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Reaction to WTO delay on easing intellectual property rules on COVID tests and treatment

Responding to news that the World Trade Organisation (WTO) will push back its deadline to reach a deal on easing intellectual property rules on Covid-19 tests and treatments to support the production of cheaper generic equivalents in developing countries, Max Lawson, Co-Chair of the People’s Vaccine Alliance and Head of Inequality Policy at Oxfam, said:

“We are nearly three years into the Covid-19 pandemic. As many as seventeen million people are estimated to have died in the time that the WTO has bickered over intellectual property rules for tests and treatments. To say that more time is needed to consider the issue is utter nonsense.

“Developing countries and civil society groups had hoped that the WTO had learned from its mistakes; that the cruel injustice of vaccine apartheid would not be repeated. Even the EU has previously said it would support action on tests and treatments. But WTO members have decided to let another year pass without making any meaningful contribution to the fight against Covid-19.

“Each day of delay will push an ever-greater share of the global toll of severe illness, deaths, and economic damage onto developing countries. That should haunt the conscience of the rich country leaders and negotiators responsible for the failure to meet the deadline.”

Notes to editors

 

Just a quarter of Pfizer’s COVID-19 treatment orders will go to developing countries

Some nations could be paying ten times the price of Paxlovid’s generic equivalent, as WHO chief calls for treatment access to battle acute and long COVID-19

Rich countries have secured almost three times as many courses of a World Health Organisation (WHO)-recommended COVID-19 medicine, Pfizer’s Paxlovid, according to new analysis from Oxfam and the People’s Vaccine Alliance.

Using new data from Airfinity, they found that just a quarter of orders for the treatment will go to low- and middle-income countries, despite the fact they make up 84 per cent of the world’s population and have a much greater need as far fewer people are vaccinated against COVID, unlike rich nations which are largely protected.

On the eve of crunch talks at the World Trade Organisation (WTO) over intellectual property rules for COVID-19 treatments and tests, the organisations are warning that we are seeing the same worrying trend of inequity that we saw with COVID vaccines.

Pfizer’s monopoly also means that some middle-income countries could be paying ten times more for Paxlovid than a generic equivalent, with reports of them being quoted as much as US$250 per course. This is despite the fact that other lower-income countries will have access to a Clinton Health Initiative (CHAI) deal with Pfizer and undisclosed generic companies, which means they could access the treatment for just US$25 a course. 

Dr. Catherine Kobutungi, Executive Director of the African Population and Health Research Center said: “When vaccines were our main medical tool to fight COVID-19, big pharmaceutical companies prioritized maximizing their profits by selling doses to the richest countries. Millions died while people in low- and middle-income countries were sent to the back of the vaccine queue. And now, we are witnessing a repetition of the same inequity with COVID-19 treatments and tests.”

“Oral antiviral treatments are easy to administer. They reduce hospitalisation and cut deaths. And they may reduce the likelihood of long COVID. Yet, right now, they’re nearly exclusively accessible to people in the richest countries. The fact is that if you are a vulnerable person with COVID-19 in a high-income country, you will probably have access to treatments that can help you survive. If you live in a lower-income country, you probably won’t. It’s grotesque inequality and it kills”, she added.

The WHO recommends using Paxlovid to cut COVID-19 hospitalisation and death rates, and has called for equitable global access to COVID-19 medicines as part of a strategy to combat long COVID. A recent, non-reviewed study suggests that Paxlovid may lower the risk of patients developing long COVID.

There are hundreds of other potential COVID-19 medicines in the development pipeline, including at least 77 in late-stage clinical trials that could be more effective and have a wider scope of use. However, intellectual property rules are giving a small number of companies a monopoly on supply, allocation, and price, meaning low- and middle-income countries are unlikely to have affordable access to these medicines either.

Because far fewer people in low-income countries are vaccinated than in rich countries, they are more vulnerable to hospitalisation and death from COVID-19. These countries have already experienced the highest death toll in the pandemic, a trend that could continue without access to treatments like Paxlovid.

Jennifer Reid, Senior Health and Vaccine Equity Advisor at Oxfam, said: “After the inequity they faced with the vaccine rollout, developing countries are now experiencing access and affordability issues for COVID treatments. It is a disgrace that those who need them the most are receiving the least and that patent laws are handing Pfizer a long monopoly on this lifesaving medicine. 

“Addressing both acute and long COVID is essential – and the WHO has been clear that countries need treatments like Paxlovid to cut deaths and hospitalisations. But the patents minefield is a massive barrier preventing many developing countries from getting the medicines and tests they need now and in the future to save lives.”

In June, after a year and a half of negotiations, the WTO rejected proposals to waive intellectual property rules for all COVID-19 medical technologies, adopting a far more limited text that only covers vaccines. Ahead of talks taking place tomorrow in Geneva, civil society organizations are urging WTO member states to immediately agree to an extension to include treatments and tests, which would allow developing countries to produce for their own populations and export for others in need, ensuring essential tools are accessible and affordable.

Mohga Kamal Yanni, Policy Co-Lead for the People’s Vaccine Alliance, said: “Decades ago, governments allowed pharmaceutical companies to control the price, allocation, and supply of lifesaving HIV medicines – and millions of people died without affordable access. Now, the same thing is happening again with COVID-19 vaccines and medicines. Companies have been allowed to decide who lives and who dies. WTO member states must ensure that public health takes precedence over commercial interest.”

 

Notes to editors

A new briefing note from the People’s Vaccine Alliance on the case for the extension of the WTO ministerial decision to therapeutics and diagnostics is available here.

Data from Airfinity shows that the richest countries who account for just 16 per cent of the world’s population will receive 74 per cent of all courses ordered of Paxlovid. Low- and middle-income countries who make up 84 per cent of the world’s population will receive just 26 per cent. Despite being first authorised in December 2021, reports suggest that few doses are available to people in low and middle-income countries.

While there is little data available on how many doses of Pfizer’s antiviral treatment have actually been delivered to low and middle-income countries, they have been waiting for months to receive doses through Paxlovid supply agreements from global initiatives like UNICEF and the Global Fund. Pfizer has allegedly insisted that the prices in these agreements remain secret, and the initiatives have not revealed the prices Pfizer charges for courses through their agreements.

Allocation to high-income vs low- and middle-income countries

Proportion of agreed allocation to high-income vs low- and middle-income countries

Source: Airfinity, a life sciences analytics company

 

High-income countries (%)

Low- and middle-income countries (%)

Pfizer: Ritonavir-Boosted Nirmatrelvir (Paxlovid)

31,828,000

 

(74%)

11,221,666

 

(26%)

 

Data note: These figures reflect deals agreed with Pfizer. There are a number of generic manufacturers expected to produce Paxlovid that have signed agreements through the Medicines Patent Pool. However, these agreements are not expected to be producing/exporting finished drug products at scale until early 2023.

According to the World Intellectual Property Organization (WIPO), there are at least 1,465 patents on treatments and 417 on vaccines for COVID-19: https://www.wipo.int/edocs/pubdocs/en/wipo-pub-1075-en-covid-19-related-vaccines-and-therapeutics.pdf

Investigation reveals big pharma’s lobbying against COVID-19 intellectual property waiver

An investigation by Politico and The Bureau for Investigative Journalism has revealed that:

  • Pharmaceutical companies threatened to withdraw investment from countries including Indonesia, Colombia and Belgium if they supported an intellectual property waiver for COVID-19 vaccines, tests, and treatments. Colombian officials in Geneva were told by their government that supporting the waiver might disrupt vaccine negotiations with Pfizer and others.
  • Top pharmaceutical industry executives enjoyed direct access to senior officials within the EU, which was opposed to a waiver, and encouraged potentially rogue member countries, including Italy and France, to fall into line.
  • The German government pressured fellow EU governments to oppose the TRIPS waiver, and when concerns were raised about how the EU waiver opposition looked to the rest of the world, Germany proposed that this could be managed with “smart communication on the topic” that “underlines the proactive role of the EU in providing vaccines globally.”
  • When it became clear to the US business lobby that they could not affect the US position in support of an intellectual property waiver, the industry looked to Europe and the UK, which they saw as more receptive. As negotiations ramped up, the US Chamber of Commerce and US pharmaceutical lobbyists including the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Biotechnology Innovation Organization (BIO) met the European Commission to lobby against the waiver. The UK’s biotech lobby met with George Freeman, a science minister, “to discuss intellectual property and the life sciences sector.”
  • Between January 2020 and September 2022, 13 pharmaceutical lobby groups and companies held nearly 100 meetings with the most senior European Commission officials. In the U.K., there were more than 360 meetings between January 2020 and March 2022 — equivalent to nearly one every two days. Boris Johnson personally attended 11 of them.
  • In the EU during 2021, COVID vaccine and treatment developers including Pfizer and Moderna and the largest pharma lobbying groups, including the EFPIA, spent at least €15 million on lobbying. The year before, the companies spent more than €15.7 million. In 2019, their lobbying costs were €13.9 million, according to data analyzed from LobbyFacts.
  • Major industry players also paid at least 31 private consultancies to lobby the Commission on their behalf. AstraZeneca and Johnson & Johnson each paid around €700,000 in 2021 for consultancies working on topics such as the EU vaccines policy and the bloc’s strategy for COVID-19.

Responding, Max Lawson, Co-Chair of the People’s Vaccine Alliance and Head of Inequality Policy at Oxfam, said:

“These shocking allegations are a testament to the huge unaccountable power of big business in global politics. Pharmaceutical companies were seemingly granted unfettered access to the European Commission and the British and German governments, while countries that supported measures to improve vaccine access faced threats from the industry. When US lobbyists couldn’t influence the US government, they turned to the EU and UK. This is not how life and death decisions should be made.

“Millions died without access to vaccines while pharmaceutical companies gouged extraordinary profits from the pandemic. Rich countries expressed warm words and pledged donations, but to Germany, the UK, Switzerland, and the European Commission, it was apparently just a PR exercise. In the end, global solidarity was snuffed out by the wealthy pharmaceutical lobby, which is not how a healthy democracy should function.

“There is, however, a glimmer of hope amid these revelations. The narrow outcome of TRIPS negotiations set an important precedent, recognising that intellectual property rules are a barrier to accessing medical tools. World Trade Organisation members are now deciding whether to extend the decision to cover tests and treatments. That could ensure that everyone, everywhere has access to lifesaving medical tools that reduce COVID-19 hospitalisations and death. While big pharma will once again use all of its lobbying might to protect its medical monopolies, governments must ensure this time that they put people’s lives before profits.”

New index shows governments worldwide stoked an inequality explosion during COVID-19 pandemic

Half of the poorest countries saw health spendings drop despite the pandemic, while 95 percent of all countries froze or even lowered taxes on rich people and corporates

Rich and poor countries alike have exacerbated an explosion of economic inequality since the outbreak of the pandemic from 2020, reveals new research by Oxfam and Development Finance International (DFI).

The overwhelming majority of governments cut their shares of health, education and social protection spending. At the same time, they refused to raise taxes on excessive profits and soaring wealth.

The 2022 Commitment to Reducing Inequality Index (CRI Index) is the first detailed analysis into the type of inequality busting policies and actions that 161 countries might have pursued during the first two years of the pandemic.

The index shows that despite the worst health crisis in a century, half of low and lower middle-income countries cut their share of health spending of their budgets. Almost half of all countries cut their share going to social protection, while 70 percent cut their share going to education. 

As poverty levels increased to record levels and workers struggled with decades-high prices, two thirds of countries failed to raise their minimum wages in line with economic growth. Despite huge pressure on government finances, 143 of 161 countries froze the tax rates on their richest citizens, and 11 countries even lowered them.

France fell five places in the index after cutting corporate tax rates and eliminating its wealth tax altogether in 2019. Jordan dropped its budget share for health spending by a fifth, despite the pandemic. Nigeria did not update its minimum wage since before the pandemic, and the US has not raised the federal minimum wage since 2009.

“Our index shows that most governments have completely failed to take the steps needed to counter the inequality explosion created by COVID-19. They ripped away public services when people needed them most and instead left billionaires and big corporations off the hook to reap record profits. There is some good news of valiant governments from the Caribbean to Asia bucking this trend, taking strong steps to keep inequality in check,” said Gabriela Bucher, Oxfam International Executive Director.

Strong actions to reduce inequality were taken by both low and middle income countries:

  • Costa Rica put up its top income tax by 10 percent
  • The Occupied Palestinian Territory increased its social spending from 37 to 47 percent of its entire budget.
  • Barbados introduced a comprehensive set of laws to improve women’s labor rights, and the Maldives introduced its first national minimum wage.

As Finance Ministers gather in Washington for the International Monetary Fund (IMF) and World Bank Annual Meetings, developing nations are facing a global economy that is making it ever more difficult to meet the needs of their population. While injecting trillions in their own economies, rich countries failed to increase aid during the pandemic. Economic inequality and poverty in poor countries are further exacerbated by the IMF’s insistence on new austerity measures to reduce debts and budget deficits.,

“The debate has catastrophically shifted from how we deal with the economic fallout of COVID-19 to how we reduce debt through brutal public spending cuts, and pay freezes. With the help of IMF, the world is sleepwalking into measures that will increase inequality further. We need to wake up and learn the lessons; preventing huge increases in inequality is completely practical, and common sense.  Inequality is a policy choice, governments must stop putting the richest first, and ordinary people last”, says Matthew Martin, Director of DFI.

Oxfam and DFI analysis shows that based on IMF data, three quarters of all countries globally are planning further cuts to expenditures over the next five years, totalling $7,8 trillion dollars.

In 2021, lower income countries spent 27.5 percent of their budgets in repaying their debts – twice the amount that they have spent on their education, four times that of health and nearly 12 times that of social protection.

“For every dollar spent on health, developing countries are paying four dollars in debt repayments to rich creditors. Comprehensive debt relief and higher taxes on the rich are essential to allow them to reduce inequality dramatically”, said Martin.

 Despite historical precedent, nearly all countries failed to increase taxation on the richest or pursue windfall profits during the COVID crisis. After the 1918 flu epidemic, the 1930s depression, and World War Two, many rich countries increased taxes on the richest and introduced taxes on corporate windfall profits. They used this revenue to build education, health and social protection systems. Taxation of the wealthiest and windfall profits can generate trillions of dollars in tax revenue.

 “Government leaders in Washington face a choice: build equal economies where everyone pays their fair share or continue to drive up the gap between the rich and the rest, causing huge, unnecessary suffering”, said Bucher.

Notes to editors

  • The 2022 Commitment to Reducing Inequality (CRI) Index is the first detailed analysis looking at governments’ policies and actions to fight inequality during the first two years of the pandemic. It reviews the spending, tax and labour policies and actions of 161 governments during 2020–2022. Its findings show clear lessons for governments now grappling with inflation and the cost-of-living crisis.
  • Co-authors Matthew Martin, Director at Development Finance International, and Max Lawson, Global Policy Lead Inequality for Oxfam, are available for interviews.
  • Dozens of civil society organizations have joined in a campaign to #EndAusterity. In a report they warned for a post-pandemic austerity shock. Oxfam senior policy advisor Nabil Abdo is available for interviews.
  • In the run up to the World Bank Annual Meeting, Oxfam launched its report Unaccountable Accounting on October 3, highlighting the inaccuracy of World bank’s accounting of climate finance. Poor countries may not be getting the crucial climate funding they need to survive. Oxfam’s climate change policy lead, Nafkote Dabi is available for interviews.
  • Oxfam Aotearoa reaction to New Zealand’s ranking can be found here.

World leaders’ UNGA pledge to vaccinate world falls woefully short as only a third of countries meet target

Two-thirds of countries are yet to meet the target of vaccinating 70 percent of people in all countries against COVID-19 set a year ago at the UN General Assembly, according to figures published today by Oxfam and The People’s Vaccine Alliance.

The campaign groups said there had been a massive failure to deliver on the promise despite President Biden persuading world leaders to commit to meeting the World Health Organization target.

They are calling for leaders to radically shift their approach for the current and future pandemics by prioritising sustainable, local manufacturing in all regions of the world to ensure developing countries get equal access to vaccines, tests and treatments. They said the continued approach of leaving Big Pharma in charge of the response has prolonged the pandemic for all of us and continues to cause havoc the world cannot afford.

The death toll from COVID-19 is four times higher in lower-income countries, where less than half (48 percent) the population have had their full initial round of vaccinations. At the current rate, it will take almost two and a half years for 70 percent of people in the poorest countries to be fully vaccinated. Meanwhile rich countries are already beginning to rollout booster programmes and in some cases fifth shots, using the new generation vaccines, the majority of which have been ordered by rich nations.

At the same time, Pfizer/BioNTech and Moderna are continuing to reap huge profits while refusing to work with the WHO to share their vaccine technology, despite it being funded by public money.

Anna Marriott, Oxfam’s Health Policy Manager, said: “This massive failure to meet promises to protect the world from COVID-19 is indefensible. While the end of the pandemic should be in sight, hundreds of millions of people in developing countries are still unprotected from COVID-19. We are calling on President Biden and other world leaders not to turn their backs on them while the virus continues to kill and cause devastation to people’s livelihoods.

“It is time to radically redesign a system that puts pharma profits ahead of people’s lives. Developing countries need access to vaccines, tests and treatments at the same time as rich countries, not years later after people have died. We are seeing the same deadly inequality for COVID-19 treatments and now for monkeypox vaccines, governments must not allow this to continue.”

Lack of vaccination means the need for COVID-19 tests and treatments is even greater in poorer nations but inequality in access is even starker, yet rich nations are at this moment fiercely resisting any attempt to extend the WTO agreement on vaccines to tests and treatments. Reports from the ACT-Accelerator indicated that almost no doses of any outpatient antivirals are available in low- and middle-income countries.

The campaign groups said this persistent gap demonstrates the massive failings in the international response to COVID-19, which continually ignored the need to diversify manufacturing so that developing countries could make their own doses and manage their own supply concurrently with deliveries to rich countries. They are calling for leaders to:

  • Implement an immediate extension of the June 2022 WTO decision on COVID-19 vaccine patents to include tests and treatments – there can be no justification for delay.
  • Support and protect the World Health Organisation led mRNA technology transfer hub, including demanding Moderna withdraw patents in South Africa and ensure the hub has freedom to develop Covid-19 and other life-saving vaccines now and into the future.
  • Deliver a Pandemic Treaty that delivers life-saving vaccines, tests and treatments as global public goods, free of the monopoly control of pharmaceutical corporations.
  • Commit to an unprecedented scale up of financing to strengthen country health systems in low and middle-income countries and global funding support to close the vaccination coverage gaps for low- and middle-income countries that have yet to hit the 70 percent target.
  • Reject Big Pharma led proposals – the so-called Berlin Declaration – which would leave full control of who lives and who dies in their hands.

A recent report found that a combination of unpredictable vaccine supplies, lack of antiviral treatments and poor funding for health systems led to lower vaccination rates in developing countries, and that vaccine hesitancy was being used as an excuse to mask the international failures in the COVID-19 response.

Maaza Seyoum, Global South Convenor of the People’s Vaccine Alliance, said: “Everyone everywhere should have access to the tools needed to fight a pandemic, But COVID-19 has been a case of survival of the richest. For most of this pandemic, big pharmaceutical companies left people in developing countries to die without vaccines and treatments while they sold doses to rich governments in the global north.

“Now, big pharma is trying to rewrite history, claiming that the industry will voluntarily ensure global access to medicines in the next pandemic. We know from COVID-19 that this isn’t true. Governments cannot rely on the good will of pandemic profiteers to do the right thing. We need to overhaul this system to put human life before private profit.”

The People’s Vaccine Alliance, a coalition of over 100 organisations, have distributed posters across New York, host of the UN General Assembly, describing the COVID-19 pandemic as “survival of the richest”.

 

Notes to editors:

A discussion hosted by the People’s Vaccine Alliance and others on ensuring justice, equity and human rights in response to global health threats, will take place on Thursday 22 September at 12.30PM US time at the Yale Club in New York. Media interested in attending can register here: https://docs.google.com/forms/d/e/1FAIpQLScKU8MtTbqFumoM-mntjTzrW8MUPXV9DwYmX3dWruo7M7LP_Q/viewform

A map of locations where photographers can find Survival of the Richest posters is available here. The red “Dedicated Site PVA” marking will be maintained by campaigners throughout UNGA high level week: https://www.google.com/maps/d/viewer?mid=1chRWsUsTHA4BoBXxFPbh5LqtmNeVfFI&usp=sharing

A recent report from Matahari Global Solutions, Treatment Preparedness Coalition and the People’s Vaccine Alliance found that unpredictable vaccine supplies, lack of antiviral treatments and poor funding for health systems led to low vaccination rates and limited the ability to treat patients. https://itpcglobal.org/wp-content/uploads/2022/08/Mapping-Access-Gaps-in-COVID-19.pdf

The International Federation of Pharmaceutical Manufacturers Associations (IFPMA) is pressuring governments to take a greater role to fund, support, de-risk, and provide data for research and development. But they want governments to hand companies a monopoly on the resulting drugs and to waive liability for any adverse impacts. In return, the industry claims it will do better to improve “equity” in the next pandemic, proposing the same voluntary measures that failed during COVID-19 in a lobbying paper dubbed the “Berlin Declaration”.

Data sourced from Our World in Data on 14.9.22

  • A search of the 194 members of the WHO on Our World in Data found that 60 countries have reached the 70 percent target, 129 are below and 5 have not reported any data.
  • The rate of people being fully vaccinated is based on the number of people who were reported as fully vaccinated between 07/06/2022 and 04/09/2022 – 37,253,644 people or 418,580 per day on average. 70 percent of the population of low-income countries, minus those who have already been fully vaccinated is, 368,878,851. Dividing this figure by the daily average rate of vaccination gives 881 days until the target is reached. This figure does include Rwanda who are the only low-income country to have already reached the 70 percent target, but it is not possible to exclude them from the dataset we are using – the difference including them makes to the overall figure is negligible though.

Oxfam reacts to The Lancet COVID-19 Commission’s report

Responding to The Lancet COVID-19 Commission’s report on lessons for future pandemics, Anna Marriott, Health Policy Manager at Oxfam and Policy Co-Lead for the People’s Vaccine Alliance, said:

“The Lancet Commission details the utter failure of rich country leaders and pharmaceutical companies to ensure the tools needed to end this pandemic were accessible to everyone, everywhere. The findings of this commission should shame the international community. Nationalism, racism, profiteering, and an overreaching intellectual property system all prevented lower-income countries from accessing or producing vaccines.

“It is vital that we learn the lessons of this report, end pharma’s deadly monopolies and build more capacity for the development and manufacturing of vaccines, tests and treatments in low and middle-income countries. Governments need to act immediately to extend an agreement made earlier this year on overriding COVID-19 vaccine patents to cover lifesaving treatments and tests. And they must safeguard World Health Organisation backed efforts to produce mRNA vaccine manufacturing on every continent from the threat of litigation from companies like Moderna. The pandemic treaty currently under discussion needs to make clear that saving lives must come before profits and decisions about who lives and who dies are never again outsourced to the CEOs of big pharma.”

 

Notes:

Read the Lancet Commission report here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01585-9/fulltext 

Read more about how Moderna’s patents threaten the WHO-backed South African mRNA hub: https://www.bloomberg.com/news/articles/2022-09-13/groups-ask-ramaphosa-to-protect-mrna-use-against-moderna-patents

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