New Delhi/Kuala Lumpur, 8 May (K M Gopakumar and Chee Yoke Ling*) – The Coronavirus Global Response pledging event on 4 May celebrated raising 7.4 billion euro for the collaborative development of vaccines, treatment and diagnostics, but there is lack of clarity on ensuring equitable access and the role of the World Health Organization (WHO).
The European Commission pledged 1.4 billion euro, while other leading contributors included France (510 million euro), Germany (525 million), Japan (762 million), Spain (125 million), Canada (551 million), Norway (188 million), UK (441 million) and Italy (71.5 million). The USA was conspicuously absent.
The “pledging marathon”, as it was called by the European Commission President, Ursula von der Leyen, will continue, and is supposed to be the start of a process to mobilise more resources.
Questions remain on whether developing and least developed countries, where hundreds of millions of people are suffering the severe health, social and economic impacts of COVID-19, would receive an equitable share of the needed resources, both financial and in terms of the medical products concerned.
[The initial 7.5 billion euro target was based on an estimate of the Global Preparedness Monitoring Board. It is an independent monitoring and accountability body to ensure preparedness for global health crises. The Board was established on the recommendation of the UN Secretary-General’s Global Health Crises Task Force co-convened by the World Health Organization and the World Bank in 2017.]
The on-line pledging event was co-organised by the European Union, Canada, France, Germany, Italy (also the incoming G20 presidency), Japan, the Kingdom of Saudi Arabia (also the current G20 presidency), Norway, Spain and the United Kingdom.
It was first announced during a World Health Organization (WHO) press conference on 24 April that launched the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to accelerate the development, production and equitable access to new COVID-19 diagnostics, therapeutics and vaccines.
The “call to action” on 24 April was made by WHO, the Bill & Melinda Gates Foundation, the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Alliance for Vaccines and Immunizations (Gavi), the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, the Wellcome Trust and the pharmaceutical industry.
The pledging effort, now called the Coronavirus Global Response, was a response to that call to action and builds on the commitment made by G20 leaders on 26 March to address COVID-19.
It envisages three partnerships. The partnership for vaccine deployment would be co-convened by the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi.
The therapeutics partnership would be co-convened by the COVID-19 Therapeutics Accelerator (a new joint venture by the Bill & Melinda Gates Foundation and the Wellcome Trust) and Unitaid.
The diagnostics partnership would be co-convened by the Foundation for Innovative New Diagnostics (FIND) and the Global Fund.
Donors (States and non-States) are free to pledge directly to one of the partnerships “to Test, Treat or Prevent” or to individual entities in the partnerships.
The European Commission has proposed a two-year collaborative framework that is renewable.
In addition to mobilising funding, the Coronavirus Global Response has a second aim, i.e. “To secure a high- level political commitment to ensure equitable access to therapeutics and vaccines everywhere, leaving no one behind”. What this means is not spelt out.
The capacity and potential of developing countries in research, development and production of COVID-19 vaccines, therapeutics and diagnostics do not seem to feature in the ACT Accelerator and now its associated Coronavirus Global Response framework.
Equitable access will be compromised without addressing the obstacles faced by developing and least developed countries, as seen in the civil society call made on 24 April to the UN Secretary-General and WHO Director- General to operationalize fair and equitable benefit sharing of medical products when the ACT Accelerator was launched (see https://twn.my/announcement/CSOLetter-Access%20to%20Treatment%20Developing%20and%20Least%20Developed%20Countries.pdf )
GLOBAL PUBLIC GOOD VERSUS INTELLECTUAL PROPERTY CLAIMS
During the pledging event, UN Secretary-General Antonio Guterres said that the new tools must be treated as global public goods, available and affordable to all.
French President Emmanuel Macron said that “when the vaccine is ready it has to be a public good, a worldwide public good”.
He further stated that the vaccine developer could be duly remunerated but access should be worldwide.
UK Prime Minister Boris Johnson also echoed the same sentiment when he said that “to win this battle we must work together to build an impregnable shield around all our people and that can be only achieved by developing and mass producing vaccine. The more we pull together and share our expertise the faster our scientists will succeed”.
However, there was nothing forthcoming on the mechanism to make this happen.
In a 5 May blog post, Ellen T’Hoen, a lawyer and public health advocate, wrote: “President Macron of France stated that … the vaccine “won’t belong to anybody”. He called it a Global Public Good. Several other speakers, including Germany’s Chancellor Angela Merkel, repeated those words and promised the vaccine would be affordable. But few offered concrete details on how to achieve universal access or addressed how the knowhow and intellectual property related to the products to be developed will be made available to all humankind”. (see https://medicineslawandpolicy.org/2020/05/the-e-7-4-billion-for-covid-19-product-and-vaccine-development-needs-a-few-strings-attached/).
The ambiguity over intellectual property claims raises concerns as products developed through the three partnerships would be mainly through public funds.
The FAQ on the European Commission website states that, “For publicly funded research, there should be open access to results, i.e. data, knowledge and to intellectual property to the extent needed to ensure global deployment and access”.
However, on intellectual property protection, the FAQ sets a different tone: “Business partners will in principle not be required to forgo their intellectual property, but funding pledged will be accompanied by commitments from donors in support of global access and fair deployment of new diagnostics, treatment and vaccines against coronavirus”.
This reflects commitment to support open access to data and knowledge from publicly funded research but not the open sharing of intellectual property or transfer of technology.
According to an earlier commentary by Asia Russell, Executive Director of Health GAP, an international organisation working on access to affordable medicines for people living with HIV, “Without red lines drawn now [on intellectual property rights], the ACT Accelerator’s success will be undercut”.
“Rather than post hoc industry-driven half measures, harmful exclusivities must be set aside in favour of rapid, non-exclusive, global licensing; commitments to non-enforcement of existing intellectual property rights; transparency; and swift government intervention to break up monopolies that obstruct equitable access,” said Russell with regard to the ACT Accelerator.
Health GAP’s call is that “Pharmaceutical companies, vaccine manufacturers, and medical device companies must provide comprehensive technology transfer needed to mobilize and expand worldwide manufacturing capacity … Governments must commit to exercising emergency powers and intellectual property flexibilities if the private sector does not cooperate”.
Dr Bernard Pecoul , the Executive Director of Drugs for Neglected Diseases initiative, in an opinion piece, proposed five ideas for the consideration of leaders. One of these was to “make health tools free of intellectual property restrictions. Legal rights to control knowledge can act as a barrier, both to research itself and to large-scale production of affordable health technologies. Funding should require that no new legal rights should be sought, and technology owners should commit to either not enforce their existing intellectual property, or to share this knowledge, by licensing it on a non-exclusive basis globally”.
A CLOSER LOOK AT THE EUROPEAN PLEDGE: GRANTS AND LOAN GUARANTEES
From the available information on the Coronavirus Global Response pledges, it is not clear exactly how much would actually go to the three partnerships or whether any funds would be available for developing countries to participate. While some funds have been pledged to WHO and CEPI, a considerable part of the pledges seem to be intended for the pharmaceutical industry and activities in the donor countries.
According to the press release of 4 May, “To help reach the objectives of the Coronavirus Global Response, the European Commission is committing 1 billion euro in grants and 400 million euro in guarantees on loans through re-prioritisation of Horizon 2020 (1 billion euro),RescEU(80 million euro), the Emergency Support Instrument (150 million euro) and external instruments (170 million euro). 100 million euro will be donated to CEPI and 158 million euro to the World Health Organization. EU-funded calls for proposals and subsequent projects under Horizon 2020 will be aligned with the objectives of the three partnerships and subject to open access to data. Funding under RescEU will go towards the procurement, stockpiling and distribution of vaccines, therapeutics and diagnostics”.
The pledged grants can go to European research institutions and it is not clear if they are “new and additional” or just a re-targeting of already approved grants or a combination of both. Their origin and destination are not defined in the announcement.
Horizon 2020 is officially defined as “the biggest EU Research and Innovation programme ever with nearly 80 billion euro of funding available over 7 years (2014 to 2020) – in addition to the private investment that this money will attract. It promises more breakthroughs, discoveries and world-firsts by taking great ideas from the lab to the market” (https://ec.europa.eu/programmes/horizon2020/what-horizon-2020).
So the announcement means that by providing guarantees (of a non-disaggregated amount, as only totals are given), Horizon 2020 will be able to get from the market 1 billion euros of additional funds that will then go to corporations marketing the findings of publicly-funded research.
RescEU is the European Civil Protection Mechanism which runs a fleet of firefighting planes and helicopters. However, according to its website, “RescEU’s scope goes beyond forest fires and it is expected to include responding to other threats such as medical emergencies or chemical, biological, radiological, and nuclear incidents.”
This kind of operation usually runs on budgets and it is not clear how they might use a loan guarantee or whether the 80 million euro are an additional grant (https://ec.europa.eu/echo/what/civil-protection/resceu_en).
The Emergency Support Instrument for the healthcare sector was created during the COVID-19 crisis to directly purchase or procure emergency support on behalf of Member States and distributing medical supplies such as masks and respirators; financially support and co-ordinate pressing needs such as the transportation of medical equipment and of patients in cross-border regions; and support the construction of mobile field hospitals.
They were already allocated 2.7 billion euro from the European Union budget before COVID-19. Again, it is not clear if the extra 150 million euro from the pledge are part of the grants or the guarantees of potential loans.
Finally, the external instruments are to be boosted with 170 million euro, but it is not clear what these will be.
provided in the European Union website refers to “EU action against
coronavirus” and a box with 12 actions that include repatriation of
EU citizens, research on vaccine, production of medical equipment
and supplies, EU standards, EU budget flexibility, global response
monitoring and fight against fraudulent products.
Similarly, Japan pledged USD 234 million to CEPI and Gavi out of their USD 834 million pledge for product development, thus channelling most of it to private corporations. Switzerland pledged 350 million euro, of which half goes as humanitarian aid to the International Red Cross. The UK pledged 744 million pounds, of which 388 million pounds will be for research and development on vaccines, treatments and tests, but it did not specify the amount to CEPI.
A question raised by many observers is whether the 7.4 billion euro constitute additional funding from the pledging governments. One concern is that budgets for development cooperation may be re-allocated towards COVID-19 responses.
According to development finance expert Bodo Ellmers of the Global Policy Forum Europe, “Donors and international organizations are announcing substantial financial packages in response to the coronavirus crisis, including in the context of development cooperation. A big problem is however the lack of additional funding.”
Most of the funds are made available by re-programming, through either re-prioritization or frontloading of resources.
This can be highly problematic, said Ellmers, because it means “that ongoing projects are terminated or commitments that have already been made are not being met, a big issue for development planning and aid predictability”.
There are domestic procedural obstacles in mobilizing additional resources in sudden crisis situations, and therefore “it is difficult to find any trace that development cooperation budgets were considered in the multi-trillion rescue and stimulus package passed in different parts of the global North,” said Ellmers.
This leaves developing and least developed countries in a major dilemma as they are then forced to turn to loans. The IMF’s pre-COVID-19 assessment already showed that almost half of all Low Income Countries are in debt distress, or in high risk of debt distress.
Ellmers stressed that “new loans might drive them even further into the debt trap, and ultimately into crisis, and do more harm than good”.
The pledging conference witnessed explicit support for WHO from many countries. President Macron of France stated that “we need a WHO to deal with crisis. We need to consolidate its role in terms of warning and coordination”, adding that France is stepping up its support to WHO.
Sweden, while pledging 3.7 million euro to WHO’s emergency fund, stated that it is more than ever important to give WHO the best possible conditions to carry out its work. “We have confidence in the WHO and appreciation for the organisation’s work”.
These statements sought to shore up support for the WHO in light of the Trump administration’s decision to freeze the US funding to the organisation.
Yet the actual amount of funds is not significant, and the role of WHO in the entire set-up is unclear.
Many observers expected the WHO to host the coordination hub of the ACT Accelerator and play a substantial role as a Member State organisation.
However, the European Commission’s FAQ states that, “In the view of the European Commission, the ACT Accelerator framework could report to a global body such as the G20, possibly extended to the African Union, the Asia-Pacific Economic Cooperation, the World Health Organization and the World Bank Group”.
The reporting would be on:
* Progress made in the three priorities, i.e. vaccines, therapeutics and diagnostics as well as work on strengthening health systems for coronavirus;
* Identification of additional resources needed in the future;
* Envisaged action to raise such resources (through pledging or otherwise).
The Commission’s description of the ACT Accelerator global response framework is that the three partnerships are the core. The Commission “will reach out to the governments that co-convened the 4 May pledging event”, thus assuming a leadership role.
In addition, there will be “a transversal work stream, across the three partnerships, [that] deals with supporting health systems in order to cope with coronavirus, in which the WHO would play a prominent role”. The precise role of WHO in this architecture is another ambiguity.
[* With inputs from Roberto Bissio, Coordinator of Social Watch.]