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Survival for All: Securing Vaccines for the Global South

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Healthcare worker provides COVID-19 vaccination

July 14, 2021 – Mass vaccination tent at Treichville Stadium, Abidjan, Cote d’Ivoire. The World Bank Group provided technical and financial support to vaccination campaign. Note: these vaccines were not directly World Bank Group funded. Photo: Erick Kaglan / World Bank. “CC BY-NC-ND 2.0 Deed”

At the beginning of the pandemic, we reported on the extreme inequality of the vaccine rollout to low income countries. Their access was hindered because of a Western patent system which was imposed globally through the WTO. At the time, activists tried to pass the TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights) Waiver, which would have suspended all patents related to COVID. This would have allowed countries all over the world to make vaccines, therapeutics and protective equipment during the pandemic crisis.

The TRIPS Waiver failed to provide access to medicines, and poor countries never received the vaccines they were promised.

But, as the world moved on from COVID, so did the efforts for equity. The TRIPS waiver failed to provide access to medicines, and poor countries never received the vaccines they were promised. Despite this, the Global South continues to fight back. On today’s show, we look back at the failures of the early pandemic and at new initiatives led by scientists and activists to circumvent patents and create broader access to medicines.

Featuring:

  • Fatima Hassan – Human rights lawyer and founder of Health Justice Initiative
  • Piotr Kolczynski – EU Health Policy & Advocacy Advisor for The People’s Vaccine Alliance
  • Achal Prabhala – Researcher and coordinator of the AccessIBSA project 
  • Petro Terblanche – Managing Director of Afrigen Biologics and Vaccines 

Episode Credits:

  • Host: Salima Hamirani
  • Producers: Anita Johnson, Salima Hamirani, Amy Gastelum, and Lucy Kang
  • Executive Director: Jina Chung
  • Editor: Adwoa Gyimah-Brempong
  • Engineer: Jeff Emtman 
  • Digital Media Marketing: Anubhuti Kumar

Music:

  • Blue Dot Sessions – “Sweetly”
  • Deef – “Nostalgia of an Ex Gangsta Rapper”
  • Doctor Turtle – “Leap Second”
  • frankum – “Reward MusicTrack – Ambiance guitar”
  • Monplaisir – “Juan Garcia Madero”
  • Monplaisir – “Ridiculous”
  • Monplaisir – “Stay Quiet”
  • Robert John – “Slinky” 

Transcript:

Making Contact Button – Some of the post solutions that’s coming from grass roots. You’re listening to making contact.

Salima Hamirani: I’m Salima Hamirani and on today’s Making Contact

Fatima Hassan: If you don’t accept these terms and conditions as global South country, you will not get a single vaccine dose. That was the condition.

Salima Hamirani: We learn about how unequal vaccine access across the world left poor countries at the mercy of powerful pharmaceutical companies. And also why attempts to level the playing field have failed.

Achal Prabhala: The WTO affirmed a kind of really weak, unusable and watered down version of this original TRIPS waiver that had been proposed for vaccines at a time when not only did nobody need the solution, the solution itself that they proposed was too weak to actually be implemented. And that’s the best summary I can give.

Salima Hamirani: But we also look at ways the global south is fighting back and ensuring that they’re not on their own during the next global pandemic.Stay tuned all that and more coming up.

fade out music

Fatima Hassan: So basically, we believe that our sovereignty was taken away at the behest of very powerful pharmaceutical companies who are unelected. And basically, hold no public office in our country, and this should never happen again.

Salima Hamirani: Welcome to Making Contact you’re listening to Fatima Hassan, a human rights lawyer in South Africa and founder and director of “Health Justice Initiative”. And we’re starting our show with a huge court victory that the Health Justice Initiative won last year. Let me explain – when the pandemic first started, South Africa had been waiting and waiting …and waiting for vaccines they’d been promised.

  • News clips montage –

Fatima Hassan: Those vaccines never came to us. For months, we were wondering where they were, we were waiting for supplies, we had a drip feed of supplies

Salima Hamirani: A drip of vaccines was just not enough because people were dying. So activists started to ask questions about what had happened to the medicines they’d been assured would keep them alive.

Fatima Hassan: Day one, we were told participate in clinical trials. Day one, we were told put funding on the table to support accelerated vaccine research. We’re all in this together. What happened? The total opposite.

Salima Hamirani: So, to get answers, Health Justice Initiative took the South African government to court to open the contracts they’d signed with Johnson and Johnson, and other pharmaceutical companies like Pfizer.

Fatima Hassan: cause we had to go to court to demand transparency. Nobody else, it was civil society and NGO that had to go to court to fight for these contracts to be open.

Salima Hamirani: They succeeded in opening the contracts in September of 2023. Here’s what they found.

Music.

First South Africa had to pay marked up prices – the vaccines were more expensive for South Africa than for Europe or Australia for example. even though South Africa is significantly poorer.

Second, they had to pay a certain amount up front – in the billions – with no guarantee of timely delivery. Which means that sometimes they had to wait months for vaccines they’d already paid for.

And third, they couldn’t resell or donate any of the vaccine doses.

Fatima Hassan: The terms and conditions in these contracts and agreements are so one sided and so in favor of multinational corporations that it has placed governments, including South Africa, in the unenviable position of having to secure scarce supplies in a global emergency, in a manner, which basically can only be described as a set of ransom negotiations.

Salima Hamirani: South Africa got bamboozled. But, one health official involved in the contract negotiations said they had no choice

Piotr Kolczynski: He described that the government felt like it was held to ransom in order to access vaccine doses

Salima Hamirani: And there’s that term again – held to ransom. And That’s Piotr Kolczynki –

Piotr Kolczynski: I’m an EU Health Policy Advisor at the People’s Vaccine Alliance.

Salima Hamirani: The People’s Vaccine Alliance is part of a network of organizations helping change the narrative around the fair distribution of medicines around the world, and they work closely with the Health Justice Initiative.

Salima Hamirani:  Piotr says that the situation in South Africa is not unique.

Piotr Kolczynski: And we are hearing these stories from South America to Asia. And governments in Latin America, for example, they accused , Pfizer of bullying in vaccine negotiations

Salima Hamirani: In some cases, Pfizer even asked countries to put up sovereign assets as collateral in case anyone sued for vaccine injury down the line.

Piotr Kolczynski: So in that sense, the private sector has been effectively driving the pandemic response. And this power imbalance that I’m talking about was particularly striking for countries in the global South.

Fatima Hassan: If you don’t accept these terms and conditions as global South country, you will not get a single vaccine dose. That was the condition. That’s why we call it bullying that’s why we say apartheid. That’s why we say vaccine nationalism. That’s why we say never again

Fatima Hassan: music

Salima Hamirani: A few years ago, we produced a piece about the lack of covid 19 vaccine access around the world. And back then in 2021, the situation was pretty dismal. Rich countries were first in line for a lifesaving vaccines. poor countries were last. And today we’re doing an update. And well, as we just heard, things haven’t gotten any better. But as time wears on, and as we face the prospect of more pandemics in the future, people in the global south are losing patience with rich countries, pharmaceutical companies and patent monopolies. They want change. Here’s how they’re going to get it.

Salima Hamirani: Joining us today is Achal Prabhala, He’s the coordinator of the Access IBSA project. He works on intellectual property and how it effects the fair distribution of medicine globally.

Salima Hamirani: (from interview) Achal welcome back to making contact, we’re really happy to have you back on -and for people who may not have heard the past show we did on this topic, can you talk about what happened back in 2020/2021 with the roll out of vaccines to the global south?

Achal Prabhala: Yeah, sure. I’d love to do this. Look, when the pandemic was declared, this was 2020 in March, it immediately became clear that the only way out of this pandemic really would be through pharmaceuticals. Pharmaceuticals that could either treat COVID successfully and therefore render it ineffective or vaccines that could prevent us from getting COVID.

And in fact, those were the very first kinds of investments, the big investments that governments made, especially in Europe and the United States. When this was happening, we had a good six months to seven months run up, I would say. I and a number of other activists were working as best as we could with public health authorities, with large development organizations that purportedly cared about public health as well as. governments our own and poor countries. I’m from India. I work in South Africa and Brazil, and I engaged with all three governments at the time, as well as rich country governments that I don’t have much influence over, like the United States and Europe to say that monopolies are going to come in your way.

I know this because I’d worked on exactly such monopolies for 20 years. I’d begun working with. HIV and AIDS in South Africa at the turn of the century, by the time I started working in South Africa, AIDS had become what we call a chronic condition. It was no more dangerous or deadly than diabetes. And yet a large percentage of people who are HIV positive and developed AIDS in South Africa were dying. And the reason they were dying is not because there weren’t drugs that could treat them. The reason they weren’t getting those drugs is because they were just too expensive. And the only reason these drug companies could get away with doing something like pricing it that much out of the reach of the majority of people around the world who needed these drugs was because of pharmaceutical monopolies in the form of patents.

Salima Hamirani: And intellectual property rights in the form of patents, did become a problem during COVID, almost immediately.

Achal Prabhala: The vaccines did appear by the end of 2020, early 2021. They went out into the world in the most unequal manner possible. The lowest income countries, in Asia and Sub Saharan Africa received nearly no vaccines at all, for months on end. Poor countries, but yet countries that were better off with vaccine manufacturing capacity, such as India, South Africa, others did have some vaccines being produced within the country that they could use. But they were much fewer, and the range of vaccines was also just far smaller, the poorer the country you lived in.

And so if you lived in Europe or the United States, you had your sort of full choice of a couple of different leading vaccines. If you lived in a poor country, at best, you had one or two vaccines that you had some kind of delayed access to, and if you lived in the poorest countries in the world, you just had nothing at all.

This was an inexcusable situation, but it also, in a respiratory viral pandemic, it was the kind of thing that really hurt them too. And so, this idea that Europe or America could save itself by vaccinating itself and sort of damn the world didn’t really work out. And the reason it didn’t work out is that these viruses don’t actually understand borders. And what they did, especially in places where there were very low vaccination rates and existing public health problems is that they mutated. So, they mutated into something called Delta, a variant in India, which then rapidly spread around the world and became the world’s dominant viral strain. They mutated into something called Omicron, which was first detected in Southern Africa and then rapidly spread around the world and then became the dominant strain in the world.

-news clip-

Achal Prabhala: So one way to have contained these mutations and an endless prolonging of the pandemic would have been to vaccinate everybody at the same time. Instead, what the West deliberately chose, because there’s no other way to put it, is to vaccinate itself and then produce these booster vaccines which were reformulations, essentially new vaccines for new viral mutations of, you know, the original virus, which again went only to them, right? But this is the sordid history of both the inequity that existed in the pandemic and then beyond

Salima Hamirani: There were some attempts at evening the playing field. For example, COVAX. COVAX was an initiative meant to help poor countries access vaccinations. The idea was that we’d be able to vaccinate the global south using money and medicine donated by charitable orgs. I asked Piotr why it failed.”

Piotr Kolczynski: COVAX was initially meant to be a program in which both high income countries and low-income countries would participate. But the countries from the Global North, like US, like the EU, they didn’t want to participate in the end.

Salima Hamirani: Instead the global north just began signing contracts on the side with pharmaceutical companies to buy up massive amounts of vaccines.

Piotr Kolczynski: COVAX effectively was with no doses to distribute to low and middle income countries, because in the first phase of the pandemic, when they became available, they were all hoarded by the global north countries,

Salima Hamirani: Its not the only program that was meant to help the gobal south that seems to have failed. In our last show we talked about an exciting idea that activists began floating at the international level – because they saw how damaging patents were to public health

Achal Prabhala: The governments of South Africa and India, but really the government of South Africa actually, decided to float this very exciting proposal at the World Trade Organization, which they called a TRIPS waiver.

Salima Hamirani TRIPS stands for trade-related aspects of intellectual property rights. which, well, doesn’t really explain what it means.

Achal Prabhala: The provision is to allow member countries of the WTO to suspend pharmaceutical monopolies during the pandemic. Why? So that countries then could have the ability to manufacture the drugs and the vaccines that they need in order to live, but also the diagnostics, the tests, many of which are monopolized.

Salima Hamirani: Achal, the last time we talked you were excited about the TRIPS waiver, and thought it really had potential – and it seems like finally after a long wait something was passed, but it wasn’t what you were expecting.

Achal Prabhala: This is a long and sad story. I think what happened at the WTO was that a very useful proposal was made before vaccines came to market. I should just note. So this was October 2020. And the only people who had vaccines in the market then were the Chinese and the Russians.

It was a solution that was needed to be implemented yesterday, even when it was proposed in October 2020. Yes. Was it implemented in October 2020? No. Was it implemented in October 2021? No. Instead, it just went on and on and on and on and really passed the point of no return at a time when honestly nobody particularly cared about COVID. Everybody was relieved to be able to return to some semblance of normal life when honestly, no Americans or Europeans were even taking the many multiple boosters that their governments had spent billions on creating for them. It was that over. By that point, the WTO affirmed a kind of really weak, unusable and watered down version of this original TRIPS waiver that had been proposed for vaccines at a time when not only did nobody need the solution, the solution itself that they proposed was too weak to actually be implemented. And that’s the best summary I can give off a really long, really tragic, ultimately pointless, and a totally catastrophic exercise.

Salima Hamirani: There’s an important lesson to be learned here, and a lesson activists are facing head on again, this time at the World Health Organization And, We’re going to talk about what’s happening at the WHO, right after the break.

Break Music

Salima Hamirani: We’re just jumping in to remind you that you’re listening to Making Contact. If you like today’s show and want more information visit us online at www.radioproject.org. We have links to articles and important projects on this topic such as a report from the Health Justice Initiative about the lessons we should have learned as a global community from the pandemic. Check it out if you have time. And now back to the show.

End break music

Salima Hamirani: Welcome back to Making Contact I’m Salima hamirani. Today we’re revisiting a topic we focused on in 2021 – vaccine and medical access for COVID around the world. In the first half of the show, our main guest, Achal Prabhala, told us why the early attempts at fair distribution of vaccines failed. In the second half we want to look at two current ideas activists are working on in the aftermath of the TRIPS waiver. Here’s the first:

Salima Hamirani: So it looks like there’s yet another new multinational agreement that’s being debated at the WHO, called the pandemic treaty. Can you talk to me about what the pademic treaty is and why its important.

Achal Prabhala: I’d love to do that. The pandemic treaty is something that I’ve been following closely. I don’t work on it within Geneva itself because I live in Bangalore and I work out of here and … but I’m absolutely committed to the, the treaty itself, to its success. Why? Because it’s the first time after this pandemic that there’s been a serious, thoughtful, intellectual exercise grounded in reason. Participated in by every single country in the world, where people are trying now seriously to put together an infrastructure that is better suited to the next pandemic. In order to make the next one less catastrophic than the one that just passed.

And the beauty of a pandemic treaty and exercises such as this, I think, is that even in the absence of the next pandemic, right? In the years before the next pandemic. It’s the kind of thing that offers us a bunch of different, really commonsensical, sound building blocks to effective public health. So, the kinds of things that work as infrastructure for the next pandemic also work as infrastructure for us staying alive between this pandemic and the next one, right?

Salima Hamirani:What are the conditions that most countries want included in the pandemic treaty? Well there’s one HUGE condition that would have made a big difference during COVID –

Achal Prabhala: What everyone is saying in the world is let’s not create monopolies and pharmaceuticals and vaccines in the first place. Let’s do our best not to have a monopoly on these things. And if in the next pandemic, there is something that has a monopoly on it, let’s allow people to override them as easily as possible.

Salima Hamirani:So, what would this look like? Well, let’s take a recent  example.

Achal Prabhala: The last pandemic, the U. S. government gave a no risk, no conditions attached, one billion plus research and development grant to Moderna, to fully fund its efforts to create an mRNA vaccine for COVID. By Modena’s own admission in their own financial reports, this 1 billion plus grant covered all of their research and development costs at no risk, which is to say, had they failed, they would’ve been liable for zero at the end of it, right? Of course, they didn’t fail. They made an mRNA vaccine, which is to tremendous credit to them. Unfortunately, what they did with their achievement was they tied it behind the fiercest monopoly protection in the world and made sure that absolutely no one except for the richest people in the world, and then the next richest people in the world got those vaccines when they needed them.

So what the pandemic treaty is suggesting is that when the next time, when the U S government sends a billion dollars to a pharmaceutical company to create a product, put in conditions that say, “Hey, we can then figure out if you’re successful, how to make your vaccine or your pharmaceutical available to everyone in the world. We can force you to license capable suppliers around the world of making the same pharmaceutical vaccine, in order not just to save people in other countries, but also to save ourselves, right?”

The United States government is opposing this. Uh, the European Union is opposing similar kinds of conditions. this is a an incredible tragedy because I think that, patience is wearing thin.

Salima Hamirani:  The pandemic treaty is going down the same road as the TRIPS waiver. Its getting watered down into an almost useless document

Achal Prabhala: This is one of those instances where I sincerely hope we get nothing rather than something, because to have in place a ridiculous, watered down, ineffective, pointless, meaningless document that masquerades as a pandemic treaty, providing some kind of false assurances to people, preventing them from doing anything actual and real about the next pandemic, I would much prefer us not to have a treaty, to be reminded every single day that we have no scaffolding, no infrastructure, no protection against the next pandemic where it appears, I actually think that’s better for us in terms of our own vigilance and protection for the future, rather than having something ridiculous that has no meaning.

Salima Hamirani: Here’s Piotr again:

Piotr Kolczynski: And this is very concerning, because while the EU and US and other rich countries claim that the lessons learned from the COVID 19 pandemic needs to be learned, they refuse to go beyond the existing structures and policies that perpetuate global inequalities

Salima Hamirani: Here’s Piotr again: Hearing activists talk about their disillusion with the pandemic treaty made me wonder if its even worth it: trying to create these international agreements because the west and pharmaceutical companies seem to overpower the will of the rest of the planet, every single time.

Piotr Kolczynski: Definitely it may seem like the World Health Organization is more democratic, more equitable space than the World Trade Organization, but you’re right. The power played by the rich countries, the US, EU, UK, Japan, Switzerland, which basically represents the interest of its own industry, makes it very difficult to reach an agreement that will make access to medicines more equitable.

So why  I think it is important for countries to engage in these processes and trying to change the international framework countries should not forget about the power they’ve got at national level

Salima Hamirani: And while we’ll be keeping an eye on the Pandemic treaty and continue hoping for a landmark resolution between all countries on how to share medicine and treatments, we’re also turning our attention to what Piotr just mentioned. The power that the global south can build so that it doesn’t have to depend on the west.

And there’s actually a really exciting new idea that’s already working – its called The mRNA Technology Transfer Protocol. I wanted to end the show with some good news, because the global stage can look increasingly dismal, and frightening, when we’re thinking about the next pandemic.

Here’s Achal explaining the mRNA technology transfer protocol:

Salima Hamirani: in the wake of Modena and Biontech saying, “Hey, we make MRNA, no one else will, we’re not sharing anything with anyone.” What they’re doing is. painfully and painstakingly recreating mRNA technology from scratch and what they recreate from scratch is being shared with every single one of their partners

Salima Hamirani: A quick note on mRNA technology :Its really important to understand that- despite how controversial they might be – mRNA vaccines are a huge medical breakthrough. In the past vaccines were extremely difficult, dangerous and expensive to produce

Achal Prabhala: Vaccines are biologic drugs and these are complex molecules because they contain a much, much more complicated and sometimes varying, biological and chemical formula to express them. Whereas something that comes in the form of a pill typically, like an antiretroviral drug, is something that can be expressed with a chemical formula. Yes? So that’s the basic difference between what we call a small molecule, like an antiretroviral drug and a large molecule or a biologic, like a vaccine. And this cell-based biology had to be painstakingly produced in a linear process that you could not avoid. You had to grow them in eggs or yeast. You had to manage them in incredibly sophisticated lab facilities that required high levels of safety protocols.

Salima Hamirani: Which is why for a long time, there’s only been a handful of vaccine manufacturers around the world. But that’s about to change

Achal Prabhala: And then suddenly, you know, you had this thing called mRNA that came along, which actually had no cell-based biology. And so suddenly you had sort of like the digital equivalent of vaccines, right? After a long analog world of vaccines.

Salima Hamirani: since mRNA technology does require the use of cells, they’re much easier to produce and much more uniform.

Achal Prabhala: You don’t have to worry about things like variance, whether there are slight differences in the cells. this is entirely a process that’s predictable and calculated,

Salima Hamirani: Which means that now, much like HIV drugs during the AIDS crisis, the global south now has the ability to create mRNA vaccines on their own at a much cheaper cost.

Achal Prabhala: That was the revolutionary potential of mRNA and the best thing that it is literally the only silver lining that came out of the pandemic, in my opinion

Salima Hamirani: The global south has never had an opportunity quite like this – and they’re planning to take full advantage, they want to use the technology to create a covid vaccine as an experiment. But the real target is a wide range of underfunded vaccines for diseases that commonly plague poor countries.

Petro Terblanche: like for example, HIV, tuberculosis, Rift Valley fever, West Nile fever, and other critical diseases that’s important to the African continent and to other low middle income countries and for which no vaccines are currently available

Salima Hamirani: That’s Petro Terblanche,

Petro Terblanche: I’m the Chief Executive Officer of Afrigen Biologics. Afrigen is a Cape Town based biotechnology company.

Salima Hamirani: Afrigen hosts the mRNA technology transfer center. the company was already researching vaccines for things like tuberculosis- another neglected global disease, so they jumped at the idea of creating an mRNA vaccine hub. One of the huge disparities that has always plagued the global south is the lack of manufacturing. Which leaves places like the continent of Africa, very vulnerable during pandemics.

Petro Terblanche: The African continent uses about 25 percent of all vaccines manufactured globally, but we only have the ability to manufacture 1 percent of what we need. So this initiative is part of the African Union and the African Center for Disease Control to manage and build a sector on the continent that will be able to supply at least 60 percent of the vaccines that we need by 2040. So its an ambitious program.

Salima Hamirani: And they’ve made a lot of process already. They even have a vaccine candidate ready to go

Petro Terblanche: We are completing our safety studies preclinical and we’ll go to non human primate studies before we do our clinical trial in humans early in 2025. We have indicated and demonstrated in preclinical development that the vaccine candidate AfriVac 2121 is comparable in safety and immunogenicity to the current registered covert vaccines.

Salima Hamirani: The vaccine that they’ve created is actually based on the original COVID strain so it won’t be used, just tested to see if the lab and techniques they’ve built are actually working. If it does work, they can scale up to build a repository of vaccines for all kinds of diseases.

Petro Terblanche: We’re using the same platform now to work on tuberculosis and HIV and other vaccine candidates. So, we call the original strain vaccine our workhorse. It will be used to validate the platform, but we will not take it to the clinic and final registration because there’s no clinical indication for its use.

Salima Hamirani: And all of it, the technology, the facilities they’re creating, the testing… all of it will be shared with all of their partner countries, in a completely collaborative process, without patents.

Petro Terblanche: First is to transfer knowledge as we progress it. We already doing training and 14 of our 15 partners have been to Afrigen and received the first knowledge transfer and training on MRNA technology. We also providing and sharing process layout. We’re sharing the design of the facilities and ultimately we will transfer the platform with all the analytics, all the assays and the process to our partners to enable them to either develop further vaccines or to manufacture mRNA vaccines.

Salima Hamirani: Which means that coming into the next pandemic – whether the WHO’s pandemic treaty fails or not – poorer countries can start producing and researching their own vaccines. Ensuring that we might – as a global community – survive.

Salima Hamirani: And that does it for today’s show. If you liked today’s piece on global vaccine access, please visit us online at www.radioproject.org to leave us a comment. I’m Salima Hamirani. Thanks for listening to Making Contact.

Author: Radio Project

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