South Africa

Accessible and affordable medicines

Covid-19: Treatments, but at what cost?

South Africa needs a surveillance strategy that will pick up the start of a second wave of infections very quickly, says Mary-Ann Davies of the University of Cape Town’s School of Public Health and Family Medicine. (Photo: Krisztian Bocsi / Bloomberg via Getty Images)

At a time when the world’s richest countries are deploying their forces in the battle against COVID-19, the pandemic is threatening Africa and some of the world’s most vulnerable populations, the least able to protect themselves. Confinement is not possible for those who need to leave their homes just to survive. The poor living conditions – water, sanitation and so on – structural weakness of health systems, and the lack of basic equipment are so profound that governments are unlikely to be able to address them.

The World Health Organization (WHO) has sounded the alarm. While we race against time in our own countries, absorbing our resources and energy, we must not forget the world’s most vulnerable populations.

Solidarity is first and foremost a moral duty. All of humanity is affected today, and our prosperous societies would be wrong to abandon the most vulnerable. This moral duty is also a practical one; in the face of a global pandemic, only a global response can be sustainable. A disjointed response would run the double risk of allowing the disease to migrate further or to re-emerge.

Twenty years ago, the certainty that only a global effort could overcome pandemics led to the creation of new organizations, which in recent weeks have mobilized to confront COVID-19: Gavi, which specializes in vaccines, is stepping up its campaigns; the Global Fund is enabling countries to use up to five percent of approved grant funding to help protect and treat vulnerable communities (about US$500 million is available for that purpose); Unitaid, which promotes innovative projects that promote equitable access to health care, is investing in diagnostics, treatment and triage tools for respiratory diseases.

But we need to go further.

Traditional development assistance programmes, as indispensable as they are, will not be enough. Initiatives are springing up, all of them useful. We must prepare for the time when treatments and vaccines will become available. But these treatments and vaccines must be accessible to all, everywhere and at the same time.

This is an appeal to the international community.

We cannot wait for treatments to be available in high-income countries in order to negotiate prices for the rest of the world, as happened in the case of HIV. The exceptional circumstances of the COVID-19 pandemic call for an exceptional response. The World Trade Organisation (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS, 1995), including those recognized in the Doha Declaration (2001), already allow countries to issue compulsory licences for treatments in the case of pandemics.

We propose to go further.

We ask that governments and institutions currently financing or contributing to the development of drugs, vaccines or technologies for COVID-19 agree from the outset in their contracts with industry to the sharing of intellectual property rights taking into account the urgency we find ourselves in. We are talking about sharing, not giving up. In practical terms, once public money is invested in the race to find treatments for this pandemic that threatens the entire planet, states must demand in return from the outset that companies give up their licences without geographical limitations to a structure that would guarantee the production of treatments that are effective and safe, and – in return for public investment – at affordable prices, everywhere.

This is not a utopian dream.

Ten years ago, Unitaid created the Medicines Patent Pool (MPP), which allows pharmaceutical companies to license their rights on a voluntary basis. This has enabled the production of generics that treat tens of millions of people around the world. Thanks to the MPP, for example, an annual treatment for HIV/AIDS costs less than US$70 in Africa, compared to the US$10,000 it costs in Europe.

Back then we had to wait almost ten years between these medicines being available in high-income countries and their arrival in less well-resourced countries. In the face of COVID-19, we must act now to ensure that everyone, everywhere, has access to treatment at the same time.

This would be a first. The shortage of several important health products and equipment caused by COVID-19 has galvanized and encouraged both governments and industry to cooperate and share technology, and enter into agreements to cooperate and to enable an increase in manufacturing capacity. Already countries including Germany, Chile, Australia and Canada have passed resolutions allowing them to move in this direction.

South Africa itself adopted a policy on intellectual property in 2018 and should prioritize enactment of legislation that allows for the use-all policy tools needed to address urgent public health concerns. Some companies have also said they are ready. The World Health Organization is working to increase transparency of the more than 700 trials ongoing around the world looking into COVID-19 treatments and vaccines.

It is the entire international community that must commit itself and move forward together, in a spirit of solidarity. We call on all the G20 governments and international institutions to make this commitment, along with the World Health Organization. The world needs your dedication to eradicate COVID-19, and to save lives in Europe and around the world. DM/MC

Marisol Touraine, Former French Minister of Health and Social Affairs, and Chair of the Executive Board of Unitaid. Malebona Precious Matsoso, Director of Health Regulatory Science Platform, Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa; and Member of the Executive Board of Unitaid.


"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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