The last two weeks have seen two extremely important developments in global health. First on 5 May came the US government’s announcement that it would support a TRIPS Waiver on intellectual property rights in relation to Covid-19 vaccines (read our Explainer here). 

Then came the publication on May 12th of the report and recommendations of the Independent Panel for Pandemic Preparedness and Response (the report and all its background documents can be found here).

South Africa can be commended for playing a leading role in both. Together with India, we were the original sponsors of the TRIPS waiver proposal to the World Trade Organization (WTO). Our former DG of Health, Precious Matsoso, is a member of the Panel.

The two breakthroughs are not unconnected. In fact, let’s put it another way, they are intricately connected: the success of a TRIPS waiver depends on it being implemented within a broader programme of health reform that tips the balance towards a human right to health.

In my view, the Panel report should be considered one of the most visionary and radical — but eminently rational and reasonable — reports on the reform of global health systems to have been published for decades. Perhaps for this very reason, we can predict with some certainty that governments and private powers are not going to act on its recommendations. This is because implementing the recommendations requires a huge reinvestment in public health; the weakening of private monopolies over medicines, medical technologies and parts of health systems; and the strengthening of multilateralism and human rights.

What is recommended?

The Panel’s recommended actions are summarised here. They fall under seven sub-headings which, they say, are necessary “to ensuring that a future outbreak does not become a pandemic.” 

Each recommendation is linked directly back to evidence of what has gone wrong (called the ‘defining moments’ of the pandemic). The seven, which the panel warns “must be implemented in their entirety” if they are to be successful are:

1. Elevate pandemic preparedness and response to the highest level of political leadership;
2. Strengthen the independence, authority and financing of World Health Organisation (WHO);
3. Invest in preparedness now to prevent the next crisis;
4. A new agile and rapid surveillance information and alert system;
5. Establish a pre-negotiated platform for tools and supplies;
6. Raise new international financing for pandemic preparedness and response;
7. National Pandemic coordinators have a direct line to Head of State or Government.

Furthermore, the report is very specific on the steps it says must be taken to end vaccine apartheid. It goes further than the TRIPS waiver proposal, which we predict will be deliberately bogged down in negotiations, because it suggests tight timeframes and a framework for overcoming the obstacle of intellectual property: 

• “High-income countries with a vaccine pipeline for adequate coverage should, alongside their scale-up, commit to provide to the 92 low and middle-income countries in the Gavi Covax Advance Market Commitment with at least one billion vaccine doses by September 2021.”
• “That major vaccine-producing countries and manufacturers should convene, under the joint auspices of the WHO and the World Trade Organization (WTO) to agree to voluntary licensing and technology transfer.” In a bold move, the Panel adds that “If actions on this don’t occur within three months, a waiver of intellectual property rights under TRIPS should come into force immediately.”
• “The G7 should immediately commit to provide 60% of the $19-billion required for the Access to Covid-19 Tools Accelerator (ACT-A) in 2021 for vaccines, diagnostics, therapeutics, and strengthening of health systems, and a burden-sharing formula should be adopted to fund such global public goods on an ongoing basis.”

So far so good, but is anybody paying attention?

Last week was another busy and tortured week in the world: the Covid crisis continues to rage in India, other countries of Asia and Latin America; Israel accelerated its unlawful and inhuman assault on Palestinians; in South Africa all eyes were on Ace Magashule and the stuttering roll-out of vaccines. 

Paradoxically, there is a serious danger that the world was too busy and preoccupied to pay attention to the big picture, too busy to process a plan billed as the only way we might end Covid and avoid an even worse pandemic in future. 

As a result, the Panel’s report came out not with a bang but a whimper. Although the media reported on it from New York to China, from Australia to India, it seems Maverick Citizen was almost the only news publication in Africa that covered it.

Africa has a population of 1.3 billion people, most of them living in poverty, vulnerable to and unprotected from disease. So, when an activist based at the WHO in Geneva asked “Why Africa is silent right now?!” the answer is that Africa cannot speak out on an issue it has not been made aware of.

This adds to the danger that this report will go the same way as many other important reports — to gather dust on the shelves.

We just cannot afford that to happen. 

Humanity’s health is a stake. 

It is for reasons like this that the 13 members of the Panel should not think their work is done. Reports don’t self-enact. They need power behind them. The Panel should realise that this power will not be found in polite diplomacy where they will be fobbed off, but by taking the report to the activists of the world, through networks of civil society, and making them aware of analysis and its recommendations.

There will be a pushback. It’s started already.

We are hearing reports that the US “is doing everything possible” to stop action and a decision at the World Health Assembly (which starts next week) in favour of a new ‘Pandemic Framework Convention’ and that they “are using their waiver decision, which is very much PR, to exert political pressure”.

Sources tell us that instead the US government “wants to shape the agenda through a White House Summit in Spring and the G20 — they want a pandemic council of the G20 that distributes funding. They have pressured Italy not to include the treaty in the declaration of the Rome summit of the G20 in October.” 

Last week we commented on how the change of position by the US on the TRIPS waiver came about because of relentless pressure from civil society, but also warned of a long road ahead. Activism worked — but to be more than a pyrrhic victory it needs to increase. 

Now the same pressure needs to be applied by civil society all over the world, including in SA, to popularise this report and demand the implementation of its recommendations. 

In a speech this week Tony Fauci said inequality has made Covid-19 “an infectious disease that disparately kills people of colour.” The Economist put it equally bluntly “The rich world suffered relatively badly, but most of the dying has been elsewhere”. So, in conclusion, we can’t put the reasons for action in a better way than the Panel itself:

“The pandemic has put health at the forefront of attention for all humanity and proven that decisive action to shape a better future is not only needed but possible. It has created both the opportunity and the obligation to act now. … It will require investment but also political will and public engagement. … Prioritising the health of people and planet is and must be a broad agenda — it includes investing in sustainable and safe food systems and clean energy…. This is the moment for transformative change.” DM/MC