In Pursuit of Development

What went wrong with COVAX, the vast global vaccine program? — Katerini Storeng

Episode Summary

Dan Banik and Katerini Storeng discuss the options available to low-income countries to access COVID-19 vaccines, the role of the WHO and the Gates Foundation and the pros and cons of the Public-Private Partnership (PPP) model in global health.

Episode Notes

Katerini Storeng is an associate professor at the Centre for Development and the Environment at the University of Oslo.  She directs the interdisciplinary Global Health Politics research group and is the Deputy Director of the Independent Panel on Global Governance for Health, an initiative to follow up the Lancet-University of Oslo Commission's agenda on the political determinants of health inequity. 

Dr. Storeng's research advances a critical, ethnographic perspective on the social and political dynamics shaping global health research and policy. She is particularly interested in how global public-private partnerships, scientific communities and civil society coalitions shape and challenge prevailing understandings and approaches to global public health.





Episode Transcription


Banik               Great to have you on the show, Katerini, welcome!


Storeng             Thank you for inviting me, Dan. 


Banik               It's about time you and I spoke because I know you're doing some great work in terms of vaccines, vaccine access, global governance, and what I think is particularly interesting for us to discuss today is the fact that while most of us living in richer parts of the world have already received two doses of the Covid-vaccines, our governments are now talking about perhaps giving us a third dose. While all of this is happening, hundreds of millions of people in many parts of the world, particularly in sub-Saharan Africa are yet to receive their first shot. There's been considerable attention in academic and policy circles on this vaccine inequity and I know you've published a lot of articles and op-ed pieces of late, you've been trying to understand why the distribution has not been as successful as it should have. Let me begin by asking, what can developing countries in Africa and elsewhere do to access vaccines quickly? 


Storeng            At the moment they have very limited ability to access doses quicker than the wealthy countries enable them to because they have been beholden to a situation where access to vaccines is monopolized by the world's wealthiest countries. As I'm sure you know, we have a situation where this was a crisis that is often called vaccine apartheid, that was in large part anticipated when the pandemic started, we knew from previous crises that there would be a scramble for the protective equipment, and also the vaccines that we hoped would be developed, and there were measures put in place to try to attenuate the risk of an unproductive nationalistic race for access to vaccines, and that has not succeeded. We are in a situation now where more than 18 months into the pandemic we have a gross inequality between rich and poor countries and access to vaccine supply that is primarily monopolized by rich countries. 


Banik               Are you saying that African countries have very little flexibility, room for manoeuvre to change things? 


Storeng            The idea was that countries should collaborate to ensure that the most vulnerable people across the globe were vaccinated simultaneously, so that the most vulnerable people who had comorbidity and health workers everywhere should get access at the same time. That was the idea of the so-called COVAX initiative and so many African countries were promised at that time that they would be able to access enough vaccines to at least vaccinate 20 percent of their population within 2021. Many African countries were in a position where they could not go into bilateral negotiations with the most promising vaccine manufacturers, and so were dependent on this pool procurement. In parallel, the African Union has also procured vaccines, but not of a volume that is sufficient and that helps to explain the situation we're in today, which is that most of the pharmaceutical companies have prioritized supply to rich countries, while poor countries are left waiting for what we now call vaccine donations. 


Banik               Let's go back to June last year, when COVAX, this Covid-19 vaccines global access initiative was established, and apparently there was a lot of emphasis on how COVAX was the only global solution to ensure some sort of equitable access, the only way to end the pandemic was through COVAX. It positioned itself as being extremely important, and this COVAX initiative was built on a public-private partnership, PPP model, but unlike some of the PPP models and partnerships that one has seen in the global health arena before, this according to you and your colleagues was some sort of a super PPP. The question here is, despite all of these lofty ambitions of being the only global solution, and many would say there were many well-intended efforts, people were all struggling and looking for solutions, politicians were figuring out a way to save themselves and save others, all of these lofty ambitions, all of this money, COVAX has really not delivered, has it? And so, the question is, how would you tell the listeners, how would you explain this failure on the part of COVAX? 


Storeng            I think it's important to remember that COVAX was in many ways a good idea, the intention at least was that the world's countries would come together and share the risks involved in developing new vaccines and scaling up their manufactures and that it would provide a pooled procurement mechanism that would enable everyone to secure access to at least part of their population at a reasonable cost. The idea was very much one of global solidarity, at least that was the rhetoric, that we would share these risks, but this was very complicated and COVAX was built on the model of a public-private partnership. We have seen in the history of efforts to address global health challenges, the PPP being the governance model that has become dominant over the past 20 years, and essentially this means that beyond states and nation-states cooperating with each other to solve a global challenges, the PPP model assumes that actors from the private sector, including corporations but also NGOs, civil society and academics, should work together to solve the challenge. A good example of this is the Gavi Alliance, which was set up in 2000 to ensure access to childhood immunization in low-income countries, or the Global Fund to Fight AIDS, Tuberculosis and Malaria, and what really sets this governance model apart from the sort of international cooperation that we knew from before, is that it's not just a cooperation between nation-states, but also brings into the decision-making structure, the board, these private sector actors. This imbues this model with a particular set of characteristics, often a focus on technical solutions and emphasis on measurable results, and sort of a business ethos that permeates the modus around these initiatives. When COVAX was established at the beginning of the pandemic, it was based on this model, but took it, we've argued, to a new level. We're saying that COVAX exemplifies what might be called a super PPP for global health. The reason we say that is that it aims to coordinate what's become a fragmented global health field, by bringing together existing PPPs in what is an extraordinarily complex model. We call it a Russian doll like structure, because it brings together Gavi, CEPI, which is the Coalition for Epidemic Preparedness Initiative, and other actors together and tries to make them collaborate with other existing PPPs in this bigger super structure. It attempts to scale up a governance model that was designed for donor-dependent countries, as I said, Gavi was established to provide access to childhood vaccines for low-income countries, but it tries to scale this up to the entire world. What happens there is a lot of tensions around the interests of the different partners because we're not talking about development aid, we're talking about pitting this against self-interest of the wealthiest government partners in these initiatives as well. 


Banik               Let's pursue this further, because I am not somebody who's worked on global health, but I have this impression, correct me if I'm wrong, that Gavi and the Global Fund have been relatively successful. They are seen to be models of how PPPs can work in global health and how you can get the private sector involved, how you could get the Gates Foundation and philanthropic organizations involved, you could build on the experience of the global development community, so there was this model, these two examples you mentioned, Gavi and Global Fund, were seen to be the way forward, but I also see, and I understand that not everyone was happy, and the legitimacy of these PPPs has been contested, right? Because of what kind of motives the private sector has, not least in the literature quite a lot of dissatisfaction in terms of decision-making within these bodies, and so I'm trying to identify that there may be certain problems that these existing PPPs had that have somehow been transferred to the COVAX initiative. The fact that low and middle income countries were not involved perhaps, civil society not consulted, that's one set of issues. The other matter of how maybe the WHO may have been impacted by all of these PPPs that are getting generously funded and member states on the other hand are maybe being stingy to fund the WHO. Could you reflect a bit on two issues? One is how have Gavi and the Global Fund and other PPPs faired in the global health field? Secondly, what has been the impact of the success of these PPPs on the WHO?


Storeng            You mentioned many of the issues already but I think it's important to historicize this a little. It's not like there was a strict divide between the state and non-state actors before PPPs were established, we already have a long history of philanthropic private foundations and non-governmental organizations and businesses playing important roles in the implementation of international health programs. But at the end of the 1990s, this really changed in a radical way when non-state actors became much more powerful and their influence became formalized through the establishment of these global health PPPs. And this was a shift that was driven by this systemic underfunding of the multilateral health institutions, like the WHO, but also by the rise of ideologies of new private management, etc. and really the rise of the PPP model in global health, at least, cannot be distinguished from the rise of the Bill and Melinda Gates Foundation, which was a co-founder of these biggest PPPs, Gavi and Global Fund, and really helped to establish this as a model. Because of the Gates Foundation's enormous wealth, it also gained a prominent position within the governance structures of these organizations and helped to bring about a cultural shift really, where business logics and a focus on technology became really prominent, right? So you'll see that all the major PPPs that have been established focus on specific health technologies, so Gavi focuses on vaccines and the Global Fund focuses on anti-retroviral or anti-malarias and we have newer initiatives like CEPI which focuses on vaccine developments to stop future epidemics. As you mentioned, these have been considered hugely successful in many respects. It's indisputable that they have helped to raise attention to neglected health issues. HIV/AIDS, the Global Fund has done an enormous amount to raise political attention to that, the issue of childhood vaccination in poor countries likewise, right? And they have been successful in terms of achieving their own predefined measurable outcomes, right? So they often claim that the number of vaccines they deliver or number of bed nets they distribute to prevent malaria, translate into numbers of lives saved. They have this emphasis on goal-achievement, which is in many ways positive but the flipside has been that the promotion of these very disease-specific technology-focused initiatives have made it difficult to simultaneously focus on the broader health system development that is needed to sustain these vertical health programs. In many ways we are seeing the consequence of that in Covid where many of the poor countries that have benefitted from support from these PPPs still find themselves unable to deliver basic health services and find their health systems buckling. You can say, well it's not the responsibility of the PPPs to strengthen the health system, but the way in which donor resources and government resources have been channelled into these PPPs has happened at the expense of funding for health infrastructures and at the expense of funding for the WHO. I also want to pick up on this issue that you raised about governance and representation because it's important to remember that global governance is challenging because we don't have a world government. The WHO is the specialised health agency of the UN and it's a member state organization that is governed by a world health assembly where all member states have representation. Now in the PPP model there is no democratic governance structure. There is a board with representatives from different constituencies that do not answer to any electorate and this has raised issues like: who should set the agenda? Who should be deciding? That depends on the composition of these boards. Although there have been changes over time, the analyses that we've done of the composition of the boards of the 18 largest PPPs for global health, show that they are dominated by wealthy governments, private sector representatives and that low income governments that are the recipients of the funding have little representation relative to the donors. Civil society has hardly any say. 


Banik               Don't you think that some of these problems are very similar to the debates on aid? You have donors controlling the funds, they decide and there may be some symbolic representation from NGOs or maybe some consultation with recipient country governments, but in the end these relationships are characterised by some kind of power asymmetry where the funder, provider, aid giver, is the one calling all the shots. What you describe here appears to be very similar to this overarching critique against aid that we've been aware of. I want to pursue the case of the Gates Foundation model, the Gates approach that you mentioned. Let's discuss first what has worked. Looking at it from a global development perspective, pre-Covid, I had a very positive perception of all the money that was flowing in, in the absence of public funds, you had the Gates Foundation and others pouring in money, in terms of malaria and HIV, what in your view has helped, apart from large doses of money? 


Storeng            It's indisputable that these organisations have helped in terms of providing access to millions of people to anti-retroviral and vaccines that they wouldn't otherwise have access to. I don't think that's really the question and I think in those terms they have been very attractive to donors because they provide demonstrable value for money. You can see that your aid money is translating into positive health outcomes. That is very good and it has brought people together in trying to find innovative solutions to health issues, attention to childhood vaccination, etc. In terms of those narrowly defined parameters of success, that's fantastic. The problem is that when the world starts to be run as a collection of different PPPs with partially overlapping mandates but that compete with each other, what you face is an enormous fragmentation of the governance field that translates into an enormous fragmentation at the level of health systems. There is substantial literature that documents the really burden it can be for a Ministry of Health or district health officer to cope with the generosity of these PPPs, each with their own sets of requirements for output measures and for reporting and contracts and grant applications, to the point where it has for many, especially low resource countries, become difficult to develop coherent national public health plans and pursue broader aims like public financing, sustainable health workforce etc. You have to see these on their own terms, Gates can claim their funding produces results, but in a broader context there are these externalities that need to be considered part of the solution. One of the interesting things in the context of Covid is, the problems you describe in the PPP model are just generic to aid, yes perhaps and most aid funding to health goes to these PPPs so this is obvious, but what's happened here is this attempt to scale up this model to a problem that affects everyone and to a resource that everyone needs. So, it's not just about channelling aid money in the most effective way possible, it's also how do we ensure everybody has access to these scarce commodities. 


Banik               I've had several guests discussing how aid is measured, this obsession with aid effectiveness, agenda for making aid more effective, measuring, documenting results, and in that process many things get lost in translation. You mentioned how the Gates Foundation by funding all these other initiatives, parallel to what country governments are doing, these could have very negative impacts on country health systems. I know from Malawi, it's not in a position to say no to money, if somebody offers money you say yes, but you get sucked into all of these routines of reporting, running around satisfying the donor rather than doing what you want to do, which is to build something more robust. How should we approach this, Katerini? Certain technical targeted solutions, Gates approach to global health, at the same time strengthening of national health systems may be undermined - how can we have a bit of both? Is that possible or is it an either or situation? 


Storeng            It's not either/or. Even before the PPPs were established focused on specific diseases and technologies, you had a combination of what we call vertical and horizontal initiatives. Some vertical focused on one issue, like polio or smallpox, and others horizontal, meaning cutting across the whole health system like workforce. What's interesting in Covid is that we haven't talked yet about ACT, which is the umbrella structure under which COVAX exists. This was the effort to create the Access to Covid-19 Tools Accelerator, made of pillars including vaccines (COVAX), also diagnostics and therapeutics and across health systems connectors. This model was based on this recognition that you can focus on specific technologies but also need to strengthen the systemic ability to implement. Again and again we see the challenge of realising this is practice because at the global level now, within this ACT, what has become clear is that vaccines get most of the funding, diagnostics and therapeutics some, and health systems almost none. Why? Because it's much more difficult to mobilise donor resources focused on something that's less tangible, not purchasing a commodity, doesn't have the same ability to tie inputs to outputs. I think it's difficult to get the balance. One way is to increase the power of the WHO both centrally and regional and national level relative to the PPPs, so you have more ability to do more cross-cutting work, because one of the problematic things with this shift in power from WHO to PPPs is that even the WHO is in many ways run as a series of PPPs. The WHO is a partner in all these initiatives, and its core budget for doing its basic, normative, guidance development work and support to member states on health systems development has been weakened. There are discussions that increasing the assessed contributions that member states make to the organisation to improve its core budget, will enhance its ability to provide that support to national ministries of health. That's one concrete way the balance can be shifted. We definitely need both, but we cannot accept, there is a rhetoric in the PPPs that they create positive synergies for health systems, we can't take that at face value because there is a lot of evidence to suggest that's not the case. 


Banik               The reputation of the WHO varies depending on where you live. In Europe, we have a tendency of seeing it in positive terms, the US especially during the Trump administration, a lot of people doubting the extent to which the WHO has the capacity to undertake radical change and there were concerns about political interference or the fact that it couldn't really stand up to powerful actors, like China, and so there was this concern in many Western capitals that the WHO was not an agency you could trust to be critical and hold to account those responsible for the Covid crisis. How do you square this with the suggestion you had to strengthen the WHO? Do you see that happening? Countries placing faith in the WHO or do you think there would be a tendency to look for different solutions? I know President Biden at the UNGA seemed to indicate that we should be doing something, but there was a feeling that he was talking about a parallel structure, and there were others saying why not put more money in the WHO? I see from the American perspective this hesitancy to further strengthen the WHO and there may well be suggestions to come up with alternative arrangements. How do you see that scenario in the near future? 


Storeng            You're right that the WHO's authority and competency has been cast into doubt repeatedly during public health crises, esp. at the start of the pandemic. But there's also a discussion on the extent to which that criticism or how we can contextualise it because the WHO is only as strong as its member states allow it to be, right? So, in the face of persistent underfunding and everybody going for parallel initiatives, it's difficult to see how it could have the strength to stand up to its powerful members states or external funders like the Gates Foundation, which is the second largest donor of the WHO. 


Banik               They stepped in when the US withdrew its support. 


Storeng            Exactly. It's a very complicated question you asked, it's the bigger question: do we need the UN? How do we govern the world? I do think it's important to recognise that it is the only normative agency we have for world health and without it we would be at a loss. It's been interesting to see the way in which it is often side-lined as part of the institutional response, even within ACT and COVAX, what is the role of the WHO? Sometimes cast as leading it, but that's not the case. What role does it actually play? It's not clear. The role we have seen the WHO play has been a moral compass to the rest of the world, with the Director General being very vocal proponent for vaccine equity, and really speaking out strongly against wealthy countries' lack of solidarity and unfulfilled promises, whether on financing of the joint pandemic response or empty promises about sharing excess vaccine doses. That has been incredibly important. Whether nation states will allow it to grow stronger is unclear, some signs of member states willing to increase their contributions, at the same time we see the establishment of lots of initiatives outside or on the periphery or slightly incorporating the WHO and lots of parallel initiatives on pandemic financing, these are very complicated debates. I do think it's important to be cognizant of the different governance models that exist in an organization where the member states are theoretically accountable to electorates and all these other forms of PPPs where they are not. And also the way in which these overlap. 


Banik               I was speaking with Gro Harlem Brundtland, former director of WHO, she made an important point similar to you, we can criticize these organisations but they're only as powerful as their member states allow them to be, and Gro was telling me that during her time, she was much freer to criticize member states than now, because of certain institutional constraints that member states have placed in the office of the DG, you have to consult and get everything sanitised. She was saying that it's a bit unfair to criticize the DG of the WHO now for being afraid to criticize member countries because that is a system that member countries have put together. Going back to COVAX and this wider issue of why it failed to deliver: one thing that has puzzled me is the fact that some of the agreements that COVAX entered into with private pharmaceutical companies, they appeared to be very opaque, no transparency really on the terms, my impression is you have rich countries doing their best to secure vaccines for their populations, at the same time being a moral compass, saying we should help low income countries, so there were all of these concerns, and then this PPP model, the previous history shows that you can have private sector and others working together in harmony, but the impression many of us are stuck with is that it's the pharmaceuticals that have benefitted. They've made money, laughing all the way to the bank and the problem still remains unresolved. 


Storeng            Absolutely and one of the things we are trying to elaborate in research is the way in which the governance model of COVAX as a super PPP has enabled this situation. You have an initiative that is based on this assumption that voluntary partnership between public authorities and private sector is the way to go and that principles for good conduct and best practice will be enough to ensure that this aim of equitable access is achieved. Very quickly it became clear that - part of the thing that sets COVAX apart from previous PPPs that have been more successful at lowering prices to drugs and vaccines for poor countries, is that wealthy donors also want the same product, and they were not willing to share from the start. We have seen that the same countries that have funded COVAX are the same countries that have monopolized the supply of vaccines by entering into these opaque agreements to get prioritized access. We have a situation that is very complicated, people will say national governments need to prioritize their own population but we are living in a pandemic and this is complicated. I think there was an assumption that the pharma companies would play more of a heroic role maybe, be a better partner, maybe say they had an ethical responsibility to deliver a life-saving product and step aside from the usual practices of our business, that definitely hasn't happened, even though Pfizer claiming equity is its north star and all the chief executives claiming their business practices are consistent with the right to health and equity. We have seen a situation where they have profited like never before, but they have also done a lot to impede equitable distribution. So, they have consistently prioritized deliveries to wealthy countries, bilateral deals with wealthy countries over deals with COVAX, you know the vaccines we've benefitted from in Norway, the Guardian published today based on a report from Amnesty on how less than 1% of the almost 6 billion Covid vaccines administered worldwide have gone to low income countries and that companies like Pfizer has delivered 9 times more vaccines to Sweden than to all low income countries combined. Moderna, which we rely on here in Norway, has not yet delivered a single vaccine dose to low income countries and it hasn't delivered on its promise to supply COVAX. A lot of criticism can be made of all the parties here, but part of the problem is that we've relied on a model that assumes that voluntary partnership, both in terms of providing reasonable prices and providing reasonable distribution of delivery, but also sharing technology to allow upscale of production, we've assumed, or the PPP model assumes that voluntary partnership is the best way of ensuring that happens. A year and a half later, in my opinion, the pharmaceutical industry partners have not delivered on the promise of partnership here. They have benefitted enormously from public sector investment to enable them to develop the vaccines and scale up production and purchase them to profit from them, but they have not done nearly enough to facilitate their equitable distribution. 


Banik               This follows a general trend we have seen in global development where many governments in richer parts of the world have tried to actively engage with the private sector. They've tried to get businesses to be involved in aid and investment efforts around the world, and the model that has been pursued is that the private sector is going to take a huge risk in some of these countries, they haven't really done business there before, and the public sector, government funding, should cushion some of the risks that some of these private sector entities will incur in these operations. It seems like the stage was set for this kind of cushioning and making sure the private sector for all the innovation it does and all the risks its taking, they should be protected. But, as I see it, in that process, because of this financialization of the pandemic response, lack of transparency, the legitimacy of an initiative like COVAX has been affected because the common man, or at least academics, civil society actors, many people are now wondering to what extent corporate interests have been accommodated. Are we helping these pharmaceutical giants to increase their profit margins as long as they keep us safe it's fine, we look the other way, so we're getting to this point where it seems like what started as a very well intentioned effort is just not enough so the question is, if we are to think about the near future, our ability to fight future problems, to seek future cures, I see this being repeated, sorry to be pessimistic but I don't see any way out as to how the private sector can be somehow expected to play this more noble, moral role. Do you see that happening?


Storeng            I think there are interesting discussions going on about it, because as you say, we're in a crisis, we're dependent on private sector innovation and expertise in this context. So the public sector stepped in, in an unprecedented way, and offset the risk for the pharmaceutical companies, both by providing grants and also by entering into so-called risk-based pre-purchase agreements where you basically guarantee a market for the vaccine or diagnostic before it's even been developed. So, the public sector does this. What was a missed opportunity in these negotiations or agreements was to not put any strong conditions on what was expected in return for that public investment. It's been very interesting to see that the CEO of CEPI, the vaccine alliance, has admitted it was a missed opportunity that those who funded vaccine development didn't put access provisions for example in the contracts. So, there is a lot of scope for improving the partnership between the pubic and the private sector even in a crisis. I think we've seen that, assuming that voluntary principles for good practice are enough hasn't happened, so we do need a situation where the public sector also puts bigger demands on the private sector after investing in innovation. You mentioned the issue of legitimacy, that the situation has damaged the legitimacy of initiatives like COVAX. Yes, to some extent, but on the other hand there is such a strong rhetoric of success and so much branding around it that I don't think what you refer to as the common man has any awareness of these dynamics. There is very little scrutiny in the public of the limitations and failures of this model. And for the most part we talk about in quite a self-congratulatory tone about the money that has been given, the doses that have been donated, the efforts that have been made to achieve global cooperation, and part of the reason that we don't have a lot of public debate about the shortcomings of this mechanism has to do with the governance model itself. It is incredibly opaque. COVAX doesn't have a board, there is no leader, and it’s governed by the boards of the other PPPs that it brings together in this global collaboration framework. We've tried to map who's who here and it's almost impossible to find out. It's a governance mechanism that's so complex that it's impossible to easily analyse its budgets or decision-making structures or who's in charge even. This contributes to the mystification of an initiative that, when combined with a very strong marketing that goes into publicizing it's successes, makes it very difficult to have a public debate about it. 


Banik               You're right that maybe the common man hasn't really bothered so much about criticizing COVAX etc. but there's one area, one issue that did attract attention, I know in some parts of the world, notably in South Africa and India, had to do with the patent waivers. There was this feeling that some of us have manufacturing capacity, just wave these rights, we've suggested doing this, and all the rich countries turned them down. Including, surprisingly, I was very disappointed that Norway did not support this either. Whatever happened to this open licensing that Oxford University promised with the AstraZeneca vaccine? What happened? We talk about open access publications in research, what about open licensing in terms of global health?


Storeng            Thanks for raising that, and I have to specify that when I talked about the common man as not so aware of this, I was talking about here in Norway where we're speaking from. It's true that in those parts of the world that are still lacking access to vaccines, not that I've travelled since this started, but there has been an enormous amount of anger and disappointment and criticism around these initiatives, and a feeling of betrayal as well I think. The patent waiver issue, I think, very soon after the vaccine became developed, it became clear that - it was AstraZeneca early on that had, or the Oxford vaccine had been promised as an open, global public good basically. But then they went into an agreement with AstraZeneca that granted it exclusive rights to it. And we see with all of the big pharmaceutical companies, there has been very little willingness to share the recipes or patents or knowledge about how to produce the vaccines, which has made it difficult to upscale production and overcome supply challenges. South Africa and India took the initiative to propose a temporary waiver, not just for vaccines but also for therapeutics and diagnostics, in the TRIPS council, the intellectual property council of the WTO, this was a year ago. Since then it's been a huge international debate with most of the low income countries supporting it and most of the rich countries opposing it. This all took an interesting turn in May when Joe Biden suddenly announced that the US would support a temporary waiver on patents for vaccines specifically, so a narrow patent waiver. This sparked a lot of discussion about whether the EU would follow, but so far that hasn't happened. You mentioned Norway, Norway is not chair of the TRIPS council where this is being debated in the WTO. And even on the radio this morning, our Minister of International Development said that Norway has not blocked the TRIPS waiver proposal but haven't supported it either, and in several cases the ruling parties (the now outgoing ruling parties) have voted against proposals from the opposition parties to support this waiver explicitly. They keep talking about the WTO is consensus based, talking about working towards consensus, but it's basically at an impasse. What's happened, we don't know what's going to happen. There have been very many Nobel Prize winners and prominent people supporting this call for patent waivers saying it is the only right thing to do, to increase low income countries' capacity to produce vaccines. The pharma industry has consistently said that patents are not the problem, that this is about raw materials and complicated procedures and lacking capacity in low-income countries, so it is a debate that encapsulates all the power dynamics we've spoken about. Regardless of what happens, it's going to take time to negotiate a consensus, if it happens at all. In the interim, we're in a situation where what's been proposed as a stop gap measure is the sharing of the excess vaccines that rich countries bought through pre-purchase agreements. That's where we're at now, where the WHO has been arguing that we need a change to the patent system to enable upscale of production, but also that rich countries need to share doses with low income countries immediately for the benefit of everyone. The pandemic will only end when you achieve higher vaccination coverage everywhere. 


Banik               I was reading June 2021 report of the G20 High Level Independent Panel, I'm always sceptical when there's a high level of something, but High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response. Of course, the major message in the report was that we need more decisive political commitment, timely follow-through, and then it identified four major gaps in pandemic prevention preparedness and response. 1. Globally networked surveillance and research need to prevent and detect emerging infectious diseases. 2. The need to strengthen the resilience of national health systems. 3. Importance of ensuring steady supply of medical countermeasures and tools, all of this aimed at shortening the response time to a pandemic, and making sure there is equitable access to remedies, and finally, 4. The global governance aspect, one really needs tightly coordinated, properly funded and clear accountability for outcomes. All of this requires a major increase in finance etc. Let's assume that we do get the money, countries are being generous, foundations putting in the money, do you think these suggestions of plugging these gaps, are they realistic? What are your thoughts on this? 


Storeng            That's a tough question but I think we do see all these initiatives coming together to define how we're going to avoid the next crisis while we're still in the midst of the current one. This High Level Independent Panel that you're talking about, it's a PPP in itself that brings together people from different spheres of society, including the private sector and foundations to try to define the future solutions. Is providing the infrastructures for preventing and detecting disease and strengthening the resilience of health systems and increasing steady supply of medical countermeasures, these are like the bread and butter of functioning health systems and welfare states, right? And so, I don't know, I am a little sceptical of all these initiatives that are focused so narrowly on pandemic preparedness and financing, because I think they sometimes are articulated as if this is something that we do as separate from the rest. If you look at the countries that have fared well in the pandemic, including Norway, there are many reasons for that, but one of them is wealth of course, in our case, and we've been able to access vaccines, but we've also been able to organize our society in a way that people were able to take time off work when they were sick, that we were able to survive a lockdown economically because people were on furlough rather than unemployed. 


Banik               And we trust the government. 


Storeng            We trust the government to do the right things. These are intangible things that you can't put in a bullet point list of actions. But I think we need to have much more broad discussions about how we want to organize our societies and how do we deal with the inequality that has been revealed by this crisis. I think somebody wrote, a think I read yesterday, about how African countries are going to trust that the wealthy countries are going to collaborate with them in dealing with the climate crisis, on the back of what we've seen now. Really, what the pandemic has shown is that - it's a complete paradox that we're facing this crisis that everyone says "no one is safe until everyone is safe" but the reality is that almost all of the countries with the means to do so have turned inwards, treated this as if it were a national epidemic, have dealt with the problems inside their own boarders very much in isolation from what is outside, so that you end up with a set of policy responses that are in many ways incoherent. We aim to achieve full vaccination in Norway at the same time as we know on an intellectual level that this is not the quickest way to end the pandemic and this "no one is safe until everyone is safe" which is at the basis of these high level panels, is increasingly sounding very hollow and untrue. Because the reality is that we are almost safe now here. At the same time, the pandemic is at a critical stage in many other parts of the world where the future looks incredibly uncertain. We're going to see the consequences of the vaccine apartheid not just in terms of health outcomes, but also economic outcomes, migration and civil unrest etc. for many years to come. So, the pandemic really just shines a light on all these other issues of inequality and economic development that helped to create the crisis in the first place. So, I don't know if these high level panels are really going to solve that. 


Banik               Katerini, it was great fun chatting with you today. Thanks so much for coming on my show. 


Storeng            Thank you very much for having me. 


Theme music 


Banik               If you enjoyed this podcast, please spread the news among your friends and share it on social media. The Twitter handle for this podcast is @GlobalDevPod. 


Thank you for listening to In Pursuit of Development with Professor Dan Banik from the University of Oslo’s Centre for Development and the Environment. Please email your questions, comments and suggestions to