DR MOHGA KAMAL-YANNI, Senior Health Advisor & LOIS CHINGANDU, Director of Evidence and Influence at Frontline Aids
“We need HIV activists to help with this because you’re already experienced in how we campaign for the use of TRIPS, flexibilities”. ~ Dr Mohga Kamal-Yanni, Senior Health Advisor
Moderator: Maaza Seyoum
Complied by: Vivienne Naidoo
Queries: info@africanalliance.org.za
Webinar Recordings & Supplementary Materials:
https://epha.org/vaccine-equity/
https://www.aa.com.tr/en/africa/covid-19-africa-fears-vaccine-shortage-urges-equity/2128751
WHO
Dr Mohga Kamal-Yanni is a Senior Health Advisor with 40 years of experience in health policy and programming with international and national development agencies, including NGOs and governments in developing countries in Africa, Asia, Latin America, and Eastern Europe. Dr Kamal-Yanni is currently providing technical and policy support to UNAIDS and the People Vaccine Alliance to access Covid-19 health technology and a key advisor to the NGO board members to UNITAID. She has in-depth experience and knowledge of policy and advocacy on access to medicines and healthcare
Lois Chingandu is the Director of Evidence and Influence at Frontline Aids. Lois plays a central role in generating evidence to support effective HIV programming and engage and influence national and regional governments, international donors and partners. She has more than 20 years of hands-on leadership experience on HIV, sexual and reproductive health and rights (SRHR), gender activism and civil society engagement. In her most recent role as Executive Director of SAfAIDS, Lois built an organisation with a global reputation for high-quality HIV and SRHR programming and effective regional and national advocacy. Lois has a long-standing commitment to ensuring the rights of marginalised people, key populations, women, and girls, who form the cornerstone of an effective HIV response.
QUESTION AND ANSWERS
*This section contains a transcribed account of the Question and Answer session*
How do we strike a balance on intellectual property rights (IP) between the rights holders and users, especially in a global crisis?
So for a start, first, these vaccines companies don’t just pull them from the wardrobe or something. These vaccines have been in the research study. When people say, oh, it’s so quickly done, actually no, that is based on 20 years and 25 years of research funded by the public by governments. So only that the research has been heavily funded, last year, there was more funding from governments to investors for final stages, then to companies to develop, and even for companies to produce what they call produce at risk, which means they might produce. Then it proves to be bad; therefore, you would have to dump it all. So that’s a waste of money. So that potential waste we the public pay for it. But that’s one thing. The public in developing countries paid for clinical trials. You didn’t pay people in clinical trials to pay cash to them, but they pay by being there and entering the trial; otherwise, we wouldn’t have had a vaccine. That’s what we say it’s part of a People’s Vaccine. So yes, even on top of all that, okay, companies need profit, nobody said no to profit, its no to maximising profit, at the expense of public health. They suspected that Moderna and Pfizer would have something like billions of dollars this year for the vaccines, so the public bears the cost, and the private takes a profit. And in the meantime, in the middle, we don’t care about public health. That is just not right. The balance is stepped in for pharmaceutical companies to balance the sheet; to have the scale balance, you need to look at public health. So you need to remove the barriers and do the technology transfer. Because it is a pandemic. I mean, if you can’t do that during a pandemic when on earth would you do that? But the other thing is there has been debates for the last 10 to 15 years that you know, academics and civil society and keeping it on board. I’m doubly charged with looking for other ways to produce medicines. So at the moment, what companies would say we need intellectual property because we need to maximise our profit so that we can pay for research and development for COVID. They haven’t paid, but the other thing is okay, you want to pay for research and development. Let’s cut the link between the price and that you want to charge and, therefore, the profit you want to make, and between financing, let’s finance Research and Development (R&D) differently. Like the way, it’s funded for COVID. And then once it’s financed, you have the cost of production and the cost of anything you’ve done for this. And then anything above that is your profit. Does the profit have to hit the ceiling? This is the thing there’s no ceiling.
Many people here in the room want to know what they can do at a local level? As I mentioned, we are hosting this session in collaboration with the People’s Vaccine and a group of comrades in Kenya who have been inspired by the People’s Vaccine and named themselves People Vaccine Kenya and have already been doing some grassroots work. So that hopefully will give us an example of what can be done on the ground.
So I am the campaign lead for People’s Vaccine Kenya. When COVID started, and people started speaking about the vaccine, the discourse was always limited exclusively to civil society organisations, non-governmental organisation. So in most times, the informal urban settlements that have been disproportionately affected by the pandemic were being left out of this conversation. So what we did is, a group of us came together and started the People’s Vaccine Kenya, where we took a different turn. Even as civil society, we took a different turn and said, let’s give a voice to these people who have lived. And if they aren’t given the vaccine, it means their life will never go back to normal. Because we see a lot of privatisation at the moment, we all saw a lot of denials. We see a lot of denial on the privatisation of the vaccine. So in terms of grassroots accessibility, I think the most important thing to do now is to understand that many people in informal urban settlements have no voice if they have a voice but have been intentionally silenced by the government. So it means you have to stand up and be the voice for these people. I realised something else, especially when organising for the vaccine, where there are people, there is power. And as Lois had said, Where there is anger, there is the power to change something. This means we are tired of the policymaking facade, especially from high-level panels, high-level organisations, all this between the World Health Organization and African Union (AU). We want it to be a bottom-up approach. We want public opinion to carve of how this takes place. For example, in Kenya, we are hanging on because we are just getting into wave three of the pandemic. As of today, I think only 4000 people have been vaccinated. And those are priority people out of the 1.2 vaccines we had gotten about two weeks ago. So you can realise that the government has no regard, and they are in continued contempt of the Kenyan population and the larger African population. I hope that answers your question.
We are focusing on The World Trade Organization, and we are focusing on the high-level continental and intercontinental bodies to achieve this TRIPS waiver. Is it possible for pharmaceutical companies to absorb their goods’ IP and patent rights by themselves? For example, since AstraZeneca has offices in Kenya, they can say for Kenyans and Kenyan scientists, you can use our know-how. This is how we made the vaccine. And this is the information we have thus far. Can the pharmaceutical company do that? Or does it have to follow the basis of international law and national law in some instances?
So companies, it is in their hands to make agreements with other companies to produce a vaccine. That’s what AstraZeneca did. AstraZeneca is not a vaccine producing company for a start. So they have to rely on other companies, even in Europe. They made agreements with Serum Institute of India, which is the biggest vaccine producer in the world in terms of volume, and may be an agreement with Argentina and with one or two other companies. And the idea is that this is a bilateral deal. The bilateral commercial contract basically. What goes into that commercial contract? You don’t know? Because once you say its a commercial contract, therefore, it’s subjective. Nobody can tell you what it is, except what they decided. When they made a deal with Serum, they say, there was lots of singing and dancing in the media. And Serum will sell them the vaccine for three dollars a dose. What’s happening is they’re selling it for five-point 25, selling it together for $7. So there’s no commitment because we don’t know what they signed. And in fact, I doubt that AstraZeneca said you make your price this or that. I don’t think they can because it depends on the cost of production. So anyway, how much profit they want to make? So the technology access pool is the other voluntary method where they put it. They put the intellectual property and technology, but they don’t control which company does work. And if it’s based on the medicine patent code for HIV, if you look at the patent pool website, the pool when they negotiate with a company, they negotiate in secret. That’s fair enough. But once the licenses ID is signed, it’s on the internet. So it’s open to public scrutiny. And we did criticise a number of licenses because of the patent for negotiating on behalf of public health. It doesn’t have commercial interests. It’s a public organisation. While if you are two companies, they both negotiate their debt with the public good, they will say that, but negotiate on commercial terms. So that’s what they can do companies, they can go by coordinated code. WHO runs the mechanism, but they don’t want that because they want that; they want to control. I don’t know if I have a wicked mind. But I think that the company, the big companies, hopes to produce billions of doses by the end of the year or next year. So they don’t want the competition. That’s my wicked brain.
Tanya asks what role Africans in the diaspora can play to ensure that vaccines reach African countries, especially those in rich countries with surplus doses?
Yes. There’s a lot that Africans in the diaspora can do. Some weeks ago, when I wrote on my Facebook book about this, many Africans came back to me saying, why are you not pushing African governments? You know, those governments have a right to look after their people. And for me, that demonstrated a lack of understanding of how the world should be functioning. And my point is if you are in the diaspora, and you’re an African, you have so much leverage to do a lot. One of the things you can do, for example, I said this in response to the UK, when the UK said, we will send any leftovers to the countries that need vaccines. And I said, you know, we should be upset about statements like that. It’s not leftovers that we need. We need equal access, you know, and even people in the diaspora could easily have questioned that. The second thing is most of these companies we are talking about here in the diaspora. Then we had a day of action where we all agreed to call the companies, you know, call their reception and ask to speak to the CEO of Pfizer of AstraZeneca of the different companies. It was funny because, in the end, the receptionist says, Do you realise that an unusually high number of calls are coming in asking for CEO? Those are some of the things that we can do. And the CEOs are aware when they heard that there was this increase in calls. They knew that this was about mobilisation. So we need things like that. We have requested people to leave messages at the Phizer doors, at the gates, anywhere, to keep reminding them that we want a People’s Vaccine. Whatever little thing you can do, goes a long way in activism. Anything, call your MP, ask them, What are you doing about People’s Vaccine? That’s all the movement that we need. For the people in these countries where we need vaccines, people were asking, Well, what should we do? Where do we go? You don’t need to go anywhere with HIV; many people started mobilising in your locality, mobilising other activists, and start checking. Some countries already received vaccines from the COVAX mechanism. We need to check who is receiving that vaccine? Is it going to the priority of people? We have countries where doctors and nurses have still not received vaccines, and the vaccines are already going to the rich and famous in that country. So we need activists to monitor those things. We need activists to call out when they see corruption when they see things that are not acceptable. So mobilise just like we did with HIV. We didn’t wait for anyone. I saw Tendayi Westerhoff and many others on this call. You are experts at what I’m talking about. You don’t need to go into any classroom for this. You know how to mobilise. That’s what we now need to do.
Just mobilise and start putting out messages and call for and demand to know where the vaccines are? Who is having them? What is the priority list? Is it being followed, and keep connecting the communities to the global advocates that are already very advanced. If you reach out to the People’s Vaccine platform, we have many already prepared resources that you need to take, translate and use. You don’t need to develop new messages. We have created a box with all the information and materials you need to go into it. Please, I am requesting that we go back to the same spirit we used to fight for HIV treatment.
I want to add an important thing that is happening right now. Many countries have requested to use the TRIPS flexibilities, and they are meeting a lot of resistance. And yet TRIPS flexibilities, I think, as Mohga mentioned, was meant for emergencies and crisis, like the one we have with COVID. Why are we meeting resistance for countries to use TRIPS flexibilities? If you track that process, you will see that the dates set for meetings, you hear that people say the next meeting is in May, and you’re like, why? We need answers now. These countries need to be allowed to use TRIPS flexibilities. That is what helped us with HIV treatment. We ended up with countries declaring emergencies and, therefore, able to use TRIPS flexibilities. We need HIV activists to help with this because you’re already experienced in how we campaign for the use of TRIPS, flexibilities.
Many African countries did take part in HIV ethics, efficacy trials for ARV’s and even now, many African countries did take part in the efficacy trials for the vaccine, especially AstraZeneca, the Oxford trial. So a lot of these countries have also been left there. And there’s been no access to benefit sharing or getting the vaccines with some priority because these countries did provide the human labour to make sure these vaccines work. Lois, what you can tell us about the disregard of these countries?
All that it takes us to question when you are silent, things can go on and on and unchecked. We need to question these things. We need to write letters to pharmaceutical companies. At the global level, we are pushing towards those things. We have done letters to the CEOs of pharmaceutical companies we are arranging to invite them to meet with survivors of COVID. So there’s a lot of things that we can do. It’s all about advocates. Unfortunately, nobody’s going to give you those things on a plate and the fact that you participated in a trial, and you were never promised that after we do get the vaccine, you will be prioritised. So unless you now demand it, it’s not going to be given to you.
Just quickly to say anybody in clinical trials anywhere globally, there’s no guarantee that they get the medicine. So it’s really up to the country when they negotiate. I mean, it’s companies that negotiate, so like clinical trials with South Africa. So in negotiating with AstraZeneca or Johnson and Johnson, the country did not negotiate what happens after. In fact, the people in the clinical trials already have them. Some of them had vaccines. The control arm didn’t have the vaccine, and who is controlled and who has. That’s what the company knows, like J&J and the others, not the people, not anybody. So there was no agreement. And that’s what should happen. An agreement, not just to only the people who were in control and didn’t have the vaccine, but an agreement saying, we’re going to give you the clinical trial sites and everything and all that, in return for you providing x million doses for our people. And that’s what did not happen. It happened now that they had some negotiation now, when it was a crisis, to be honest, and health workers were complaining in South Africa.
Now, Johnson and Johnson is giving x many doses to South Africa as part of the trial. It’s not a sale after the trial. It’s done as part of the trial. So that’s the learning lessons here for all countries to watch. You invest in clinical trial sites because that’s a good thing. And with them, you agree if your product passed subsidies, I want X number. And, you know, I want free, or I want a low rate or whatever. So you have to have this negotiation. And then sign the agreement. I guess countries didn’t know that at the time, I think.