The elephant in the room at the WHO Executive Board

The World Health Organization (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus spoke harshly about the lack of Covid-19 vaccines in developing countries at the opening of the organisation’s 148th executive board meeting earlier this week. He said the world is on the brink of a “catastrophic moral failure” because of unequal Covid-19 vaccine distribution. “More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25.”, he explained.

But he left the elephant in the room unmentioned: most pharmaceutical companies refuse to share the know-how and technology needed to produce vaccines on a large scale. It should hardly come as a surprise that rich countries are buying up Covid-19 vaccines and developing countries are left behind. We have seen this also happen when lifesaving HIV medicines became available to address the AIDS pandemic. While people with HIV in rich countries gained access to life-saving antiretroviral medicines, 8000 people a day died of AIDS in the developing world without treatment.

To prevent a repetition of this scenario in the Covid-19 pandemic, WHO set up the Covid-19 Technology Access Pool (C-TAP) eight months ago. This Pool should have ensured that the intellectual property, knowledge and know-how needed to produce vaccines on a large scale is shared, thereby increasing global production capacity including in developing countries. Not only can such pooling and collaboration prevent shortages of Covid-19 vaccines, but also contributes to better preparedness and increased production capacity for the future. Despite the fine words of European leaders who, just under a year ago, promised that no one could “own the vaccine,” the WHO Covid-19 Technology Access Pool is empty. 41 countries officially support C-TAP in words but few with action. This failure cannot be bought off with donations to the COVAX facility. COVAX after all, also needs the success of C-TAP to be able to buy affordable vaccines on a large scale.

OXFAM, on behalf of the People’s Vaccine Initiative, and Health Action International have written a letter to the WHO Director-General to ask for a more forceful approach on C-TAP by the organisation. Specifically, they recommend the WHO:

Provide clarification of the strategy for C-TAP, who is providing political leadership, and who is providing the necessary technical leadership with regards to practical issues for the transfer of know-how and technology for manufacturing;

• A commitment to bi-weekly public briefings to report on the progress of CTAP;

• The publication of clear guidelines and model agreements that C-TAP is seeking regarding the sharing of rights in inventions, data, biologic resources and know-how, including specifically the components of full technology transfer that C-TAP is seeking for each relevant technology;

• Require licensees to commit to obtaining WHO prequalification and regulatory authorizations and to the equitable pricing and distribution of products;

• Commit to full transparency of all technology transfer agreements with rights holders and with licensees;

• Publish a report on global manufacturing capacity for each relevant COVID-19 medical technology, including each type of COVID-19 vaccine, with commentary of the measures necessary to bring a facility into GMP compliance for production for specific vaccines and other COVID-19 health technologies;

• Publish current financial support for C-TAP and required funding for the pool to operate speedily and effectively.

The letter will reach the WHO when the Executive Board is still in session and Dr Anthony Fauci is taking the lead of the US delegation to the WHO. Dr Fauci recently endorsed the C-TAP and answered ‘Yes, yes, and yes’ when asked whether the National Institutes of Health (NIH) should join C-TAP. Considering the role the NIH plays in the development of new Covid-19 vaccines and therapeutics his response is very significant. In 2009 the NIH was also the first licensor to the Medicines Patent Pool, a move endorsed by the Obama White House which called on patent owners from around the world—including governments, companies, universities, non-profits, and individuals— to license their HIV technologies to the Medicines Patent Pool. Dr Fauci’s recent comments beg the questions will the Biden administration do the same and put its weight behind making the Covid-19 Technology Access Pool a success?

Ellen 't Hoen
Ellen 't Hoen
Ellen ‘t Hoen, LLM PhD, is a lawyer and public health advocate with over 30 years of experience working on pharmaceutical and intellectual property policies.


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