COVID-19: What is needed to address emergent pathogens?

The international arrivals area at Terminal 5 in Heathrow Airport, London, UK as travel restrictions were imposed following the discovery of the Omicron variant of COVID-19. Photo by Leon Neal/Getty Images.
The international arrivals area at Terminal 5 in Heathrow Airport, London, UK as travel restrictions were imposed following the discovery of the Omicron variant of COVID-19. Photo by Leon Neal/Getty Images.

It is important to understand the emergence of the new COVID-19 variant Omicron with all its myriad mutations – on this occasion first detected in South Africa – is not unexpected.

What it highlights are the continuing and fundamental risks to everyone associated with not seriously addressing the governance, structural, technological, and socioeconomic inequalities still at play globally in the fight against disease and poor health.

Mutations such as those present in this latest variant will continue to surface, as in all likelihood will other infectious viruses with pandemic potential.

The Omicron variant – rapidly detected thanks to South Africa’s relatively advanced genomic sequencing capability and willingness to engage with international partners and collaborating agencies – has resulted in a series of travel bans restricting South Africa’s citizens and impediments to international trade.

Race for market share and profit

For drug and vaccine manufacturers, largely based in high income countries, it represents the firing of a start-gun in the next race for market share and profit as they test whether currently-licensed IP-protected vaccines will be effective or whether a new or modified vaccine is necessary.

In effect, this means a low/middle-income nation – along with the continent it sits in – is economically penalized, socially ostracized, and socio-politically stigmatized for demonstrating global solidarity and doing the right thing through timely reporting and sharing of the variant’s genetic data.

Meanwhile a small group of hugely wealthy pharmaceutical companies finds new opportunities to generate exorbitant profits as fear starts to once again grip politicians, policymakers, and the wider public.

On governance, there should be a global health and intellectual property architecture which is equitable and represents the interests of all nation states, rather than giving outsized influence to a few powerful and wealthy countries which largely focus on the narrow range of pathogens relevant to themselves, and on protecting their own pharmaceutical industries.

On structures and technologies, when a new diagnostic, vaccine, or therapeutic solution emerges, access to it and the relevant technology transfer should be rapidly enabled around the world for the global public good, that development and quality-assured manufacturing capacity is present in every global region, and that sustainable and well-regulated local markets are created to allow both innovation, pricing and prioritization based on local need.

To address the acute needs of the current COVID-19 pandemic, this means persuading – and even compelling – pharmaceutical corporations to immediately suspend intellectual property rights for vaccines, tests, treatments, and other medical tools by agreeing to the proposed waiver of the TRIPS Agreement at the World Trade Organization (WTO).

Many national governments already have existing legislation, such as the Defense Production Act (DPA) in the US, which can be invoked during a state of emergency so companies have to turn over assets and redirect resources to produce strategic goods during times of crisis if they refuse to do so voluntarily. In the past, the mere threat of using these legal instruments has quickly brought big multinationals to the negotiating table to fulfil their social responsibilities.

In terms of the technology transfer needed, this could be managed transparently and equitably through existing mechanisms for sharing COVID-19 know-how such as the World Health Organization (WHO) COVID-19 Technology Access Pool, as well as through national and regional platforms such as the South Africa mRNA Technology Transfer Hub.

Profit guarantees and purchase commitments

For big pharma, the case to protect their IP and income come what may is already on shaky ground given they have received more than $8 billion in public money to develop and bring the diagnostics, vaccines, and therapeutics to market, as well as enjoying guaranteed purchase commitments from numerous governments guaranteeing their profits.

They have also been indemnified against any litigation from claimants pursuing damages in the unlikely event the extensively-tested therapies cause unexpected side-effects or directly lead to adverse health outcomes.

Big pharma has not had to carry any of the significant financial risk but effectively has a carte blanche in charging what it likes for what should be global public goods. Already Pfizer-BioNtech and Moderna – makers of two of the most successful vaccines – are projected to make pre-tax profits of more than $34 billion dollars from vaccine sales in 2021 alone.

Even for the most hard-nosed free-market capitalists, surely there are some limits to what is a reasonable profit ceiling during a global catastrophe?

Movement restrictions – such as international travel bans – do clearly slow and limit the spread of infectious disease and, as has been seen with the current pandemic, they allow countries time and breathing space to prepare medical countermeasures and adapt strategies to control local outbreaks.

To limit negative socioeconomic impacts of these restrictive measures on trade and travel, there should be a sufficiently resourced global regime in place which supports countries reporting new variants through the period of significant financial and social hardships which then ensue.

A disaster or pandemic response fund specifically engineered around wide and far-reaching impacts of trade and travel restrictions – and not one simply limited to addressing outbreak-related health service needs – should be part and parcel of a global pandemic treaty.

Addressing these and other socioeconomic inequalities to fight this pandemic ultimately means creating a well-informed and educated public and political class concerned about universal values, common global public goods, and a shared sense of well-being – rather than the tribal arrangements dominated by self-interest and profit currently on display in most areas of the world.

Dr Osman Dar, Project Director, One Health Project, Global Health Programme.

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