Symposium | Building Resilience: Advancing Local R&D and Production of Health Products in the WHO Pandemic Agreement
The Pandemic Treaty – A Role for Local Capacity in Addressing Vaccine Inequity and Lack of Access?
By Nicole D. Foster
Published on 12 November 2024
The Director General of the World Health Organization (WHO), Tedros Ghebreyesus’ August 14 declaration of Mpox as a public health emergency of international concern has reignited debate around the problem of the Global South’s vaccine access during public health emergencies. During the COVID-19 pandemic, the world witnessed distressing levels of vaccine nationalism and inequity with many developed countries securing large amounts of vaccines through pre-purchase agreements, leaving low and middle income countries with little or no vaccine access. As was the case with COVID-19, the main stocks of the Mpox vaccine are located in the developed world, with Denmark’s Bavarian Nordic being one of the few companies globally, with an approved vaccine. This has meant that the Democratic Republic of Congo and neighboring states—the epicenter of the current outbreak—have had to rely primarily on donations of vaccines from development partners, such as the European Union, to protect their people and control the outbreak.
The Draft Pandemic Treaty and ‘Sustainable, Geographically Diversified, Local Production’
While donated vaccines are welcome, they inevitably raise questions about alternative, more predictable, sustainable, and equitable responses to public health emergencies. One such alternative response, which is reflected in Article 10 of the draft pandemic treaty entitled “Sustainable and geographically diversified local production,” aims to improve global production and distribution of vaccines and related medical products through the development of local/regional capacity within the Global South in particular. This would potentially lessen their dependence on global supply chains (currently concentrated primarily in the Global North) and allow for quicker, more resilient responses to pandemics. Accordingly, draft Article 10 requires Parties to take appropriate steps to achieve more equitable geographical distribution and rapidly scale up global production of pandemic-related health products. It also identifies other collaborative measures Parties should take, such as supporting and/or facilitating skills development and capacity-building, promoting and/or incentivizing public and private sector investments, and setting up procurement arrangements (together with the WHO and other relevant international organizations).
Commenting on draft Article 10, Morich et al note that, ‘[w]hile it is not perfect, this is the first time that, to our knowledge, an international, legally-binding instrument seeks to expand local production of health products.’ It is however worth noting that, while the majority of draft Article 10 is highlighted in green (signaling text for which initial agreement was reached between/amongst member states), its final fate remains uncertain as it is inextricably linked to the highly contentious areas of financing, intellectual property, technology transfer, supply chain management, and logistics, the final details of which can significantly affect its full implementation and impact on the ground.
Developments on the Ground
Developing countries have complemented the work on the draft pandemic treaty at the multilateral level, with independent initiatives at the national and regional level to make sustained progress on building local capacity. One such notable initiative is the December 19, 2023, launch of the Health Development Partnership for Africa and the Caribbean (HeDPAC) which seeks to strengthen health cooperation between Africa and the Caribbean and is legally registered as an international not-for-profit organisation in Barbados and Rwanda. The initiative, which is championed by Barbados’ Prime Minister Mia Amor Mottley, President of the Co-operative Republic of Guyana H.E Mohamed Irfaan Ali and President of the Republic of Rwanda, came out of recognition of COVID-19’s ‘indelible scar on our global solidarity’ and its disproportionate burden on developing countries, especially on women and children. Work is well underway on building the necessary infrastructure to support this venture, with the Rwanda Food and Drug Authority having already presented Barbadian authorities with a Biopharma White Book that sets out a strategic roadmap for the development and growth of the pharmaceutical industry.
HeDPAC forms part of a larger vision articulated by these three leaders on November 8, 2022, at the margins of the Conference of the Parties (COP) 27 in Sharm El-Sheikh to build a ‘transatlantic bridge between the Caribbean, Latin American and Africa to develop and manufacture pharmaceuticals for global public health.’ The stated aim of this transatlantic partnership is to develop and manufacture 60% of all essential, contemporary pharmaceuticals for the people of Latin America, the Caribbean, and Africa within their respective continents by 2040. The initial focus of this new initiative will be on next-generation oncological drugs, preventive and therapeutic vaccines, and women’s health modalities.
This vision is in turn aligned with the target set by the African Union and its Partnership for African Vaccine Manufacturing for Africa to manufacture at least 60% of its regular immunization needs within the continent by 2040. Progress was recently made towards this goal with the Global Vaccine Alliance (GAVI) Board on December 8, 2023 to establish the African Vaccine Manufacturing Accelerator (AVMA), a financing mechanism aimed at creating a sustainable vaccine manufacturing industry in Africa that will provide up to US$1 billion in support.
Looking Ahead
The WHO’s Director General rightly noted that ‘[e]xpanding local production [for medicines, diagnostics, vaccines and other tools] and strengthening local regulatory capacity are essential for reducing health inequities between and within countries – not only for the pandemics of tomorrow, but to treat the diseases of today.’ The recent efforts at the international, regional, and national levels to build local capacity are therefore welcome and to be encouraged.
At the same time, it must be emphasized that the establishment of sustainable local manufacturing capacity at the national or regional level is a complex endeavor requiring significant investment, technology transfer, skilled labor, and a strong regulatory framework, all of which have proven to be some of the most contentious issues during the pandemic treaty negotiations and will not be easily achieved. Moreover, the recent experience of Aspen Pharmacare in South Africa during the height of the COVID-19 pandemic offers a cautionary reminder that, over and above the actual ability to produce, local capacity must also involve secure demand and secure domestic or regional procurement arrangements. These challenges notwithstanding, it is hoped that we will continue to see continued commitment by developing countries to realizing this worthwhile goal.
About the author
Nicole Foster is Law Lecturer at The University of the West Indies Cave Hill Campus and founding Head of the Law Faculty’s Law & Health Research Unit. Currently, she is also General Editor of the Caribbean Law Review.