Devex CheckUp: The coming pandemic treaty fight over equitable access

On her last day at WHO, Dr. Mariângela Simão turned off her alarm at 6:15 a.m. and realized that tomorrow, she wouldn’t need to set one.

Simão retired from WHO last week. But before leaving, she spoke candidly with Jenny about her regrets, some of her unfinished business, and the work she’s most proud of accomplishing at WHO — which is bringing the issue of access to medicines to the fore in global health. She’s seen “equitable access” become part of the sector’s jargon, she says, and is excited that a pandemic treaty could potentially address the problem. But that’s a long way off: Negotiations in Geneva are just starting to heat up.

• Many countries and organizations participating in the third meeting this week of the Intergovernmental Negotiating Body — the group in charge of drafting and negotiating a potential treaty — underlined the importance of equity and access to health products. However, they disagree on certain provisions included in the “conceptual zero draft.” 

• The U.S. says that any references to technology transfer in the draft should be voluntary. The International Federation of Pharmaceutical Manufacturers and Associations says waivers won’t increase manufacturing of health products during a pandemic, and that conditions on publicly funded research may only “slow down time-critical innovation.” Australia, meanwhile, says it does not support the inclusion of intellectual property waivers in the draft, as that’s already “under the remit of WTO.”

• But a push by several low- and middle-income countries to extend a waiver on COVID-19 vaccines to treatment and tests isn’t making any progress either at the World Trade Organization. Instead of meeting a deadline for a decision on Dec. 17, several high-income countries prefer to delay a decision on the matter. The U.S. even wants to launch an investigation into whether extending the waiver would actually increase access.

• Mohga Kamal-Yanni, policy co-lead for the People’s Vaccine Alliance, wrote to Jenny that even though negotiations on a treaty have yet to take place, the narrative from high-income countries is already “incredibly worrying,” with the countries speaking the language of equity, but seemingly reluctant “to address any of the problems that drive it.”

• She, along with other access advocates, also raised concerns on a proposal to include the private sector and other nonstate entities in a treaty’s governance structure. NGO Knowledge Ecology International specifically objected to having representatives with “commercial interests” on a treaty’s governance — including potentially the Bill & Melinda Gates Foundation, which the organization said already exerts “excessive influence” in global health.

• Meanwhile, the board of Gavi, the Vaccine Alliance is contemplating the future of COVAX, a global effort launched during the COVID-19 pandemic to ensure equitable access to COVID-19 vaccines. They’ll decide whether to shut down the initiative in 2023, according to the New York Times — although Seth Berkley, chief executive at Gavi, says the current proposal seeks to integrate the work of COVAX into Gavi, not close it down.

• The move isn’t entirely a surprise. During the launch of the Access to COVID-19 Tools Accelerator’s transition plan in October, Dr. Bruce Aylward, its coordinator, said adult vaccination isn’t Gavi’s focus, and that it “would be a shift if GAVI is to continue in the longer term to provide access for COVID-19 vaccines.” Still, some raise questions about whether it’s the right time.

• For Simão, the future rests on member states. “We have the chance to frame what a future [pandemic] response can look like, if member states … really want to overcome this next time,” she says, “and that goes beyond individual interests.”

Read: WHO's Dr. Mariângela Simão on COVID-19 regrets and unfinished business

ICYMI: ACT-A set to transition to a new phase

Plus: Little progress on COVID drugs agreement at WTO, civil society warns

PEPFAR future

Speaking of access, our colleague Omar Mohammed recently spoke with U.S. global AIDS coordinator Dr. John Nkengasong, who leads the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, about the initiative’s new five-year strategy. Here’s what he learned:

On manufacturing: PEPFAR plans to engage financial institutions to boost regional manufacturing of health products in global south countries, including across the African continent. PEPFAR won’t be providing capital to these banks, but it is committed to buying products made from these regions, says Nkengasong.

On localization: Nkengasong says PEPFAR is making progress in channeling more of its funding to local entities. However, that’s not without complications. Some international organizations have established local subsidiaries, while some local partners subgrant a portion of their funding to international organizations.

Read: How PEPFAR aims to spur medical manufacturing in Africa (Pro)

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Overheard in Marrakech

Goldstein intimated her thoughts to Amruta on the sidelines of the International Social and Behavior Change Communication Summit underway in Morocco this week. Do you have thoughts? Let us know, as we dig into more detailed coverage of the topic.

Make yourself indispensable

Global health is a huge sector, and on the Devex jobs board, there’s always a vacancy waiting to be filled. But which global health positions are most in demand, and which ones pay the highest salaries? Devex contributor Fatima Rico analyzed nearly 800 job positions posted from January to October 2022 from 11 organizations in 139 countries to find out.

Read: What we know about development salaries in global health (Career)

+ A Devex Career Account membership includes all the valuable tools you need to be successful in your globaldev job hunt. Sign up today and start your 15-day free trial.

One big number

That’s how much malaria cases and deaths exceeded WHO targets in 2021, says Dr. Abdisalan Noor, head of the Strategic Information for Response Unit of WHO’s Global Malaria Programme.

The WHO target was for malaria cases to have declined to 31 cases per 1,000 at-risk people, and deaths to have gone down to 7.8 per 100,000 by last year. But the latest figures from the World malaria report, published by WHO today, found that malaria cases and deaths were nearly twice that, partly due to limited resources — the funding gap for malaria was $3.8 billion in 2021 — and declining effectiveness of interventions such as insecticide-treated bed nets.

I can wait forever …

… Said none of the health organizations that have been waiting for Gavi to implement a 2018 decision to support countries with their hepatitis B vaccinations at birth.

In an open letter published this week, the organizations, including the World Hepatitis Alliance and the Médecins Sans Frontières’ Access Campaign, asked Gavi to honor its commitment — which was supposed to start in 2021 but was delayed due to the COVID-19 pandemic.

But they will have to wait some more. A Gavi spokesperson tells Jenny that the “pause” continues, although Gavi is still preparing for a “possible future” program. The Gavi board will discuss the issue in mid-2023.

Read: Health groups ask Gavi to start delayed hepatitis B vaccinations 

What we’re reading

African parliamentarians accuse the Global Fund to Fight AIDS, Tuberculosis and Malaria of neglecting them and using them for fundraising purposes. [Health Policy Watch]

China has eased its anti-COVID-19 measures following protests, and will now allow those with mild cases to isolate in their homes rather than at public quarantine facilities. [AP News]

Uganda’s Ebola outbreak appears to have disappeared — which creates a challenge for its vaccination program. [Science]