This is an onsite, slightly edited republication of the complete G|O Briefing newsletter

Today in The Geneva Observer, it has been a year to the day since the WHO declared COVID-19 a global pandemic. The scientific achievement of developing a batch vaccines against the novel coronavirus in such a short time is undeniable. Yet, access and distribution problems have quickly turned into contentious political and moral questions.  In today’s Geneva Observer, John Zarocostas reports on a two-day virtual vaccine summit during which tensions were in evidence over the lack of supplies for poorer nations and the problems marring production.

Also, UNAIDS tells us we had our figures wrong in our Tuesday Briefing about its contingency plan to reduce staff. We beg to disagree.

In Dr Okonjo-Iweala’s Hard Gender Challenge, an op-ed, Caroline Dommen urges the omnipresent WTO’s new Director, Dr Ngozi Okonjo-Iweala, to ensure that trade reduces structural gender imbalances in the economy rather the entrench them.

COVID-19 Vaccine Summit reveals deep fault lines in International Geneva​ ​

Ramping up global production of effective vaccines is seen as the best chance to accelerate the immunization of the world's population and contain the ongoing pandemic that has killed millions, disrupted daily life, and wreaked havoc in the world economy. Mounting tensions over “vaccine nationalism” between rich countries and between rich and poor nations related to over-procurement and hoarding by rich countries and widespread use of pandemic-related export restrictions or bans are collectively hampering the global response and in particular excluding the poorest nations from adequate access.

Efforts to secure equitable access to COVID-19 vaccines is also a hot political issue in the Human Rights Council, the World Trade Organization, the UN General Assembly, and many other fora.

“The scarcity of COVID-19 vaccine supplies has led to a situation in which around 75 countries are able to move ahead with vaccination while 115 countries wait as people die,” Ngozi Okonjo-Iweala, WTO Director-General, told the Global COVID-19 Vaccine Supply Chain & Manufacturing Summit on March 9 during the meeting convened by the London think tank Chatham House.

Not only was this morally “unconscionable,” she said, but it would also prolong the pandemic and cause economic harm to all countries, echoing concerns shared widely among Geneva's international community.

These tensions were in evidence during the two-day virtual summit (March 8-9) co-sponsored by COVAX and pharmaceutical industry umbrella groups IFPMA, DCVMN, and BIO to address the issue of shortages. The lead participants hailed the event as “productive” and noted the scale-up of manufacturing could see output reach 10-14 billion doses in the coming year.

Although the WHO was a co-sponsor, it did not take a lead role in the event which was attended by more than 100 of the biggest players in the field. Instead, CEPI (the Coalition for Epidemic Preparedness Innovations) and industry players were the driving force behind the event. WHO Chief Tedros Adhanom Ghebreyesus was invited but did not attend, informed sources said. Instead, the WHO was led by its chief scientist Dr. Soumya Swaminathan.

The absence of the WHO chief—who since January has become increasingly outspoken over issues surrounding equitable access to COVID-19 vaccines—was also noted by health experts and diplomats. WHO officials said he had a busy schedule and not to read too much into that.

But informed sources say that behind the scenes, tensions between the WHO, rich countries, and major pharmaceutical manufacturers have been brewing for some time and began to heat up after Dr. Tedros' hard-hitting remarks during a session of the agency's ruling Executive Board on January 18, when he declared:

“As the first vaccines begin to be deployed, the promise of equitable access is at serious risk. More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25.”

“I need to be blunt:​ ​The world is on the brink of a catastrophic moral failure​—and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” Tedros added.

The WHO chief then blasted the role of pharma:

“Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices, and attempting to jump to the front of the queue. This is wrong. Forty-four bilateral deals were signed last year, and at least 12 have already been signed this year. The situation is compounded by the fact that most manufacturers have prioritized regulatory approval in rich countries where the profits are highest, rather than submitting full dossiers to WHO.”

The salvo by Dr. Tedros was unfair said industry sources, speaking on condition of non-attribution. “He can't point the finger at (individual) Member States—some of which have ordered 7-10 times more vaccines than they need—so he blames the manufacturers who are scaling up capacity from zero to 10 billion doses in record time.”

Commenting on the virtual summit, Thomas Cueni, a Swiss national and Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said, “Let's put the current challenge in perspective: pre-COVID-19 global vaccine manufacturing capacity was 3.5 billion doses per year, 5 billion if you include seasonal flu shots. This year for COVID-19 vaccines alone, manufacturers have scaled up new capacity from zero to 10 billion, doubling world vaccine capacity of what is a very complex process in a matter of months.”

Similarly, Sai Prasad, President of the Developing Countries Vaccine Manufacturers Network (DCVMN), said, “With rapid capacity expansion and new manufacturing partnerships, global access to COVID-19 vaccines will become a global reality in the months to come in all countries.”

The WHO chief's very strong public statements in recent weeks in favor of the proposal by India and South Africa calling for a temporary waiver from WTO intellectual property norms now backed by over 100 countries but opposed by the EU, the US, Japan, Switzerland, and a few other developed nations have also not gone down well in pharma circles and some major Western capitals.

On March 5 Tedros declared, “Many countries with manufacturing capacity can start producing their own vaccines by waiving intellectual property rights as provided for in the TRIPS agreement. Those provisions are there for use in emergencies. If now is not a time to use them, then when? These are unprecedented times, and WHO believes that this is a time to trigger that provision and waive patent rights.”

Was the vaccine summit an attempt to cut the legs from the WTO's waiver initiative?

One senior global health official ventured to The G|O that the vaccine summit “was an attempt of cutting the legs from the WTO proposal,” and Tedros staying away from the event showed his political support for the WTO waiver initiative.

Health diplomats, sympathetic to the waiver initiative, privately admit that a temporary WTO waiver would not have any effect in scaling up supplies of COVID-19 vaccines in the short -term. However, it has merit for enhancing production capacity in developing countries in the medium and longer term.

Tedros has also criticized the lack of transparency surrounding some recent technology transfer deals surrounding COVID-19 vaccines. Nor is the WHO pleased, sources say, that so far, no pharmaceutical companies—from rich or developing countries—have signed up to the COVID-19 Technology Access Pool (C-TAP), a mechanism it established last June that enables the voluntary licensing of technologies in a transparent and non-exclusive way by providing a platform for developers to share intellectual property and data including trade secrets and know-how.

“This sharing of knowledge and data could enable immediate use of untapped production capacity and help build additional manufacturing base, especially in Africa, Asia, and Latin America,” Tedros has noted.​

These issues and tensions will be front and center when the leaders of the US, India, Japan, and Australia hold a virtual summit meeting Friday, March 12.

-JZ

UNAIDS responds to The G|O

In our Tuesday Briefing, we revealed that contingency plans drawn up by UNAIDS included a 40% staff reduction over the next few years as well as a first scenario calling for the elimination of positions left vacant by retirements.  This measure alone, we reported, “would lead to a 15% reduction of the current staff over the next three years.”

UNAIDS did not return The G|O request for comments until after publication. Received yesterday, UNAIDS’ email, condensed for space, states:

“UNAIDS is undertaking an organizational alignment to modernize and strengthen UNAIDS for efficiency and impact. The alignment process is being implemented in a transparent, inclusive, and consultative way involving all staff.

The numerical targets mentioned in your report are false, and the organization remains financially sound.  The aim of the alignment is not to reduce staff numbers but rather to ensure our staff are optimally deployed to support countries in implementing the new Global AIDS Strategy, that will be adopted by the Programme Coordinating Board this month.”

We take good note of UNAIDS’s response. We fully stand by our reporting and maintain that the numerical targets mentioned in our Briefing are accurate.

Today's Briefing: Philippe Mottaz - John Zarocostas

Edited by: Paige Holt