IHP news 661 : Heading for a disappointing TRIPS waiver "compromise"?

IHP news 661 : Heading for a disappointing
TRIPS waiver “compromise”?
( 18 March 2022)

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,

While Putin’s horrific war in Ukraine is getting almost all world media attention, for very
understandable reasons, an empathizing Dr. Tedros pointed out the obvious on Wednesday. He
stressed there are also a number of other ongoing humanitarian and war/conflict-related tragedies
being largely neglected now (or rather: even more ignored than usual), among others pointing to the
fact that ‘nowhere on earth people are more at risk than in Tigray now’.

Over to the main ‘global health’ news of the week then. We seem to be inching “closer to an
agreement to waive Covid vaccine patents”. On Tuesday, a compromise was struck between the
US, EU, India and South Africa that could end the deadlock, 18 months after a TRIPS waiver proposal
was first taken to the WTO. Unfortunately, with the current ‘compromise’ text we’re pretty far
removed now from the initial proposal raised by India and South Africa in October 2020. Even if this
is “progress” of sorts ( certainly given the gridlock of the past months), reactions are mixed, to say
the least, and very much so among health activists. As for researchers, Katerini Storeng was no
doubt not the only one wondering on Twitter, “ Genuine progress towards equitable access or “baby
steps” that maintain pharma’s interests?” But believe it or not, Thomas "Decepticon" Cueni (IFPMA)
didn't sound too happy either about even this watered down draft, but that might just be wicked
Cueni -“tactics”. Finally, let’s not forget, as Thomas Bollyky rightly argued, this comes very late in
the pandemic… And as a reminder - any agreement will have to be accepted by the WTO's 164
member countries in order to be adopted. ( true, if we kick out Russia, only 163 )

Meanwhile, the Covid pandemic seems now firmly in "Transformers" territory, with “Deltacron”
having seen the light recently. As for (preventing & preparing for ) the next pandemic, the 1st
session of the brand new Intergovernmental Negotiating Body (INB) to draft a “pandemic
preparedness instrument” for WHO took place early this week. Curious where this whole process
will “land” eventually, especially against the current geopolitical backdrop.

Moving across the ocean then, the next PEPFAR boss, John Nkengasong appeared before the U.S.
Senate Foreign Relations Committee on Tuesday, pledging among others a respectful partnership
with local leaders. In this newsletter, we also offer you the usual overview of other key publications
and reports from this week, with among others a hard-hitting Lancet Nigeria Commission.

Now that it’s ever more clear that we can’t just finance all Global Public Goods with ODA money in
this super-wicked world of ours, we leave you with some tweets and other stances. First of all, one
from Agnès Soucat: “we need to distinguish the global common good argument from the equity
argument”. True. As for “identifying” the necessary billions (or even trillions) for both sorts of
causes, with Piketty, we agree an international financial registry that would keep track of who

 1

owns what in the various countries is long overdue. Jairo Funez put it like this in a tweet: “Russian
billionaires are considered oligarchs because the West has the notion that the former never truly
became modern. The West however could never have oligarchs since its modern billionaires
support "free" enterprise & are in no way interested in domination and exploitation.”

So ‘replenishment folks’, you know what to include in your various ‘cases’ in the coming months.
Unless if you want to wake up, sooner rather than later I’m afraid, in a world ruled by Putin, the
radical-right and other fascists.

Enjoy your reading.

Kristof Decoster

Featured Article

I have a dream for Anna and all her sisters

Alice Sherbro (MSP in Health economics, policy, and management, Karolinska Institutet)

Anna is a 36-year old woman living on the streets of New York. She has been homeless since the
beginning of the Covid-19 pandemic. She has been using toilet paper as her sanitary pads when she
can, otherwise she would reuse old fabrics. She doesn’t have access to clean underwear, and she lives
in shame and uncertainty every month. Before Covid, she was a waitress living from paycheck to
paycheck and sleeping on a friend’s couch. When the pandemic hit, she lost her job, a place to sleep,
as well as her freedom to manage menstruation with dignity.

After the last two years, it’s unclear how, when or whether mankind will stop the Covid-19
pandemic. This leaves little hope for the other “pandemic”, one that has existed for as long as
humanity i.e. the poor menstrual management crisis that has existed since before the COVID-19
pandemic. The question is what could have been different for “Anna”, in this case a fictional
character, but in reality, one who, unfortunately, without doubt, is living somewhere in New York
and many other big cities around the world at this very moment?

Menstruation is a natural cyclical biological process that occurs in more than half of the world’s
population. Every day approximately 800 million people menstruate. Yet in many countries,
menstruators struggle with “poor education and inadequate access to menstrual hygiene tools
including but not limited to sanitary products, washing facilities, and waste management”. In short,
they face period poverty. The World Bank estimates that 500 million women and girls globally live in
period poverty, meaning that about 12.8% of women and girls live in poverty and struggle to access
the resources to manage their periods. This in turn generates stigma that prevents menstruators
from living with menstrual dignity. Many middle and low-income countries in Africa and America, as
well Southeast Asia, try to address period poverty through implementing water, sanitation and
hygiene (WASH) measures and Sustainable Development Goals (SDGs) (3, 4, 5, 6 and 10) -related
recommendations to create new policies. Quite a few of these policies focus on girls in schools.

 2

Period poverty is however not just a problem in the “South”, with data showing that period poverty
is increasingly becoming an issue in wealthy countries as well. In the USA, for example, every 5th girl
lives in period poverty.

Enter “Anna”. She’s a part of a group of marginalized women who live in period poverty in the
North. When promoting policies addressing period poverty, most interventions fail to reach the last
mile, even in the ‘Global North’. Indeed, homeless women, and women from low and middle-income
households living in high-income countries are often not considered a target group for these
policies. Instead, typical target groups are adolescents and young adults and in recent years new
policies have tended to target schools, colleges and universities. Don’t get me wrong: this focus on
the young is obviously major progress. But it’s not enough. There’s a need for a universal coverage
policy for menstrual products. Countries should follow the example of Scotland to put into law and
contextualize a policy of providing menstrual sanitary products for all menstruators.

Let’s zoom in perhaps a bit more on some of the experiences of the homeless and other unprivileged
and marginalized populations of women who are forgotten and often not included in these policies.
A 2016 UK report on “the experiences of menstruation by homeless women” emphasized the
problem of period poverty as well as the devastating mental and physical toll that stigmatization of
menstrual dignity brings with it. Cheryl, Emely and Michaela are some of the women who
participated in this study, and shared their experience:

 “It’s having the money to get hold of sanitary towels, ‘cause I’m using the money for other
 things. But if I buy the cheap brands, it’s 20 minutes and I’m flowing again. It’s like cheap
 nappies, you just can’t take that risk” – Cheryl

 “It’s like having a warden, and you don’t really want to be like ‘please sir, can I have
 something for my bleeding?’ ” -Emily

 “I would never ask; I’d be too embarrassed” -Michelle

Menstrual sanitary products, which are essential for the health of menstruating people, are
identified and taxed as luxury products, making them unaffordable for (too) many menstruators.
This problem is a reality, in both low and high-income countries. As a result, menstruators are left to
resort to alternative resources such as toilet paper, and fabrics. Some even resort to offering sexual
favors or services to be able to buy or afford menstrual products, pushing people who menstruate
into prostitution.

Even where help is available, it is often limited. For instance, while homeless women’s and other
women’s shelters may provide menstrual sanitary products, it is not guaranteed that products will
always be in stock. In addition to this, the stigma and embarrassment that many women feel stops
them from reaching out for help (see above-mentioned testimonies).

On the bright side, during the past 5 years, a movement to counteract period poverty has gained
momentum. New policies have been created and many different NGOs have become involved in
helping homeless women and others in need, to get menstrual products. Unfortunately, the
campaign against period poverty has taken a big step backwards as a result of the Covid-19
pandemic. The significant economic impact of the pandemic on many families has caused them to

 3

prioritize other basic needs, which means women from many different socioeconomic classes are
experiencing period poverty.

In conclusion, whether the (Covid-19) pandemic is now “over” or not, we need to deal with this
(centuries old) period poverty “pandemic”. We must look at the policies that exist and create new
ones that reach beyond what has been done today to be able to answer the question of “what could
have been different for Anna?”. Scotland is the obvious role model in this respect. We should learn
from them and take steps to ensure that all menstruators feel free and liberated in their
menstruation, regardless of age or socioeconomic status. Lawmakers need to create universal
policies to reach all menstruators at all socioeconomic levels.

Even though there is inequality, stigma and period poverty, I still have a dream, a dream that flows
through me, where everyone who menstruates, can do so freely and with dignity.

Highlights of the week

TRIPS waiver compromise on the horizon?
We start with some coverage, then offer some reactions from various corners.

With the exception of Ngozi, nobody seemed really pleased. Or as HPW put it, WTO Head
Welcomes Compromise on IP Waiver for COVID Vaccines – But Activists and Pharma Express
Dismay

Reuters - U.S., EU, India, S.Africa reach compromise on COVID vaccine IP waiver
text
Reuters;

“The United States, European Union, India and South Africa have reached a consensus on key
elements of a long-sought intellectual property waiver for COVID-19 vaccines, according to a
proposed text reviewed by Reuters. Sources familiar with the talks described the text as a tentative
agreement among the four World Trade Organization members that still needs formal approvals
from the parties before it can be considered official. Any agreement must be accepted by the
WTO's 164 member countries in order to be adopted.”

“Some elements of the consensus deal, including whether the length of any patent waivers would be
three years or five years, still need to be finalized, according to the text. It would apply only to
patents for COVID-19 vaccines, which would be much more limited in scope than a broad proposed
WTO waiver that had won backing from the United States, according to the document. The
document authorizes use of "patented subject matter required for the production and supply of
COVID-19 vaccines without the consent of the right holder to the extent necessary to address the
COVID-19 pandemic". … …. It said IP rights would also be waived for ingredients and processes
necessary for COVID-19 vaccine manufacture, a move aimed at granting critical know-how to many
countries lacking expertise, especially for advanced mRNA-type vaccines.”

 4

“The text contained several limitations, including that the waiver is only available to WTO member
countries that exported less than 10% of global exports of COVID-19 vaccine doses in 2021. The
tentative agreement does not include COVID-19 treatments or tests, and the limitations would likely
exclude China from any waiver, a source familiar with the negotiations said…..”

“The text, which was produced in negotiations last week, was being circulated to officials in Brussels,
Washington, Johannesburg and New Delhi before being presented to other WTO members. Adoption
of the IP waiver by the consensus-driven organization is far from certain.”

Politico- Compromise reached on COVID-19 vaccine intellectual property rights
waiver
https://www.politico.eu/article/compromise-reached-on-covid-19-vaccine-intellectual-property-
rights-waiver/

Also free to read, this Politico piece (and recommended).

“… Although the breakthrough appears potentially significant, advocates calling for broader global
access to effective COVID treatments expressed dismay that the compromise only relates to
vaccines. …. James Love, director of Knowledge Ecology International, said it was “appalling” that
the waiver was limited to vaccines. Doctors Without Borders’ Shailly Gupta was similarly scathing,
asking in a tweet: “What about therapeutics that are or will be needed for those who will continue to
fall sick due to #COVID19 in low and middle income countries?” Love added that countries already
have the freedom to allow the non-voluntary use of patents “even without prior negotiation with
patent owners in cases of emergency or a pandemic.” He also criticised the limitation to certain WTO
members, saying it protects “American and European vaccine manufacturers from competition from
developing country suppliers.”….”

“….The limitation restricting the solution to only developing countries, is notable as at the WTO
countries self-declare their developing or developed status….”

“Further, the compromise waives the need for the product to be predominantly for the domestic
market, thereby enabling exports of the vaccine to other eligible countries. In the document, the
Commission notes that this has been a key request from the proponents of the waiver. “

 • See also HPW:

“…the compromise now has good chances of being approved since EU countries had been the
major opponents to the proposal by South Africa and India, submitted in October 2020, to waive IP
on COVID-19 vaccines and other pandemic-related health products for the duration of the
pandemic. …”

 • But see also Bloomberg - WTO Touts Progress in Covid Vaccine Waiver Talks But No
 Agreement Yet

“….It remains unclear whether two key opponents to the IP waiver proposal -- the U.K. and
Switzerland -- will support the compromised text. …”

 5

WTO DG Okonjo-Iweala welcomes breakthrough on COVID-19 vaccine waiver
https://www.wto.org/english/news_e/news22_e/dgno_16mar22_e.htm#.YjHFEQgEDY8.twitter

“World Trade Organization Director-General Ngozi Okonjo-Iweala today warmly welcomed the
breakthrough among four WTO Members on a waiver of the Trade Related Intellectual Property
agreement for the production of vaccines against the COVID-19 pandemic. This is a major step
forward and this compromise is the result of many long and difficult hours of negotiations. But we
are not there yet. We have more work to do to ensure that we have the support of the entire WTO
Membership,” the Director-General said. While the agreement between the European Union, India,
South Africa and the United States is an essential element to any final deal, she cautioned that not
all the details of the compromise have been ironed out and that internal domestic consultations
within the four members are still ongoing. Moreover, she stressed that work must commence
immediately to broaden the discussions to include all 164 members of the WTO.”

Reaction Thomas Cueni (IFPMA)
In my humble opinion, Thomas Cueni has been right up there with Albert Bourla and other Stéphane
Bancels in this pandemic. History won’t be kind for them.

Reuters - Drugmakers condemn plan for COVID vaccine patent waiver
Drugmakers condemn plan for COVID vaccine patent waiver | Reuters

“Global drugmakers condemned on Wednesday an initiative by four World Trade Organization
members to introduce an intellectual property waiver for COVID-19 vaccines, saying it could
undermine the industry's ability to respond to health crises in future.”

“"Biopharmaceutical companies reaffirm their position that weakening patents now when it is widely
acknowledged that there are no longer supply constraints of COVID-19 vaccines, sends the wrong
signal," said Thomas Cueni, director general of the International Federation of Pharmaceutical
Manufacturers and Associations (IFPMA). Cueni said in the statement (IFPMA) the proposals
amounted to "political posturing that are at best a distraction, at worse creating uncertainty that can
undermine innovation’s ability to respond to the current and future response to pandemics."

He said the global pharmaceuticals industry was producing more than 1 billion vaccine doses a
month, thanks to collaboration within the legal patent protection framework, and the focus should
shift from production to distributing shots in poorer nations. “

For more reactions from Big Pharma, see also Reuters - …. drugmakers balk | Reuters

“….Global drugmakers in the International Federation of Pharmaceutical Manufacturers and
Associations (IFPMA) said the move could undermine their ability to respond to future crises…. …..
Pfizer declined to comment on the initiative and its German vaccine partner BioNTech had no
immediate comment. The two have pledged to provide 2 billion doses of their COVID vaccine to low
and middle income countries in 2021 and 2022. AstraZeneca, the maker of another major COVID
vaccine, also declined to comment….”

 6

First reactions by health activists
 • Analysis James Love (KEI) – https://www.keionline.org/37544

 “It is a very limited and narrow agreement. It only covers vaccines, it limits “eligible members” to
developing countries, and only those who exported less than 10 percent of world exports in 2021
(China is excluded). Countries are required to follow Article 31 of the TRIPS, which of course, is an
existing and not a new flexibility, but with “clarifications” and a partial waiver of 31.f. The
clarifications are actually new obligations on countries that do not presently exist in Article 31. With
the exception of the partial waiver of paragraph f in Article 31 (exports to “eligible countries”), the
agreement makes Article 31 more restrictive and burdensome. In other words, outside 31.f, the
agreement makes Article 31 worse. “….”

And a scathing final assessment: “….Overall, this agreement will be welcomed by PhRMA members,
if it ends the conversation about IP and the pandemic at the WTO.”

 • Public Citizen - Statement: Leaked Proposal on COVID Medicines Waiver Helps No One But
 Floundering WTO

“….The text is not yet available, but reports indicate this proposal represents the worst elements of
both the U.S. and EU positions. ….”

 • People’s Vaccine - statement Max Lawson

 • MSF Access - Compromise neglects COVID-19 treatments and diagnostics and fails to
 address intellectual property barriers beyond patents, but there’s still time to get it right

Devex - TRIPS waiver compromise draws mixed response
A Green; https://www.devex.com/news/trips-waiver-compromise-draws-mixed-response-102860

“The proposed compromise would allow eligible WTO members to issue a single authorization to
waive multiple patents, including on vaccine ingredients and processes, without fear of a challenge
from the patent holders…..”

With some more reactions, among others from Leena Menghaney, the South Asia head of Médecins
Sans Frontières’ Access Campaign (who’s fairly negative about the compromise), and also from Luke
McDonagh (cautious optimism).

On the latter: “… If the reports that India and South Africa have acceded to the compromise are
accurate, though, "that commands a certain level of trust,” said Luke McDonagh, an expert on
intellectual property at the London School of Economics. Their approval may reflect the evolving
landscape around global vaccine production, particularly the advent of the WHO-backed mRNA
vaccine technology transfer hub in South Africa. Launched in July 2021, the hub is already producing
mRNA vaccines at laboratory scale and will soon be transferring its technology to six African
countries. That signals a rapid increase in capacity in the global south from the outset of the

 7

pandemic, which McDonagh called a “remarkable success. Given what has been achieved, the key
issue does become about patents,” especially around issues like exports. “I can’t see why South
Africa and India would agree to a compromise unless they thought it would really assist in the
boosting of pharmaceutical production,” he said.”

Finally, a link:

Trade Beta blog – ‘Quad’ raise hopes of a COVID-19 deal and revival for the beleaguered WTO
(by P Ungphakorn) Recommended.

Geneva Health Files - A compromise on the horizon? TRIPS Waiver talks in the
'Quad' at the WTO
P Patnaik; Geneva Health Files;

In-depth analysis from last week on Friday, in which Priti Patnaik already anticipated the
compromise.

“….While the Russian invasion of Ukraine has upended trade diplomacy at the WTO in recent days,
the TRIPS waiver discussions have proceeded among a small group of members and is likely
nearing a compromise, although differences persist. …. …. Sources familiar with the process told us
that technical deliberations among the quad that includes the US, the EU, India and South Africa, are
now nearing completion. These discussions are soon expected to follow at the level of the ministers
of these four WTO members. “If the current text is acceptable by high-level decision-makers, it will
then be taken up by the wider membership”, a source said. It is understood that the process of taking
the proposal to the wider membership will be brokered by WTO DG, Ngozi Okonjo-Iweala…..”

The analysis had more on the process of the QUAD discussions, and then offered some substantive
elements of a potential compromise.

“Pandemic treaty” discussions

HPW - New WHO Negotiating Body on ‘Pandemic Instrument’ Meets Amid Civil
Society Appeal
https://healthpolicy-watch.news/protect-pandemic-instrument-negotiations-from-undue-influence-
of-private-sector-appeals-civil-society/

“The first session of the newly constituted Intergovernmental Negotiating Body (INB) to draft a
“pandemic preparedness instrument” for the World Health Organization (WHO) began on Monday.
The six-member body, representing all WHO regions, is made up of Precious Matsoso (South Africa),
Roland Driece (the Netherlands), Ambassador Tovar da Silva Nunes (Brazil), Ahmed Salama Soliman
(Egypt), Kazuho Taguchi (Japan) and Viroj Tangcharoensathien (Thailand). The two-day session will
elect two co-chairs, as well as agree on the working methods and timelines of body “based on the
principles of inclusiveness, transparency, efficiency, Member State leadership and consensus”,

 8

according to the agenda. … …. Meanwhile, almost 200 civil society leaders have asked the six
negotiators to protect the process from any “undue influence of the private sector and its powerful
lobbyists”. In an open letter addressed the six negotiators, the leaders have asked the INB to pay
attention to a number of issues….”

Policy Brief - A new Treaty on Pandemics – Key to (re)build trust in international
cooperation?
M Voss, C Wenham, M E-Turner et al ; https://www.klimawandel-gesundheit.de/wp-
content/uploads/2022/03/Policy-Brief_Pandemic-Treaty_short.pdf

Must-read policy brief (10 p.).

“The international community responded to the multiple governance failures of responding to the
pandemic by agreeing to three major consensuses at a Special Session of the World Health
Assembly (WHASS): Understanding there are large gaps in pandemic preparedness and response; a
need to develop a new instrument [to mitigate failures experienced]; and the need to strengthen
existing norms and framework including the International Health Regulations (IHR). Subsequently, an
intergovernmental negotiating body (INB) was established to draft a convention, agreement or
other international instrument for pandemic preparedness and response under the Constitution of
the World Health Organization (WHO). The justification for a pandemic treaty is that whilst the
technical expertise on how to govern and end a pandemic exists, political will to do so is missing. It is
hoped that the technical expertise will inform and therefore increase the political will . A new
instrument – a proposed pandemic treaty or framework convention for pandemic preparedness and
response – may be a key to (re) build trust in international health cooperation. Yet, a new
pandemic treaty cannot stand on its own and will not be the solution to all failures in global
health. As such, there are concrete next steps for the INB, WHO member states and particular the
German government in its current G7 presidency to take to achieve as much as possible with the
proposed pandemic treaty, without overstretching its mandate to make it unachievable….”

HRI, Community and Civil Society seek OHCHR engagement in Pandemic Treaty
process
https://www.hri.global/contents/2180

Cfr a tweet : “Vulnerable, marginalised & criminalised groups were disproportionately affected by
#COVID19 responses. Yet they are left out of #PandemicTreaty negotiations at @WHO. We asked
@UNHumanRights to promote human rights and CS participation in this process.”

South Centre (Research paper) - Can Negotiations at the World Health
Organization Lead to a Just Framework for the Prevention, Preparedness and
Response to Pandemics as Global Public Goods?

Viviana Muñoz Tellez; South Centre.

“This paper advances that WHO Member States, having agreed to the objectives of advancing
equity and solidarity for future pandemic prevention, preparedness and response, now must

 9

operationalize these. The paper offers suggestions for the ongoing WHO processes of: 1) review of
recommendations under examination by the Working Group on Strengthening WHO Preparedness
and Response to Health Emergencies, 2) consideration of potential amendments to the International
Health Regulations (IHR) 2005, and 3) elaboration of a draft text for an international instrument on
pandemic preparedness and response.”

Politico - U.S. pushes for more global sharing of health tech in next pandemic

https://www.politico.com/news/2022/03/17/u-s-global-health-tech-sharing-next-pandemic-
00017977

“Easier access to vaccines at center of Biden administration's WHO effort ahead of future public
health emergencies, document reveals.”

“The Biden administration wants the World Health Organization to improve global equity in the
next public health emergency by pushing manufacturers to voluntarily share their products and
technology, according to a document drafted by the Department of Health and Human Services and
obtained by POLITICO. Biden administration officials coordinating with a WHO group focusing on
preparedness in health emergencies wrote the paper, outlining ways to expand equity through a
potential pandemic treaty or some other kind of global agreement. The document — details of which
were previously unknown — is a window into the Biden administration’s effort to ensure low- and
middle-income countries have equal access to the data, vaccine and treatments needed to respond to
the next pandemic. It lays out U.S. “targets” for improving equity, including widening access to
vaccines by increasing manufacturing capacity worldwide — specifically through the “promotion
and facilitation” of the voluntary licensing of the products, according to the paper….”

“The paper, created for the Working Group on Strengthening WHO Preparedness and Response to
Health Emergencies, lays out ideas for not only greater manufacturing capacity of the products but
also increased sharing of genomic sequencing and pathogen data as well as purchasing agreements
and the liability protection language included in those contracts….. ….. According to the document
obtained by POLITICO, the administration believes greater equity could be achieved if
manufacturers voluntarily licensed and transferred their technology — steps companies across the
world, including U.S. vaccine makers, refused to do during the Covid-19 pandemic. The paper says
that to strengthen the organization’s preparedness and response to health emergencies, the WHO
should promote and facilitate the “voluntary licensing of critical public health response products by
manufacturers on mutually agreed terms, including the voluntary transfer of technology and know-
how on such terms.”…”

Covax & ACT-A

Germany to co-host 2022 Gavi COVAX AMC Summit, pledges additional funding for
COVID-19 vaccination in lower-income countries
https://www.gavi.org/news/media-room/germany-co-host-2022-gavi-covax-amc-summit-pledges-
additional-funding-covid-19

 10

“Germany will co-host the 2022 AMC Summit to help raise urgent funding to support lower-income
countries’ dynamic COVID-19 vaccination needs. In addition, Germany has pledged an additional
EUR 350 million to Gavi for the COVAX AMC, as part of a broader US$1.22 billion funding package
for the ACT-Accelerator, pending cabinet and parliamentary approval. Both the Summit and pledge
are in support of Germany’s G7 Presidency goal to promote healthy lives worldwide, strengthen
efforts to address COVID-19 on a global scale, and prepare for future pandemics and health crises.”

“….Gavi, the Vaccine Alliance announced today that the Government of Germany will host a
leader-level meeting aimed at helping raise at least US$5.2 billion in urgent financial support for
COVAX, including US$ 3.8 billion in donor funding for lower-income countries supported by
the Gavi COVAX Advance Market Commitment (Gavi COVAX AMC). The virtual event – “2022 Gavi
COVAX AMC Summit: Break COVID Now” – will be co-chaired by Svenja Schulze, German Minister
for Economic Cooperation and Development and José Manuel Barroso, Gavi Board Chair. It will take
place on 8 April 2022….”

PS: “…. Gavi is seeking urgent funding for a “Pandemic Vaccine Pool” – a flexible financial
instrument that blends direct, contingent and innovative financing and will be able to act as a
rapid response mechanism to support lower-income countries’ needs in the face of these inevitable
changes. Alongside US$ 2.7 billion in funding from sovereign and private sector donors, multilateral
development banks and lower-income countries can also contribute via cost-sharing, providing
another source of rapid funding for vaccines made available through the pandemic vaccine pool to
the COVAX AMC. Gavi is also seeking US$545 million to fund ancillary costs of dose donations,
buying syringes and paying for logistics to get doses to countries, helping donations continue to be
a sustainable and complementary source of supply alongside funded doses from COVAX
agreements.”

Tweet WHO Afro (from Monday)
“Around 708 million #COVID19 vaccines have been received in #Africa to date. 64% from the
#COVAX Facility, 30% from bilateral deals & donations, and 6% through the @AfricaCDC 's Africa
Vaccines Acquisition Trust.

More on Global Health Governance/ Financing / Security

Reuters - In U-turn, U.S. backs WHO budget overhaul, but LatAm is opposed -
sources
https://www.reuters.com/business/healthcare-pharmaceuticals/u-turn-us-backs-who-budget-
overhaul-latam-is-opposed-sources-2022-03-16/

“Negotiations on boosting the World Health Organization's budget to help it prepare for future
pandemics made mixed progress last week, with Washington withdrawing criticism but other
donors voicing opposition, sources involved in the talks told Reuters. The overhaul of funding is seen
as critical to retooling the 74-year-old U.N. body to face future health challenges and is a top priority
for director-general Tedros Adhanom Ghebreyesus as he seeks a second term.”

 11

“In closed-door talks between donors on March 10-11, major donor the United States expressed a
willingness to raise mandatory contributions from 2024 if certain criteria such as better budget
transparency are met, three sources told Reuters. That represents a key reversal from its previous
position where it had raised doubts about a plan under which mandatory fees would rise to
account for half the agency's $2 billion core budget by the biennium 2028-2029, compared to less
than 20% now. …. However, large Latin American countries expressed reservations, including Brazil,
Mexico and Colombia, saying that the hikes would be too costly, the same sources told Reuters….”

“….One of the sources said that the funding revision might be reduced to around 30%-40% with
gradual rises extended until 2031 to convince hesitant countries. The next funding talks are
expected next month with donors aiming to fix recommendations for the WHO's decision-making
body in May.”

Devex - Biden's PEPFAR pick pledges 'respectful partnership' with local leaders
https://www.devex.com/news/biden-s-pepfar-pick-pledges-respectful-partnership-with-local-
leaders-102863

“Dr. John Nkengasong appeared before the U.S. Senate Foreign Relations Committee on Tuesday,
nearly six months after the White House announced its intent to nominate him to serve as U.S. global
AIDS coordinator. Currently the director of the Africa Centres for Disease Control and Prevention —
a position he holds on secondment from the U.S. government — Nkengasong described to
lawmakers how he would lead the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, if
the Senate votes to confirm him…..”

“…. Nkengasong told lawmakers that while the pandemic has negatively affected some HIV
programs, those same platforms have been used to scale up vaccination against COVID-19. “I think
it’s really an opportune moment to harness that investment that we’ve put in place for the last 20
years to make it a more robust and efficient system in fighting the HIV pandemic as well as other
emerging diseases,” he said. In his opening remarks, Nkengasong, who was involved in the creation
of PEPFAR in 2003, said that the initiative’s early challenge was to help build health systems from
the ground up. “The goal now must shift,” he said, calling for a pivot from helping to build health
systems in lower-income countries to ensuring they are sustainable and resilient in the face of both
the continuing HIV pandemic and future disease threats.”

“ “For this to happen, it is my belief that we need to capitalize on the capacity and experience of
those in the countries where we work, coming to the table with a deep respect for their
perspectives and needs, and taking into account their knowledge and local expertise,”
Nkengasong… … In his written testimony, Nkengasong added that PEPFAR should work in “respectful
partnership and accountability” with local leaders and regional institutions….”

“… A full Senate vote on Nkengasong’s nomination has not yet been scheduled.”

Plos GPH (Opinion) - Strong health systems are learning health systems
K Sheikh & S Abimbola;
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000229

 12

“The COVID-19 pandemic has brought to the surface discussions about the need for stronger
health systems, especially in poorer countries. Global health funders are beginning to back up their
rhetoric in this area with investments. The EU, USA, UK, France, and Germany, among others are
investing billions on the health systems strengthening (HSS) agenda in poorer countries. Among
multilateral funders, the Global Fund currently spends $1 billion each year on their “resilient and
sustainable systems for health” portfolio, and Gavi’s new 5-year strategy will likely infuse $1.7 billion
into strengthening health and immunization systems. These sums are insignificant compared to the
loss to lives and livelihoods and the trillions in economic losses that are the cost of inaction—and
this slew of investments in HSS is welcome news. But there is a hitch. Policymakers and practitioners
who work in those health systems are accustomed to seeing the global interest in HSS fluctuate. It is
mainly when emergencies (such as Ebola or COVID-19) strike, that the world wakes up to the
importance of HSS, and by then, it is often too late. We expect a lot from our health systems. …. ….
There is still a disconnect between our lofty expectations from health systems, and the inputs that
they receive to make them stronger. Health systems do not become stronger overnight. Many
investments purport to strengthen them but fail to do so. The gains of well-intentioned and well-
designed investments to strengthen health systems are limited, when they do not focus on
strengthening the ability of health systems to learn. Learning–i.e., the ability to create, gather and
use relevant knowledge and intelligence, to bring about improvements in performance–is a key
neglected element in global HSS efforts….”

PHCPI and the Global Fund join forces to strengthen primary health care around
the world
https://improvingphc.org/blog/2022/03/14/phcpi-and-global-fund-join-forces-strengthen-primary-
health-care-around-world

“The Primary Health Care Performance Initiative (PHCPI) welcomed the Global Fund as its newest
core partner. …. …. The Global Fund joins PHCPI partners including the World Bank, World Health
Organization, UNICEF, Bill and Melinda Gates Foundation, Ariadne Labs and Results for
Development.”

Lancet (World Report) - CEPI launches 100-day vaccine “moonshot”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00513-X/fulltext

Must read. “CEPI has raised $1·5 billion for its work on tackling the next pandemic as civil society
calls for a sharper focus on equitable access to new vaccines. Ann Danaiya Usher reports.”

Excerpt: “Manuel Martin at the Médecins Sans Frontières Access Campaign says that CEPI has been
“spot on” when it comes to the science and “ahead of the curve” in many of its investment decisions.
“It's just that we haven’t really seen the impact that they were meant to have on equitable access in
a real and tangible way,” he says. Martin has written a policy brief on CEPI, seen by The Lancet, for
the People's Vaccine Alliance, a coalition of 100 civil society organisations coordinated by Oxfam. In
it, he writes that CEPI's governance structures and policies are in need of fundamental reforms to
ensure fair global distribution of future medical innovations. CEPI's equitable access policy, which
was whittled down from 13 pages to two back in 2018, is described as “brief, vague, and weak”. Only
four of 12 voting board members are from LMICs, and there is no civil society representative. The
minutes of CEPI's equitable access committee, which was created in 2019, have not been published
on CEPI's website since May, 2020. And of the 17 COVID-19 vaccine candidates and platforms that

 13

CEPI has invested in, only five are in LMICs, all of which are in Asia; none is in Latin America or
Africa….”

Devex - CEPI hopeful despite underwhelming replenishment
https://www.devex.com/news/cepi-hopeful-despite-underwhelming-replenishment-102862

“After meeting less than half of its funding goal in its latest replenishment, the Coalition for
Epidemic Preparedness Innovations says it is anticipating additional funding commitments. “I can’t
speak about specific discussions at this point, but a number of additional commitments are in train
and will be announced in due course,” CEPI CEO Dr. Richard Hatchett told Devex in an email….”

PS: “…. CEPI’s replenishment comes amid a shift in the narrative in the global health space, from
the COVID-19 emergency to preparing for the next pandemic. It also comes months ahead of
the Global Fund to Fight AIDS, Tuberculosis and Malaria’s seventh replenishment conference in the
fall, where the multilateral organization will be asking for $18 billion for its work from 2024 to 2026.
These present opportunities and unique challenges to CEPI’s fundraising. Jaume Vidal, senior policy
adviser for Health Action International, said that governments, the pharmaceutical industry,
academia, and civil society “still believes” in CEPI and its mission — although there remain concerns
from civil society over transparency on its deals, and accessibility of the vaccines it supports. But
there’s a real competition for funding. “We have this competition of initiatives not only for funding
but also [for] political space. I mean, what's going to happen with COVAX now? What’s going to
happen with C-TAP? What’s going to happen with ACT-A?” he said. CEPI also lacks many of the
community and civil society voices that compose Global Fund’s constituencies and are instrumental
in engaging with and raising awareness about the fund’s works and fundraising. In addition,
making the case to raise funds to prepare for what’s yet to come — which is what CEPI is doing —
poses difficulties, he said. …. Hatchett recognizes the challenges in fundraising for research and
development….”

Devex - The US foreign affairs budget and what comes next
https://www.devex.com/news/the-us-foreign-affairs-budget-and-what-comes-next-102836

“Last week, the U.S. Congress passed a budget bill with an unexpectedly small increase to the
foreign affairs budget and without any supplemental funding for the global response to COVID-19.
The final bill, which awaits President Joe Biden’s signature, shocked many development advocates
who are now wondering what went wrong — and how to make foreign aid a priority for lawmakers
at a time of proliferating global crises….”

“…. Advocates thought the bill could include billions more in base appropriations for the foreign
affairs accounts and an additional nearly $5 billion for global COVID-19 response in emergency
funding. But budget negotiations and domestic politics resulted in a nearly flatlined budget despite
mounting needs. …. ….. this result, especially the lack of COVID-19 supplemental funding, is a bit of
a “come to Jesus moment about where priorities lie,” Buckingham said, adding that the global
development community “should probably be taking stock of what’s happened.”….”

PS: there remains bipartisan support for more funding for the global response, though, it seems.

 14

• See also Politico’s Global Pulse: “Covid-19 funding delays impact global vaccinations —
 That package is still in the works, and the White House is warning there will be significant
 consequences both domestically and internationally without quick passage. Around the
 world, that could mean the U.S. would play a smaller role in donating and distributing Covid
 vaccines — as well as tests, therapeutics, oxygen and other medical aid, senior
 administration officials said. Plans to extend Global VAX surge support, which focus on last-
 mile vaccine delivery challenges, would be on hold for 20 or more countries….”

Climate Change news - ‘Betrayal’: US approves just $1bn climate finance for
developing countries in 2022
Climate Change news;

“The Biden Administration committed to deliver $11.4 billion a year in climate finance by 2024, but
Congress approved a mere fraction of that.”

Politico’s Global Pulse – Global Health Funding gets a boost
https://www.politico.com/newsletters/global-pulse/2022/03/17/paxlovid-goes-generic-and-global-
00017981

On the bright side, however, some more funding for GHS: “ — The omnibus package that President
Joe Biden signed this week significantly boosts global health funding — the largest increase in
years. For the first time, global health funding exceeds $10 billion, as measured by the
Congressional Research Service. Most of the nearly $700 million increase in this year’s budget
comes from a massive bump in the Global Health Security budget, up from $190 million to $700
million….”

Devex - As philanthropy grows, so do limits on cross-border giving: Report
https://www.devex.com/news/as-philanthropy-grows-so-do-limits-on-cross-border-giving-report-
102797#.YitjwEaiMgw.twitter

“A global rise in legislative restrictions on cross-border philanthropic donations — a trend that
Russia helped spawn — corresponds with an international decline in democracy and a shift toward
authoritarianism, findings from a new Indiana University report suggest. More countries are
passing such laws as their governments try to block foreign donors from funding human rights
groups and other nonprofits, the report found…..

“ “The Global Philanthropy Environment Index 2022,” released [last week on ] Thursday by IU’s Lilly
Family School of Philanthropy, showed that philanthropic giving grew worldwide between 2018 and
2020. Still, cross-border giving decreased, even as some countries became more prosperous and
residents presumably had more disposable income that could be donated to charities….”

PS: “…. Russia was among the first to pass these kinds of “foreign agent” laws to limit such funders
about a decade ago. Under Russian law, nonprofits receiving funding from outside the country are
classified as foreign agents. Human Rights Watch has said the law has been used to “demonize

 15

independent groups that accept foreign funding and carry out public advocacy.” “And then we saw
this idea spread where there was so much scrutiny around foreign donations,”

Geneva Solutions - Countries to resume talks in Geneva for a new biodiversity
agreement

https://genevasolutions.news/climate/countries-to-resume-talks-in-geneva-for-a-new-biodiversity-
agreement?utm_source=twitter

“Negotiations to set new biodiversity goals will be held over the next two weeks in Geneva, after
being delayed for two years. “

“Starting Monday, around 196 delegations will gather for the first time in person since the beginning
of the pandemic at the International Conference Centre Geneva to refine a roadmap to halt nature’s
decline by 2030. The current draft on the table, which was released in July 2021, sets out 21 targets
including the conservation of at least 30 per cent of the world’s land and sea areas, reducing
pesticides by at least two thirds, cutting at least $500 billion per year in subsidies that are harmful to
biodiversity and ramping up financial flows to developing countries by $200 million. … Negotiators
in Geneva will try to iron out as many unresolved issues as possible and will then send a draft for a
final round of negotiations in Kunming, China, later this year, where ministers will gather and
shake hands on a final deal.”

“The biodiversity agreement was supposed to be completed in 2020 to replace the previous targets
agreed in Aichi in 2010 as they expired. But the meetings, which shifted to virtual mode, have
dragged on for two years because of the pandemic. The summit was postponed as governments,
especially developing ones, expressed concern about being at a technological disadvantage at online
meetings. With the foreseeable easing of sanitary restrictions, the meeting was rescheduled for April-
May of this year, but there are unofficial reports that it will get delayed a fourth time to be held
between June and September. An official date has yet to be announced…..”

TWN - BD: Non-Paper on biodiversity and health undermines benefit sharing
norms

N Ramakrishnan; https://www.twn.my/title2/health.info/2022/hi220304.htm

“An informal paper that will be the basis of discussion by Parties to the Convention on Biological
Diversity (CBD) this week regrettably undermines the fair and equitable benefits sharing norms
arising out of access to, and use of, genetic resources and their derivatives. The Non-Paper on
biodiversity and health will be discussed by a “contact group” during the CBD’s resumed 24th Session
of the Subsidiary Body on Scientific, Technical and Technological Advice (SBSTTA 24) that is taking
place in Geneva from 14 to 29 March 2022. The concern is that dilution of benefit sharing norms would
lead to the monopolisation of health products including vaccines, therapeutics and diagnostics, which
are developed using genetic resources such as pathogens, thus compromising the equitable access to
health care products, technologies and know-how…..”

And a link: TWN - Biodiversity: Proposed criteria for “Specialised Instruments” on access and benefit
sharing raise concerns

 16

Novo Nordisk Foundation, Open Philanthropy, and Bill & Melinda Gates
Foundation Launch Initiative to Support New Antiviral Medicines for Future
Pandemics

https://www.gatesfoundation.org/ideas/media-center/press-releases/2022/03/funding-new-
antiviral-medicines-and-preventing-future-pandemics

“Global initiative will accelerate the discovery and development of antiviral drug candidates that
can be distributed quickly and equitably next time the world faces a pandemic threat.”

“Today, the Novo Nordisk Foundation, Open Philanthropy, and the Bill & Melinda Gates Foundation
announced an initial commitment of up to $90 million of coordinated funding toward Pandemic
Antiviral Discovery (PAD), a new initiative to catalyze discovery and early development of antiviral
medicines for future pandemics. With equitable access as a core principle of the initiative, the founding
partners are committed to ensuring that discoveries and innovations supported by PAD are accessible
to people in low- and middle-income countries. The goal of PAD is to help researchers worldwide
identify and develop phase 2-ready antiviral drug candidates that target pandemic threat viruses,
including coronaviruses, paramyxoviruses, and orthomyxoviruses. These three virus families are
widely considered to have the highest potential of generating a future pandemic threat, but many of
the diseases they cause primarily affect people in low- and middle-income countries and lack market
incentives for the research and development of effective drugs to treat them. These virus families
include notable epidemic threats, such as Nipah virus, influenza, and Middle East Respiratory
Syndrome (MERS)…..”

mRNA hub/tech transfer….

FT - Will ‘open-source’ vaccines narrow the inequality gap exposed by Covid?
https://www.ft.com/content/61e1d51e-b415-4161-b157-032e5207ab7f

“WHO-backed scheme to create mRNA vaccines aims to erase the unfair distribution of jabs during
the pandemic.” Some excerpts:

“The Cape Town initiative is part of a new push by global health authorities, academics and
philanthropists to address that and promote alternatives to “Big Pharma’s” business model, which
relies on legally enforceable patent protections to raise investment to fund new drugs. The chronic
lack of access to vaccines in the developing world has emboldened some researchers to embrace the
concept of “open-source pharma” — an idea modelled on the free software movement, which
encourages collaboration and sharing to improve code. …. ….. Matthew Todd, chair of drug
discovery at University College London and one of the founders of the open-source
pharmaceuticals initiative, says the pandemic has driven global collaboration on developing
vaccines and antiviral treatments, which could have a lasting impact on the industry. “The idea of
sharing everything you’re doing and developing a medicine that’s freely available with liberal
freedoms associated with it is really quite a new thing,” he says…..”

“…For months, the battle for access was centred on intellectual property rights. But the so-called
Trips waiver — proposed by India and South Africa in 2020 — which would allow for flexibility in

 17

patents for the manufacture of vaccines, is still being discussed at the World Trade Organization. The
hub, in contrast, aims to make the technology accessible to poorer nations and also train qualified
staff to produce vaccines locally without breaking any intellectual property rules. “….”

“… Closing the vaccination gap Martin Friede, the co-ordinator of the WHO’s initiative for vaccine
research, says the new scheme is drawing on experience from a previous hub, set up to spark
production of pandemic influenza vaccines. “This was a copy [and] paste” of a 2006 plan that came
about after an H5N1 scare the previous year …. ….. He says the mRNA initiative has received at least
€40mn from a host of countries including France, Germany, South Africa and others, while the
Geneva-based Medicines Patent Pool, a non-profit group that has helped strike low-income country
access deals for Covid drugs, assists with legal and licensing aspects of its work. Marie-Paule Kieny,
the director of research at France’s National Institute of Health and Medical Research (Inserm) and a
WHO veteran, has been pivotal in creating these hubs, according to Friede and Swaminathan. And
she successfully lobbied Macron and his advisers to help bankroll the mRNA version. The South
African hub has a series of “spokes”, or recipients of the technology in Africa and beyond. The theory
is that they will harness the technology locally, for Covid or other as-yet-unidentified diseases. ….”

PS: “…. In February, a team at the Texas Children’s Hospital Center for Vaccine Development in
Houston celebrated the roll out of Corbevax, a patent-free vaccine costing less than $2 a shot, which
has been granted emergency use authorisation in India. Unlike the mRNA jabs developed by
BioNTech/Pfizer and Moderna, there is no requirement for Corbevax to be stored at very low
temperatures © Dwayne Senior/Bloomberg Biological E Limited, a Hyderabad vaccine and
pharmaceutical company, licensed the technology developed by the Texas vaccine centre at low
cost from BCM Ventures, part of Baylor College of Medicine, and has a contract with the Indian
government to deliver 300mn doses. There are hopes the jab can also be rolled out in Bangladesh
and Indonesia, where regulatory approvals are being sought, and in Africa, where there are plans to
set up manufacturing in Botswana…..”

And a link:

 • Global Public Health - University patenting and licensing practices in the United Kingdom
 during the first year of the COVID-19 pandemic (by S Keestra et al)

“ We investigated measures taken by the top 35 publicly funded UK universities to ensure global
equitable access to COVID-19 health technologies between January and end of October 2020…..”

Ukraine

Nature News - Surge of HIV, tuberculosis and COVID feared amid war in Ukraine
https://www.nature.com/articles/d41586-022-00748-6

“Infectious diseases are likely to spread as Russia’s invasion displaces people and disrupts health
services.”

 18