Access to medicines and other health products has now become a central topic in the global health space, thanks in part to the COVID-19 pandemic, said Dr. Mariângela Simão, who until recently led the division that is focused on the issue at the World Health Organization.
“I think the pandemic helped … there’s [now] a lot of people in the industry talking about equitable access,” she told Devex prior to her departure from WHO.
But Simao, who has worked on access to health products, including for HIV, for much of her career, said ensuring people’s access to health products needs to go beyond rhetoric.
“The next step is … taking concrete measures to ensure that next time we don't go through the same problem. Because it's a recurrent problem,” she said, adding a potential pandemic treaty now under negotiation is one measure that excites her and that, she believes, could help address this problem.
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During her time at WHO, Simão oversaw several efforts to facilitate access to health products. The most well-known of them is the COVID-19 Technology Access Pool, or C-TAP, an ambitious undertaking that encourages developers of COVID-19 health products to voluntarily share intellectual property, knowledge, and data with other manufacturers, so they can produce and increase the availability of lifesaving COVID-19 vaccines, treatments, and diagnostics.
More than two years since launching in 2020, however, one review says it has failed to reach its full potential, having only secured two licenses to date.
Devex asked Simão, who says she’s leaving WHO to retire — she turns 67 next year — about lessons from C-TAP, what’s missing from current initiatives focused on pandemic preparedness, and what she regrets not being able to accomplish during her time at WHO. She also shared her advice to her successor, and what she looks forward to after WHO.
The text below has been edited for length and clarity.
If you’re going to describe in one word the work you’ve done at WHO, what would that be?
Never-ending. What we did during the COVID pandemic, I said, we did what we did to the best of our abilities, and it was not enough.
You said you've tried to the best of your abilities. What do you think could have been done better with C-TAP?
What we saw with C-TAP is that [there’s] great interest … mostly of public researchers who made their technology available. There are still several licenses being negotiated right now. But it could be a good platform for pandemic periods beyond COVID, if we think about different ways to do technology transfer. Here I’m linking to, for example, to the mRNA [vaccine technology transfer hub] initiative, with its hubs and spokes, which is a different model from the bilateral agreements we see.
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Industry prefers bilateral agreements, because they can set the terms they want. When we're talking about … more transparent methods, where everybody comes in and shares, it's much more difficult for the industry to come.
We're doing a review of C-TAP and seeing the lessons learned. We've discussed, for example, that if public health researchers, institutions have difficulties … in doing licensing to the MPP [Medicines Patent Pool], which is a Swiss foundation … they could do it through C-TAP, which is a WHO-led initiative that has MPP as an implementing party.
I think the principles still stand. There's a lot to learn on how to deliver for the next pandemic. But I think there's a question of trust between big pharma and these more collaborative models. That’s something that needs to get better overall.
There are now a lot of initiatives and discussions in place on how the world can be better prepared for the next pandemic. What excites you most, and what do you think is missing from the current initiatives in place or discussions that are happening?
I think a binding instrument will help the world … [But] where we needed to get challenged there for example is moving from an equity angle, which is a human rights angle … to a more operational angle, which is equitable access.
We have the chance to frame what a future response can look like, if member states … really want to overcome this next time, and that goes beyond individual interests, industry or otherwise, trade, and so on.
What would be your advice to your successor?
One is that you need to be persistent.
The second advice [is] if you are to commit mistakes, not the same ones.
Is there one mistake you promised yourself not to commit again?
I wish we could have done more to tie in some of this highly profit-oriented business into being ashamed of doing business that way [during the pandemic]. I regret [it].
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We saw some good behaviors during the pandemic … but we had problems in accessing some of the products that were made available to high-income countries much earlier than they were available to COVAX, because they paid more. And I regret that we couldn't do more.
Is there anything you wanted to accomplish at WHO, but weren't able to?
We have a high number of contracts that are short-term contracts. And I wish we could have turned many of these into a longer-term contract. But that's related also to WHO’s funding.
And there are things that I regret [that] I was still unable to finish. … We did not finalize our report on morphine, for example, because we are run over by the pandemic and kind of exhausted our resources. But these are important issues. There are people who are in palliative care … who don't have access to painkillers.
What are your plans now after WHO?
I’m going back home. You know I joined the U.N. 12 years ago … [and] I’ve been working in the public health system for 42 years. So my first thing is to regain some balance between [my] private life and work life, and then decide what to do.
Brazil is … going through an exciting moment. We have a strong health system. There's a new leadership coming back. So I'm very happy to be going back home. But also on a very personal note … I don't want to grow old in a place where I'm a foreigner. I want to go back to my … hometown, where the baker knows me by name.
Do you still plan on working in the access to medicines space?
Access to medicines and health [products], it's in my DNA, coming from the HIV [space] and from primary health care before that. So I will continue to help in whatever way I can. But it's good to be out of the ties that you have, professional ties with [the] government or with international organizations. It’s good to be your own person again and choose what you want to do.
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
