In the last number of weeks, many emergency pandemic related health measures were removed in Ireland and the UK, and there is an expectation in many other high-income countries that remaining measures will end in the very near future. This news has been greeted with understandable relief and a palpable new hope for the future. However, despite this hope, we must remember that we are still in the midst of a global pandemic, many people in other countries are not as fortunate, and until the pandemic is brought under control everywhere, we may continue to face future uncertainty and stop/start restrictions.
With this in mind, the international community is already looking to plan for the future. On the 1st December 2021, the World Health Assembly reached a consensus decision among World Health Organization (WHO) Member States to start drafting a WHO international legal instrument to address pandemic prevention, preparedness and response. An intergovernmental negotiating body will be established, which will hold its first meeting by 1st March 2022 and will submit its recommendation to the World Health Assembly by 2024.
We welcome these attempts to address pandemic preparedness globally, and we hope that negotiations on a pandemic treaty will be successful and expedient. However, it is vital that the move to establish a pandemic preparedness instrument does not detract momentum from solutions to the COVID-19 crisis and from for urgently needed solutions for global vaccine equity.
The global dashboard on vaccine equity shows that whilst over 67% of people in high-income countries have had at least one dose of COVID-19 vaccines, just over 11% of people in low-income countries have had the same. In November, for instance, four times the number of vaccine booster doses were administered in high-income countries than overall doses in low-income countries. Several global mechanisms to address vaccine inequity have been put forward, including: the WHO’s COVAX model; the COVID-19 Technology Access Pool (C-TAP); an mRNA hub in South Africa; and the Trade-Related Aspects of Intellectual Property Agreement (TRIPS) waiver proposal to temporarily waive intellectual property (IP) rights over COVID-19 health technologies
All of these proposals have their merits and weaknesses and can be complementary to each other, but their success has been very mixed to date. C-TAP – a proposal to voluntarily share IP, data, and know-how related to COVID-19 vaccines, medicines, and diagnostics with the aim of increasing supplies – for instance has had no industry engagement from vaccine rightsholders to make it a viable option for vaccines. Alongside this, COVAX – a system to donate vaccines to low-income countries – has faced major supply issues because IP holders are using their IP rights to maintain an artificial scarcity of vaccines worldwide. Crucially, COVAX is based on charity: it does not enable countries to produce their own vaccines to develop sustainable supplies. With industry failing to sufficiently engage with voluntary solutions to meet global demands for COVID-19 vaccines in all regions, mandatory solutions for vaccine equity are needed. This is why support for the TRIPS waiver – a proposal to suspend IP rights related to COVID-19 vaccines, medicines, and diagnostics is a key step to increase vaccine production globally –is still vital at this time.
Yet, some countries and regions, particularly the EU, continue to block the waiver, mainly by arguing that other mechanisms for sharing or donating vaccines globally (such as COVAX or C-TAP) exist, even though these have proven to be insufficient to address the global vaccine needs. This argument is circular; in fact, it is highly likely that the pitting of global or regional proposals to increase vaccines against each other has created delays in agreeing a TRIPS waiver, and has also likely hindered the success of other mechanisms.
While clearly necessary in the long run, there is potential for the pandemic treaty to be used to delay agreement on the Waiver or detract support from it; the fact is that negotiations started on this just as momentum was building behind a TRIPS waiver.
In reality, given the timelines for the pandemic treaty instrument, at best it will be agreed on by 2024, with additional time required for implementation. However, the negotiation of international legal texts can often be drawn out, if experience with other treaties is anything to go by. Already, delays are evident, for example the US initially opposed the instrument being legally binding, though it appears to have relented on this.
Clearly, with the pandemic treaty at best still three years away, it will not offer a timely solution for COVID-19, and the world does not have time to wait. The pandemic treaty must be viewed as a future pandemic preparedness instrument and an important step for future pandemics, but not a solution for current global COVID-19 vaccine needs.
A clear distinction must be drawn in public and policy discourse: the pandemic treaty is a forward-looking instrument, needed to address future pandemics. However, it is equally important to recognise what it is not: it is not a solution to COVID-19 or vaccine equity in the short to medium term. We urge national governments to view the treaty and discussions around solving the current COVID-19 crisis for all countries globally as related but separate – and to urgently take concerned global action to address COVID-19 now. This is essential so that other countries can also look forward to a better future, and so that those of us in high income countries can have greater confidence and certainty in a future without the devastation brought by COVID-19.