World Bank support for Covid-19 vaccination does not guarantee equitable access

The World Bank announced in October 2020 that it would make $ 12 billion available to help “developing countries finance the purchase and distribution of COVID-19 vaccines, tests and treatments for their citizens.” The package is part of its support for the $ 160 billion pandemic through June 2021, which goes beyond healthcare, as noted in the World Bank’s June 2020 report. Approach document to the response to the Covid-19 crisis. A World Bank fact sheet noted that the first vaccination programs were approved in January and included Lebanon, Cape Verde, Mongolia and Tajikistan.

While the World Bank’s rapid response to Covid-19 and the $ 12 billion vaccine assistance program have been well received, there are concerns that its impact will be significantly undermined if key gaps in its broader response to the Covid-19 are not corrected. In December 2020, Oxfam to analyse 71 project documents related to the World Bank’s COVID-19 Strategic Preparedness and Response Program, which has a broader mandate than the vaccine initiative and aims to help countries “prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness. The analysis identified the lack of attention to free access to health care as a “fatal flaw,” noting that “only 8 of the World Bank’s 71 COVID-19 health projects include plans to remove barriers financial access to health services …[and] none of the 8 specifies that fee waivers will cover all health services as recommended by the WHO. The report noted that despite a pre-existing global shortage of 17.4 million health workers, “two-thirds of national projects do not include any plans to increase the number of health workers, and that the 25 projects that do so have significant gaps ”. Oxfam called on the Bank to remove user fees from projects, close gaps in support for health workers, and cancel debt repayments on its loans.

Adding to these concerns, Allana Kembabazi of the Uganda-based organization Social and Economic Rights Initiative stressed that “countries like Uganda that have already borrowed to mitigate the pandemic cannot afford more loans. The World Bank, in true solidarity, should only provide grants to support vaccination against COVID and strengthen public health systems, which are the first point of call for the poor. “

Only 8 of the World Bank’s 71 COVID-19 health projects include plans to remove financial barriers to accessing health services …[and] none of the 8 specifies that fee waivers will cover all health services as recommended by the WHOOxfam International

World Bank support part of larger global gaps

World Bank efforts complement COVID-19 Vaccine Global Access (COVAX), which is one of the three pillars of the COVID-19 Tool Access Accelerator (ACT), launched in April 2020 by the World Health Organization (WHO), the European Commission and France in response to the Covid-19 pandemic. COVAX, which is coordinated by WHO, the Coalition for Epidemic Preparedness Innovations (CEPI) and Global Alliance for Vaccines and Immunization (GAVI), acts as a vaccine purchasing mechanism and negotiates agreements with vaccine manufacturers. The mechanism pools the resources of countries and is funded by donations from the richest nations without the need to call on contributions from the world’s poorest. The concerns were outlined in a May 2020 report brief by the Southern and Central East African Health Community (ECSAHC) and the Regional Equity Network in Eastern and Southern Africa (EQUINET) on the initiative, including its limited nature in the time and the potential subordination of WHO’s role by philanthropic organizations more aligned with the interests of the pharmaceutical industry. The program aims to have 2 billion doses of vaccine available by the end of 2021, which is far from reaching the global vaccination rate of 70% deemed necessary by the WHO. According to BBC, COVAX has raised $ 6 billion to date and needs at least an additional $ 2 billion to meet its 2021 target.

As the world passed 2.5 million deaths attributed to the pandemic, UNAIDS Executive Director Winnie Byanyima was blunt in her assessment of the situation in January item for the british newspaper The Guardian, stressing that “nine out of 10 people living in the poorest countries are about to miss a vaccine this year”, and that “the science, know-how and technology of vaccines, largely paid for by more than 100 billions of dollars in taxpayers’ money, can no longer be considered the private property of pharmaceutical companies. »December 2020 item by the press online Interception noted that pharmaceutical company Pfizer is expected to earn $ 19 billion in revenue from the vaccine in 2021 with a profit margin valued between 60 and 80 percent. A February EQUINET brief noted that achieving Africa’s immunization target would cost “between US $ 8 billion and US $ 16 billion, with an additional 20 to 30 percent needed for delivery and administration.”

As of May 2020, more than 140 world leaders and experts sign an open letter calling for a popular vaccine and demanding “the rapid establishment of a global plan for the manufacture and fair distribution of all vaccines, treatments and tests which is fully funded by rich countries and which ensures transparency” at the price real cost “. The call for equitable distribution and sharing of technical know-how has a long history, with the 1974 United Nations General Assembly Declaration on the establishment of a new economic order on the premise that “the benefits of technological progress are not shared equitably by all members of the international community”. He called on developed countries to “promote technology transfer and the creation of indigenous technologies for the benefit of developing countries”.

Bank support fails to remove structural barriers to equitable access

Beyond the specific criticisms of the implementation of the World Bank’s Covid-19 response, at a fundamental level, it fails to address long-standing structural obstacles to equitable access to vaccines: the lack of indigenous production and distribution capacity, linked to decades of deindustrialization and the obstacles posed by the protection of intellectual property rights. As director of the African Centers for Disease Control and Prevention, John Nkengasong, pointed out in a maintenance with the press The Africa report, Africa “still depends on importing more than 99% of its vaccines and therapies”. Policies promulgated by the Bank and the Fund, such as demonstrated by Cambridge University economist Ha-Joon Chang, limited the use by southern countries of the very policies used by industrialized states to develop their capacity to achieve a high degree of concentration in development and production pharmaceuticals, including vaccines (see Observer Winter 2017-2018, Observer Spring 2016). The World Bank’s support for this uneven vaccine production and distribution capacity is evident in its silence on the demand by 100 countries for a waiver of certain aspects of the Agreement on Trade-Related Intellectual Property Rights (TRIPS), in order to increase access to vaccines, drugs and medical technologies necessary to prevent, contain or treat COVID-19, which was once again defeated the 11th of March. The World Bank seems happy to ignore the lessons of the HIV and AIDS epidemic, where the manufacture of generic antiviral drugs in developing countries has been key to enabling dramatic reductions in prices and increased access. As Explain by Benjamin Hunter and Susan Murray in their June 2019 article in an academic journal Development and change, the World Bank, rather than contributing to robust public health systems and the expansion of local production and distribution capacity, has been a strong proponent of the financialization of health care (see Observer Winter 2020; Observer Spring 2017; Update 66). The failure of the Bank’s Emergency Pandemic Financing Mechanism (PEF) is a clear example (see Observer Fall 2020).

While Reuters Press Agency reported in January, World Bank President David Malpass said Bank officials “are working with countries to address … rules that leave vaccine manufacturers open to lawsuits or judgments,” the lack of support of the Bank for improved distributed local production, the TRIPS waiver and the lack of action on the price of vaccines are deeply problematic. Bank support does not resolve the costs and other structural obstacles associated with immunization efforts and may in fact exacerbate the debt burden of some countries.

In the absence of concerted multilateral action, strongly supported by the World Bank and the IMF, developing countries will have no other choice but to respond to the Covid-19 crisis by borrowing to finance vaccine purchases. and cutting essential services or support to vulnerable communities, while pharmaceutical companies continue to reap the rewards.

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