At the start of 2021, the immediate tasks for the world were: share more vaccines now, provide more money for that international endeavour, and get serious about tech transfer to allow production to take place in more facilities around the world.
Just how committed is the Biden administration? A number of its initiatives seemed designed more to project systemic rivalry, particularly against China, than to embrace multilateralism. In early May, US Trade Representative Katherine Tai announced that Washington would support a waiver on intellectual property for vaccines. A number of countries, led by India and South Africa, had long been calling for the removal of restrictions on the transfer of patents in pharmaceuticals, something that had been agreed at the WTO in 1995. It had become an emotive issue.
Tedros hailed it move as ‘a monumental moment’. The move delighted civil society groups, but startled allies. A number of biotech-strong countries, including Germany, Switzerland, Canada and Britain opposed the idea. The White House is likely to have assumed that it would not prevail, but the initiative secured two goals: it put pressure on big pharma to do more to free up licensing and transferring technology, and it made America look good.
In the same week, Biden declared: ‘Our nation is going to be the arsenal of vaccines for the rest of the world. I literally have, virtually 40 per cent of the world leaders calling and asking, can we help them. We’re going to try’. He promised that the US would deliver 80 million vaccines, including from AstraZeneca, which had not been approved by his own country’s regulator, the FDA.
By this point, the US had not exported a single vial. A whole year after the establishment of COVAX, a mere 70 million vaccines had been sent through the multilateral facility – a tiny proportion of the not so ambitious two billion target.
To compensate at least in part for the political failures, a number of non-governmental organizations (NGOs) worked hard to find practical solutions to help alleviate the suffering. For its part, Chatham House brought together big pharma, leaders of international organisations and health experts in a global vaccine supply chain and manufacturing summit to look for an agreed set of measures to tackle shortages. The March 2021 summit led directly to the establishment of a COVAX Manufacturing Task Force to address bottlenecks.
Yates, who helped to bring the parties together for that summit, also points to the work of the International Panel for Pandemic Preparedness and Response (IPPPR). In a report commissioned by the WHO and published in mid-May, the group of 13 global statesmen and women, led by former New Zealand prime minister Helen Clark and former president of Liberia Ellen Johnson Sirleaf, sketched out a credible road map across all areas of COVID-19 policy, providing a midway point between radicalism – what should be achieved – and realism – what, given the disappointing circumstances, could be achieved.
The IPPPR called for a UN Pandemic Treaty and an International Pandemic Financing Facility that could mobilise funding of up to $10 billion per year. It also proposed a new global surveillance system, in which the WHO would have explicit authority to publish information about outbreaks without the prior approval of national governments and to dispatch experts to investigate pathogens with guaranteed right of access.
In spite of the exhortations and the clear proposals, the chances of countries coming to any form of meaningful consensus on the pandemic remained elusive. Meeting in Rome, the Global Health Summit of the G20 proposed a watered-down push for waivers and stopped short of committing wealthier states to provide more funds for the WHO. A few weeks later, the World Health Assembly, the WHO’s policy-making body, stepped back even further, delaying even consideration of a convention, agreement ‘or other international instruments on pandemic preparedness and response’ until a special conference in November.
On the eve of each of these forums, elder statesmen and women, health experts and activists urged governments to do more. They cited compelling economic arguments. Fully financing ACT-A for 2021 would cost less than one per cent of what governments have spent on stimulus packages for their own citizens.
The task is enormous and urgent. The number of doses needed to vaccinate 70 per cent of the world’s population is a staggering 11 billion. So far only about 1.7 billion have been produced; far, far fewer have been equitably distributed.