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Rich nations like Australia urged to address the globe’s “dangerous gap” in vaccine equity

Introduction by Croakey: More than six million people living in Melbourne are proof again that “it’s not over here till it’s over everywhere”, after being plunged into another seven days of lockdown as the city seeks once again to take control of a COVID-19 outbreak.

Unlike the outbreak that sparked last year’s gruelling 112-day Melbourne lockdown, this new wave is raising big questions for the Federal Government on hotel quarantine and its vaccination rollout, particularly its failures in aged care.

But, as Marie McInerney reports, it also raises issues of what Australia should be doing regionally and globally and whether it really supports the so-called TRIPS waiver of intellectual property provisions that is seen as a “game-changer” for global vaccine equity.


Marie McInerney writes:

Rich countries like Australia are being warned we are at a “perilous time” in the COVID-19 outbreak and that the pandemic might not be brought under control for years unless support and vaccines are urgently rolled out to poorer countries.

The heads of the International Monetary Fund (IMF), World Bank, World Health Organization (WHO) and World Trade Organization (WTO) came together overnight to issue what they described as “an extraordinary call” on rich nations to back a US$50 billion health, trade and finance roadmap “to end the pandemic and secure a global recovery”.

In a joint Op Ed published by leading media outlets across the world, they warn of the “dangerous gap” in vaccine equity between richer and poorer nations, with the former already planning booster shots, while “the vast majority of people in developing countries – even frontline health workers – have still not received their first shot”.

“The worst served are low-income nations which have received less than one percent of vaccines administered so far,” they said, warning that inequitable vaccine distribution is not only leaving untold millions of people vulnerable to the virus but allowing deadly variants to emerge and “ricochet back across the world”.

Governments “must act without further delay or risk continued waves and explosive outbreaks of COVID-19 as well as more transmissible and deadly virus variants undermining the global recovery,” they said, offering a “blueprint” to boost manufacturing, supply, trade flows and equitable distribution of diagnostics, oxygen, treatments, medical supplies and vaccines.

The IMF, World Bank, WHO and WTO leaders issued their joint statement as this year’s World Health Assembly drew to a conclusion and a round of G7 meetings are set to start, and following a Global Health Summit co-hosted by the EU and Italy, which chairs the G20.

It also came ahead of tonight’s (Australian time) virtual Gavi COVAX Advance Market Commitment (AMC) Summit, co-hosted by Japan, that is aiming to accelerate access to 1.8 billion COVID-19 vaccine doses for lower-income economies.

Countries wondering how they could afford to back such commitments to global pandemic action could look to supporting the Biden Administration’s proposal, to go before the G7 meeting, for a global minimum corporate tax rate of “at least 15 percent”, which could deliver billions of dollars to jurisdictions across the world.

Not out of the woods

This year’s World Health Assembly was held under the theme: “Ending this pandemic, preventing the next: building together a healthier, safer and fairer world”.

It adopted more than 30 resolutions and decisions in different areas of public health: decisions on diabetes, disabilities, ending violence against children, eye care, HIV, hepatitis and sexually transmitted infections, local production of medicines, malaria, neglected tropical diseases, noncommunicable diseases, nursing and midwifery, oral health, social determinants of health and strategic directions for the health and care workforce.

In two major COVID-19 developments, it took steps towards a global pandemic treaty, with talks to open in November, and recommended that coronavirus “variants of concern” will be known now by letters of the Greek alphabet instead of countries of origin.

“The naming system aims to prevent calling #COVID19 variants by the places where they are detected, which is stigmatizing and discriminatory,” it said.

Opening the WHA on 24 May, WHO director general Dr Tedros Adhanom warned that while COVID-19 cases are beginning to decline, there have still been more reported this year than in all of 2020, and that no country should consider itself out of the woods regardless of how many vaccinated.

It would be a “monumental error for any country to think the danger has passed”, he said, urging member states to commit to vaccination of at least 10 percent of the population of all countries by the end of September, and at least 30 percent by the end of the year.

In his remarks closing the WHA on 31 May, he stressed the need to address the WHO’s funding constraints and to enact a global treaty on pandemic preparedness and response, to create “an overarching framework for connecting the political, financial and technical mechanisms needed for strengthening global health security”.

According to the Burnet Institute’s latest update, the seven-day rolling average of daily global cases has declined 39 percent from 828,000 on 29 April to 508,000 on 29 May, but Japan and South Korea are experiencing fourth waves while Taiwan is dealing with its first significant wave of community cases.

It says steep declines in case numbers in Europe are likely due to the imposition of restrictions rather than vaccines, as coverage is not yet sufficient to provide herd immunity, and that Taiwan’s current situation “serves as a stark warning for Australia”.

It says COVAX is missing its targets with just 69 million doses delivered at the end of May, with a ban on exports of Indian manufactured vaccines and delays in regulatory approval of the Novavax vaccine threaten COVAX deliveries.

Shocking disparity

Speaking on ABC radio today about global vaccine equity, Lawrence Gostin, director of the WHO’s Collaborating Centre on National and Global Health Law, said the development of COVAX has been an “incredible achievement”.

But he said it’s “nowhere near where it needs to be” nor close to its “modest goal” of vaccinating 20 percent of low income country populations by the end of the year, with a rate of “well under one percent” currently in most low and middle income countries.

“COVAX in theory is a wonderful thing but the world hasn’t stepped up to where it should be,” he said, noting the shocking disparity: more than 50 percent of US adults are fully vaccinated while there are currently “virtually no vaccines in low income countries”.

Having around 70 percent of the global population vaccinated would “make a huge difference”, Gostin said, pointing to COVID-19 infection rates, hospitalisations and deaths “dramatically plummeting” now in the UK and US,  due to strong vaccine rollout. The UK reported no new deaths overnight on Wednesday for the first time since March 2020.

“If we could start to get at the 50, 60, 70 percent range globally, we’d be getting nearly back to normal,” Gostin said. “But we’re not on track to be anywhere near close to that and probably if we don’t really amp up our game we’re going to see many countries taking two or three or four years to reach that level.”

That has significant national consequences also for high income countries, he said, with variants circulating around the globe and likely to re-seed themselves in countries like Australia. “So it’s very much in all our interests to get vaccine rates high everywhere.”

Gostin said India’s devastating outbreak has delivered “a huge blow to the global vaccine effort and particularly to COVAX”, having been expected to be the engine room for manufacturing and global distribution of vaccines.

The WHO announced overnight also that it has approved a COVID-19 vaccine made by Sinovac Biotech for emergency use listing, paving the way for a second Chinese shot to be used in poor countries; however, Gostin cautioned that China was “very much self-interested and doing negotiating deals to gain favour with countries to give them vaccines”.

“That’s not the way to go,” he said.

Where is Australia on TRIPS waiver?

One of the biggest items on the agenda to advance global vaccine rollout is the so-called TRIPS waiver on intellectual property protections on COVID-19 vaccines, with hopes rising since US President Joe Biden announced an about-turn on the issue in May.

That would be “a game changer”, Gostin said. “You can donate a dose and save a life but if you teach and transfer the technology to make the vaccines yourself, you save a hundred (lives), and you can ultimately save the world.”

But there’s concern that Australia, while having recently made noises about supporting the waiver, is “wanting to have its cake and eat it too”, as one advocate told Croakey.

That seems to be the case in a letter from Trade, Tourism and Investment Minister Dan Tehan to a number of non-government organisations which have been campaigning for Australia to back the TRIPS waiver.

In the letter dated 1 June, obtained by Croakey, Tehan notes that Prime Minister Scott Morrison welcomed the US announcement on the waiver but adds that the development of COVID-19 vaccines “through voluntary mechanisms – in partnership with vaccine developers – is our best chance at delivering widespread, equitable access to safe and effective vaccines”.

Tehan says Australia is working in partnership with AstraZeneca and Australian pharmaceutical manufacturer CSL to produce 50 million Astra Zeneca vaccines in Australia, “including setting aside production capacity to assist our friends in the Pacific”.

Australia has provided initial emergency shipments of vaccines to countries facing critical COVID-19 outbreaks: Papua New Guinea (8,480 doses), Timor-Leste (20,000 doses) and Fiji (10,000 doses), with further deliveries “slated for the coming weeks”, he said.

He added that “limited global manufacturing capacity and expertise, as well as vaccine input scarcity, remain the key impediments in scaling up vaccine production”.

“We are therefore realistic about what an IP waiver can achieve,” the Minister said in a stand that was echoed by former Finance Minister, now OECD Secretary-General Mathias Corman, who said the waiver is “not the main challenge in the race to get vaccines distributed around the world”.

Amnesty Australia, one of the organisations to receive the letter this week, says it is concerned that Australia is “actively” trying to delay negotiations on the TRIPS waiver, despite wanting to be seen to support the US intent and approach.

The global organisation has been told Australia is one of 12 countries that are “trying to ensure that the process doesn’t move to text-based negotiations” at a WTO meeting next week, said Amnesty Australia campaigner Joel Mackay.

In response to concerns that a TRIPS waiver would not address all global vaccine manufacturing and roll-out issues, Mackay said the Federal Government and the WTO “need to be able to walk and chew gum at the same time”.

Doing nothing on TRIPS at the moment is holding back universal and fair access by months and months, he said.

However, the Public Health Association of Australia said it “remains optimistic” that Australia will “wholeheartedly” support the TRIPS waiver at the WTO meeting next week.

“While issues like technical capacity and infrastructure are essential parts of the vaccination pathway, they are necessary but insufficient,” PHAA CEO Terry Slevin told Croakey. “Having access to the IP of COVID-19 vaccines is another essential ingredient.”

Slevin said the waiver can also remove the complexity of each of the IP owners wrestling individually with IP protection challenges, so all parties can proceed to their stated aim of helping the whole world to be vaccinated.

“And the Australian Government can help by enthusiastically supporting the WTO to remove that barrier,” he said.

Questions for the Government

Croakey has submitted a list of questions to the Federal Government, asking:

  1. What is the Federal Government’s response to the appeal overnight by the WHO, IMF, WTO and World Bank for a $50 billion global injection towards vaccine equity? Will Australia lift already announced funding/supplies and move forward timelines?
  2. What is Australia’s position on a TRIPS waiver – what result is the Federal Government seeking to achieve in WTO negotiations?
  3. What does Australia want to see from the upcoming G7 meeting on pandemic action?
  4. The Prime Ministers of Australia and New Zealand last week made a number of commitments including to provide safe and effective vaccines for the Pacific and Timor-Leste “at the earliest opportunity”, plus wrap-around supports – what is the timeline envisaged, is this a step up in already announced support?
  5. What does the Federal Government regard as the biggest barriers to ending the pandemic?

We have yet to receive a response but will publish it when it arrives.

Former Health Department Secretary and a key advisor in Australia’s COVID-19 responses Jane Halton, who is co-chair of the global COVAX initiative and chair of the Coalition for Epidemic Preparedness Innovations, also repeated calls for global vaccine equity today, using similar sentiments to Amnesty.

Asked whether Australia can look to providing greater support to poorer nations, including in the Pacific, while it is struggling with its own vaccination rollout, she told ABC radio today that “it’s possible to walk and chew gum”.

“Whilst we have countries in the world who cannot get equitable access to vaccines, it means the virus is running rampant…so yes we do have to now get equity back into this discussion and make sure we can vaccinate as a priority the vulnerable all around the world,” she said.

Further reading

See this useful Twitter thread on pandemic treaty issues, by Roojin Habibi, an Iranian-Canadian scholar, international consultant and lawyer specialising in global health and human rights law.

Resolution on Strengthening WHO Preparedness for and response to health emergencies can be found here: https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_ACONF2-en.pdf

Decision on a Special session of the World Health Assembly to consider developing a WHO convention, agreement or other international instrument on pandemic preparedness and response can be found here: https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_ACONF7-en.pdf


See Croakey’s archive of stories about the TRIPS waiver.

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