Five million lives worldwide have already been lost to Covid, and WHO / ACT-A grimly predicts that 5 million more lives will be lost in the coming months. Alarmingly, too, Covid cases will drop from the 260 million confirmed so far to 460 million by the end of 2022.
The damage from Covid has been so catastrophic that when the World Health Assembly (WHA) meets in extraordinary session, from November 29, its task is nothing less than to prevent such a tragedy. does not happen again. The damage caused by Covid has been so ruinous that we now need a binding international agreement to prevent future epidemics from ever reverting to pandemics.
In the words of WHO Director-General Dr Tedros Ghebreyesus, a new deal should be backed by a high-level commitment to health for all based on equity and solidarity among nations. Not only should all people have equitable access to what they need for their health, regardless of their wealth or income, but the international community should ensure the equitable use and distribution of available medical resources. For this to happen, we need a fully functioning global surveillance system, rapid monitoring and sharing of emergency support, and predictable funding.
Nothing illustrates the need for this more clearly than our collective failure, as the international community, to deliver on our promise to ensure equitable distribution of vaccines. Because if, thanks to brilliant science and solid manufacturing performance, we will have produced 12 billion vaccines by Christmas – enough to immunize every adult in the world – 95% of adults still remain unprotected in countries with low returned. It is perhaps the greatest public policy failure of our time.
The WHO internationally agreed adult immunization target for each country – 40% by December – is expected to be missed by 82 countries. On current trends, it will take at least until Easter to get closer to 40%, and even then, dozens of countries could miss out. In fact, since the G7 meeting in June, where leaders pledged the entire world will be vaccinated by 2022, the gap between have-not and have-not vaccines has widened rather than narrowed. In high-income countries, immunization rates have fallen from 40% in June to 60 to 70% now, but they have moved at a freezing pace in low-income countries – from 1% to less than 5%. Six adults receive their booster shots in middle- and high-income countries for every adult currently vaccinated every day in a low-income country, and 90% of African health workers remain unprotected.
Although important regional initiatives such as the African Union AVAT Vaccine Procurement Mechanism, have taken steps to bridge the inequality gap by purchasing 400 million single-injection vaccines from Johnson & Johnson and 110 million from additional doses in Moderna – 50 million between December and March – it is still not enough to meet the needs of a continent of 1.3 billion people.
This inequality can be explained simply: 89% of all vaccines were purchased by the G20 – the richest countries in the world – and they now retain control of 71% of future deliveries. The promises of the countries of the North to give vaccines to the countries of the South were not accepted: only 22% of the donations promised by America were sent. Europe, UK and Canada performed much worse and only shipped 15%, 10% and 5% respectively. Covax, the global vaccine distribution agency, which had hoped to send 2 billion vaccines by December, now expects to deliver only two-thirds. Such is the scale of vaccine storage in the wealthiest countries that health data research group Airfinity estimates that by the end of 2021, 100 million unused doses in the G20 stockpile will exceed their expiration date and will be wasted.
For the G20 countries, having and accumulating life-saving vaccines and denying them to the poorest countries is morally indefensible. Letting tens of millions of doses go to waste is an act of medical and social vandalism that may never be forgotten or forgiven. An urgent and continuous month-to-month delivery plan and air transport of vaccines, coordinated by the G20 countries, are now required to use unused capacity where vaccines are needed most.
But vaccine inequalities show why more fundamental changes are needed in the international architecture of health decision-making. Of course, few international organizations have had the freedom and independence to make binding decisions that national governments are obliged to follow. The discretionary power enjoyed by the World Trade Organization’s Court of Appeal and the International Criminal Court, whose decisions are final, are areas in which an international organization can override nation-states and because of this, they are attacked by a coalition of anti-internationalists.
While there is a global health treaty focused on reducing the demand for and supply of tobacco, and a 2011 agreement to ensure that WHO can requisition supplies of influenza vaccine when needed, the he global binding agreement that has been called for to allow global health authorities to do more to prevent, detect, prepare for and control a pandemic still eludes us.
The special summit of the World Health Assembly offers us a unique opportunity to fill these gaps by serving as the launching pad for a process that will urgently develop a legally binding international agreement under the auspices of the WHO Constitution. They can draw on important reports – the G20 report by Larry Summers, Tharman Shanmugaratnam, Ngozi Okonjo-Iweala, Mario Monti’s report to the WHO European region and, the recommendations of the review of the WHO led by former Liberian President Ellen Johnson Sirleaf and former New Zealand Prime Minister Helen Clark.
First, our global health leaders must have more authority to develop and improve health surveillance Second, we must build on the pioneering work of ACT-A and Covax (the global allocation agency vaccines), to ensure equitable manufacture and distribution of PPE, tests, treatments and vaccines so that all countries can detect, respond to, treat and protect against current and future pandemics.
Third, we need a global pandemic preparedness council. But all of this will only work if we design a sustainable financing mechanism to address the glaring global inequalities in health delivery around the world. Too often in times of global crises – even those where we are faced with life and death decisions – we are reduced to going around the begging bowl or calling “engagement” conferences in some way. which is more reminiscent of the organization of a boost in a fundraising charity.
Ideally, pandemic preparedness should be funded through a burden-sharing formula where costs are shared among countries with the greatest capacity to pay. Even today, a little less than 20% of the WHO budget is covered in this way. The eradication of smallpox in the 1960s and 1970s made history, not least because the final effort to eliminate the disease was initiated by a burden-sharing agreement under which the richer countries shared the costs.
Given the trillions of dollars in lost trade due to Covid – roughly $ 9 trillion, the $ 10 billion a year budget for pandemic prevention and preparedness deemed necessary by the high-level independent panel of the G20, would offer one of the greatest returns on investment in history. But we need to act now – and this week’s World Health Assembly is the starting point – if we are to be prepared for all future eventualities.
Gordon Brown is WHO Ambassador for Global Health Financing and former Prime Minister of the United Kingdom.