Ensuring equal access to healthcare

Ensuring equal access to healthcare
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Health Action International European Policy Advisor Ellie White speaks to HEQ about the No Profit on Pandemic campaign.

Independent non-profit organisation Health Action International (HAI) aims to promote and support safe, equitable, affordable access to medicine and healthcare globally through targeted research and advocacy endeavours. As part of its drive to promote long-term policy change enabling access to quality care around the world, HAI has officially lent its support to the ‘No Profit on Pandemic’ European Citizens’ Initiative (ECI), which is calling on the European Commission to work to ‘make anti-pandemic vaccines and treatments a global public good, freely accessible to everyone’.

Ellie White, HAI’s European Policy Advisor and lead on the No Profit on Pandemic campaign, speaks to HEQ about campaign’s calls for action and the need to address health inequity.

What are the key goals of the No Profit on Pandemic campaign?

The campaign is a European Citizens’ Initiative. ECIs are a means by which European citizens can ask the European Commission to respond directly to a suggestion for legislation if they can gain a million signatures in favour of it within a set period of time – in this case, that period runs through to May 2022. The signatures have to come from a quarter of EU Member States, in order to show that a good proportion of all citizens in Europe feel a certain way about the proposed legislation.

The No Profit on Pandemic ECI is calling on the Commission to do everything in its power to ensure that there is equal access to COVID-19 vaccines and therapeutics across the globe, rather than just having a European focus. It has four main calls for action:

• ‘Health for all’ is primarily about intellectual property (IP) management, detailing how new and emerging health and care technologies can be shared and how we can ensure that people across the globe have access to these therapeutics

• ‘Transparency now’ calls for public sharing of information around what pharmaceutical companies and the Commission are discussing in negotiations, transparency around costs of production of medication and profit margins, and current data on the safety and efficacy of COVID-19 vaccines and therapies

• ‘Public money, public control’ is a call for public return on public investment – this is a concept which works beyond COVID-19; essentially, when public taxes fund research then the public should not have to necessarily pay again for the results of that research through higher prices on medicines or technologies

• The final call is the title of campaign, ‘no profit on pandemic’, which aims to discourage pharmaceutical companies from profiting or profiteering from the pandemic

What is the significance of ensuring equitable global access to vaccines, particularly within the context of a global pandemic?

There are two prongs to this discussion. The first is a very simple moral case: there is no moral reason that the Global North or wealthier countries should have access to vaccines and other people or regions should not. Then there is the more self-involved facet, which may be more effective in convincing European lawmakers to move towards equal access, which is that if we do not have equitable access to vaccines then variants of COVID-19 will continue to flourish. If that is the case, there simply will not be an end to the pandemic as we see it, because as we have seen in the ways that the virus spread originally and how variants are spreading now, it is far beyond borders and far beyond the control of individual countries. It is very naive to think that it would be possible to vaccinate one population and then be finished with the pandemic – we have to think more globally and more equitably, and consider that until we are all safe, no-one is safe.

What are the key risks posed by vaccine nationalism and unequal distribution of vaccines?

Aside from the issues around the spread of variance, there is also a more amorphous issue in that, if we start to consider global health issues in nationalist or jingoistic terms, we will begin to undo a lot of the good work which has been done in the community in terms of regarding issues like antimicrobial resistance and climate change as threats to the health of the global population, rather issues affecting the health of individual nations or regions. We can expect to see lockdowns continuing for multiple years if we do not get COVID-19 under control at the global level; and in the broader picture, we need to start to think about public health as a global concern, particularly as our economy globalises and people continue to expect to be able to travel halfway across the world for holidays.

How do IP laws and patents on medicines affect the availability of vaccines, particularly in lower-income regions?

At the moment, medical patents are mainly held by wealthier countries; and these are the same countries which are hoarding COVID-19 vaccines. This means that those wealthy countries can exert control over how low- and middle-income regions and countries access medicine. Meanwhile, these lower-income regions typically have less manufacturing capacity than the Global North in general, meaning that even once they have the clinical or technological expertise to produce vaccines or medicines, they will not necessarily be able to manufacture them in the quantities that they need.

Another issue revolves around Advanced Market Commitments, which wealthy countries have signed with a limited number of manufacturers and pharmaceutical companies: this means that even before vaccines are produced, they will have been spoken for and purchased by a wealthier country. We can look in the news and see headlines saying that Moderna has produced three billion doses, but that does not mean that there is going to be equitable access to those doses, or that the COVAX facility is going to be able to access them from the free market; so lower-income countries are on the back foot at every stage.

There have been some agreements between pharmaceutical companies and a few low- or middle-income countries – AstraZeneca has drawn up agreements with Brazil and India – but there are not very many of these agreements; and as we have seen in the arrangements between the UK and the EU, the highest bidder and the fastest bidder are getting greater access to vaccines, so it does make sense. This model of pharmaceutical-led medicines means that the lower-income regions and countries are inevitably going to be in second place when pharmaceutical companies are looking at whom to negotiate with.

What measures should be put in place to ensure vaccine equity and transparency at the policy level?

HAI has been working with a consortium of Dutch organisations on the World Health Organization’s (WHO) COVID-19 Technology Access Pool(C-TAP), which is essentially a way for research institutions and governments to share technology, knowhow and data in order to enable other countries to upskill and produce their own vaccines. That is something we have really been pushing for: we think it is a sensible way to approach this issue of intellectual property giving all the chips to the wealthier countries.

The other policies we have been championing include the TRIPS waiver, which was originally suggested by India and South Africa and which would waive certain articles of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement at the World Trade Organization (WTO). And that would mean that these IP laws, which are currently quite inequitable, would be temporarily waived for the duration of the pandemic or until a certain level of inoculation has been reached. There is a growing consensus that this measure could be instrumental in progressing efforts to combat the pandemic, because it circumvents IP issues and it circumvents this lack of clinical knowledge; but there remains the argument that without scaling up manufacturing, other measures are not going to be sufficient: looking at ways to increase manufacturing capability is also particularly important on a policy level.

Beyond all that, what we really need to see is the EU institutions taking a step forward and being accountable on transparency, on equitable access and on the ways in which they are working. At the moment, we really do not know much about how the EU negotiates with pharmaceutical companies: the contracts and negotiation documents have been placed in the European Parliament library; MEPs can go and look at them, but they cannot take any pictures or make notes, and most of the text is redacted. There is really not a lot of transparency going on at all; and that really needs to change, because without access to all that information, how can we expect low- and middle-income countries to have a chance when negotiating?

Ellie White
European Policy Advisor
No Profit on Pandemic campaign lead
Health Action International

This article is from issue 17 of Health Europa. Click here to get your free subscription today.

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