview of state of affairs as of end of last week.

AstraZeneca Policy update from this week
Was again a fairly busy week in this respect…

 • On the EMA stance: Politico (analysis ahead of the EMA briefing on Wednesday)- Regulators
 walk fine line assessing AstraZeneca vaccine

Cfr tweet Jilian Deutsch: “European regulators are reluctant to limit the use of the
Oxford/AstraZeneca vaccine because, although there could very well be a link between blood clots
and the vaccine, its benefits still outweigh its risks. “

And then on Wednesday, Stat - In rare instances, AstraZeneca’s Covid-19 vaccine linked to blood
clots, regulators say

 16

“The European Medicines Agency has concluded there is a link between AstraZeneca’s Covid-19
vaccine and “very rare” but dangerous clotting events reported in a number of countries where the
vaccine has been used, events which in some cases have been fatal. … … Regulators stressed that the
benefits of the vaccine, which was shown to be 76% effective at preventing Covid infections in a
large U.S.-based study, still outweigh its risks….. The announcements are another blow to the effort
to create an affordable and easy-to-administer product envisioned as the backbone of the
vaccination campaign in much of the world…”

 • As for WHO’s current stance, see also UN News - COVID-19: AstraZeneca vaccine benefits
 still ‘largely positive’

“The benefits of the AstraZeneca COVID-19 vaccine are still “largely positive” and outweigh risk of
rare but serious blood clots, according to an official with the World Health Organization (WHO),
speaking on Tuesday during the agency’s regular press briefing from Geneva. “

See also Cidrap News :

“Experts from the European Medicines Agency (EMA) and the United Kingdom's Medicines and
Healthcare Products Regulatory Agency (MHRA) both emphasized that the benefits of the vaccine
continue to outweigh any risks. In a related development, the World Health Organization (WHO)
vaccine safety group reviewed the latest information from the EMA, MHRA, and other countries
and said the link is plausible but not confirmed, with more studies needed. … … In an interim
statement, the WHO said its vaccine advisory group met today, and while acknowledging a possible
link, it noted that the blood clot numbers in people who have received the vaccine are very low
compared with the nearly 200 million people across the world who have received the AstraZeneca
vaccine. It also said the rare events should be weighed against the 2.86 million people who have died
from COVID-19….”

And link Politico - Comms crisis: Regulators fail to assuage concerns over Oxford/AstraZeneca
vaccine

Guardian - One in three Covid survivors diagnosed with mental health condition
https://www.theguardian.com/world/2021/apr/07/one-in-three-covid-survivors-diagnosed-with-
mental-health-condition

Based on new Lancet Psychiatry study, which finds “34% developed psychiatric or neurological
conditions after six months”.

See also Stat - 1 in 3 Covid-19 patients are diagnosed with a neuropsychiatric condition in the next
six months, large study finds

HPW - Strong Link Between COVID-19 Infection & Mental Health Diagnoses – New Lancet Study

“…Covid’s connection to the brain is not new. What’s different is the distinction between
neurological and psychiatric complications. People with very severe Covid-19 had a higher risk of
complications like stroke or dementia, but people who developed anxiety or depression spanned the
spectrum of illness severity.”

 17

SCMP - China research team finds 24 new bat coronaviruses within 2km radius
https://www.scmp.com/news/china/science/article/3125216/china-research-team-finds-24-new-
bat-coronaviruses-within-2km

“None appeared to be direct ancestor of new coronavirus causing Covid-19 but range of genomic
diversity ‘surprising’ to scientists; Their non-peer reviewed paper shows a closely matching virus to
the one behind pandemic, with different spike protein…”

NYT - Researchers Are Hatching a Low-Cost Coronavirus Vaccine
https://www.nytimes.com/2021/04/05/health/hexapro-mclellan-vaccine.html

On the next generation vaccines (it is hoped).

 “…. A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and
Vietnam could change how the world fights the pandemic. The vaccine, called NDV-HXP-S, is the
first in clinical trials to use a new molecular design that is widely expected to create more potent
antibodies than the current generation of vaccines. And the new vaccine could be far easier to
make…. Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in
specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-
produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in
factories around the world. If NDV-HXP-S proves safe and effective, flu vaccine manufacturers could
potentially produce well over a billion doses of it a year. Low- and middle-income countries currently
struggling to obtain vaccines from wealthier countries may be able to make NDV-HXP-S for
themselves or acquire it at low cost from neighbors….”

Guardian - Brazilian Covid variant: what do we know about P1?
S Boseley; https://www.theguardian.com/world/2021/mar/01/brazil-covid-variant-p1-britain

“What threat does variant that is causing devastation in Brazil pose, and how is it different?”

Covid-19 vaccine access (and other bottlenecks)

Devex - In Brief: Only 70,000 people are fully vaccinated for COVID-19 in Africa
https://www.devex.com/news/in-brief-only-70-000-people-are-fully-vaccinated-for-covid-19-in-
africa-99610

“While the majority of countries in Africa have received shipments of COVID-19 vaccines, only
about 70,000 people across the continent are fully vaccinated with two doses, said Vera Songwe,
executive secretary of the United Nations Economic Commission for Africa. This figure pales in
comparison with other parts of the world where some countries have fully vaccinated large portions
of their populations. “When you look at how many people have gotten two vaccines, we are still at
about 70,000. We haven’t even reached 100,000 in terms of who has gotten the full set of the

 18

vaccines on the continent,” Songwe said during an online discussion Wednesday. In Africa, 45
countries have received shipments of vaccines. This has resulted in the administration of 12 million
doses, but almost all are first doses….”

See also WHO Afro (8 April) - Less than 2% of world’s COVID-19 vaccines administered in Africa

“ Less than 2% of the 690 million COVID-19 vaccine doses administered to date globally have been
in Africa, where most countries received vaccines only five weeks ago and in small quantities. Forty-
five African countries have received vaccines, 43 of them have begun vaccinations and nearly 13
million of the 31.6 million doses delivered so far have been administered. The pace of vaccine
rollout is, however, not uniform, with 93% of the doses given in 10 countries….”

“… Through the COVAX Facility, 16.6 million vaccine doses – mainly AstraZeneca – have been
delivered to African countries.”

WHO/GAVI – COVAX reaches over 100 economies, 42 days after first international
delivery
https://www.who.int/news/item/08-04-2021-covax-reaches-over-100-economies-42-days-after-
first-international-delivery

Update as of yesterday (Thursday).

“The COVAX Facility has now delivered life-saving vaccines to over 100 economies since making its
first international delivery to Ghana on 24 February 2021. So far, more than 38 million doses of
vaccines from manufacturers AstraZeneca, Pfizer-BioNTech and Serum Institute of India (SII) have
now been delivered, including 61 economies eligible for vaccines through the Gavi COVAX Advance
Market Commitment. COVAX aims to supply vaccines to all participating economies that have
requested vaccines, in the first half of 2021, despite some delays in planned deliveries for March
and April….”

PS: next week (15 April) there’s the COVAX investment meeting, hosted by the US.

Reuters - African Union drops plans to buy COVID vaccines from India's SSI, pivots
to J&J
Reuters;

“The African Union has dropped plans to secure COVID-19 vaccines from the Serum Institute of
India for African nations and is exploring options with Johnson & Johnson, the head of the Africa
Centres for Disease Control and Prevention said on Thursday. The institute will still supply the
AstraZeneca vaccine to Africa through the COVAX vaccine-sharing facility, John Nkengasong told
reporters, but the African Union would seek additional supplies from Johnson & Johnson….”

See also FT - African Union halts AstraZeneca vaccine purchases over supply concerns “ Body says
decision is unrelated to blood clot worries in Europe.”

 19

“…“We didn’t want to compete with Covax,” he told the Financial Times. “[AstraZeneca] vaccines
from the Serum Institute of India are coming to the continent, anyway.” Nkengasong stressed that
the decision had “nothing to do” with concerns in Europe about blood clots, insisting that “we
recommend the use of the [AstraZeneca] vaccine”….”

PS: African leaders meet virtually next week to discuss expanding vaccine manufacturing capacity.

See also HPW:

“The Indian government’s decision to suspend exports of the vaccines from the Serum Institute of
India (SII) to countries in Africa will further prevent public health agencies from maintaining
specific vaccination schedules in a predictable manner, especially from mid-April to July, according
to Dr John Nkengasong, Director of the Africa CDC. Speaking during a press briefing on Thursday
Nkengasong said: “If the shipment of vaccines was not interrupted because of the situation in India,
we would have had a nice coverage between now to June, and then from June or July onwards, our
own deliveries will kick in and even more COVAX deliveries will come in”….”

Geneva Health Files - The cautionary tale of the COVAX Facility
Geneva Health Files;

As already mentioned in last week’s IHP newsletter, these aren’t the best months for the Covax
facility. Priti Patnaik gives an overview here of the many challenges facing the Covax facility, some
of them unanticipated.

UN News - How can we vaccinate the world? Five challenges facing the UN-backed
COVAX programme
https://news.un.org/en/story/2021/04/1088932

Read together with this piece, which also has a good overview of some of the challenges. The ones
listed here are: export controls; getting vaccines to those who need them; more funding needed to
help roll-out in poorest countries; richer countries should share excess doses; vaccine hesitancy.

Reuters - Biden administration names coordinator for U.S. vaccine diplomacy
worldwide
Reuters;

“…The Biden administration on Monday named a coordinator to lead U.S. COVID-19 vaccine
diplomacy globally as it sought to assure countries seeking more supplies from Washington that it
was moving as fast as possible. U.S. Secretary of State Antony Blinken named Gayle Smith, a former
U.S. Agency for International Development (USAID) coordinator under the Obama administration, as
the coordinator for the Global COVID Response & Health Security at the State Department. … In
remarks at the Department, Blinken said as Washington ensures its own vaccine supply, it has begun
exploring how to share more with other countries….”

 20

In other words (see Devex) - The vaccine diplomacy race heats up.

Common Dreams - G20 Nations Slammed for Calling Covid Vaccines a 'Public
Good' While Denying Them to the World
Common Dreams;

“Progressive campaigners on Wednesday denounced G20 nations for offering lip service to the
importance of treating coronavirus vaccines as a "global public good" while simultaneously
blocking an effort to lift restrictive patent protections and share vaccine recipes with the
developing world. After a virtual meeting Wednesday afternoon, finance ministers from the G20
countries released an eight-page joint communique declaring that they "recognize the role of Covid-
19 immunization as a global public good and reiterate our support to all collaborative efforts,
especially to the four pillars of the Access to Covid-19 Tools Accelerator (ACT-A) and its COVAX
Facility." But the document does not express support for a South Africa and India-led proposal at
the World Trade Organization (WTO)…

FT –India to restart Covid vaccine exports in June if local cases fall
https://www.ft.com/content/fcdffb8f-f86e-4bd9-adec-20256aeb0a07

“The Serum Institute of India, the world’s largest vaccine manufacturer, will resume exports of the
Oxford/AstraZeneca Covid-19 vaccine in June but only if domestic coronavirus cases decline….”

“Adar Poonawalla, the chief executive of Serum Institute, said the company would prioritise meeting
demand in India in the next few months but hoped to restart international shipments in June
“without compromising the needs of our country”. Poonawalla added that if infections in the
country of 1.4bn people continued to climb, the company would have to push back exports
further…”

Times of India - Covid-19: AstraZeneca sends legal notice to SII over delays
https://timesofindia.indiatimes.com/articleshow/81960902.cms?utm_source=contentofinterest&ut
m_medium=text&utm_campaign=cppst

You gotta be kidding….

Al Jazeera (op-ed) - Virus variants point to need to scale manufacturing
Peter Singer; https://www.aljazeera.com/opinions/2021/3/26/virus-variants-point-to-need-to-scale

“New realities are imposing themselves, demanding different approaches to disease surveillance and
vaccine development, production and distribution.”

I like Singer’s comparison with anti-virus upgrades. “… However, the new vaccines also give us a
peek into a possible new future, based on genomic information and vaccine platform technologies. In
principle, within days of detecting and sequencing variants, or future viruses with pandemic

 21