COVID-19 would count as being among some of the most severe pandemics the world has seen in the last 100 years. An estimated 18 million people may have died from COVID-19, according various credible estimates, a scale of loss not seen since the Second World War. Further, with over 120 million people pushed into extreme poverty, and a massive global recession, no single government or institution has been able to address this emergency single-handedly. This has given us a larger perspective of how nobody is safe until everybody is safe.
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Widespread health inequity
Health-care systems have been stretched beyond their capacity and gross health inequity has been observed in the distribution of vaccines, diagnostics, and therapeutics across the world. Now, with the World Health Organization (WHO) having declared the monkeypox outbreak as a Public Health Emergency of International Concern (PHEIC) with over 32,000 cases from over 80 countries (August 2022), the world faces the risk of another health crisis.
While high-income economies are still recovering from the after-effects, the socioeconomic consequences of the novel coronavirus pandemic are irreversible in low and low middle-income countries. The monopolies held by pharma majors such as Pfizer, BioNTech, and Moderna created at least nine new billionaires since the beginning of the COVID-19 pandemic and made over $1,000 a second in profits, even as fewer of their vaccines reached people in low-income countries. As of March 2022, only 3% of people in low-income countries had been vaccinated with at least one dose, compared to 60.18% in high-income countries. The international target to vaccinate 70% of the world’s population against COVID-19 by mid-2022 was missed because poorer countries were at the “back of the queue” when vaccines were rolled out.
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Even six to eight weeks after the PHEIC declaration, countries, except for Asia, did not take the requisite precautions. Similarly, when world leaders pledged €7.4 billion ($8.07 billion) in a digital fundraiser for developing a coronavirus vaccine and treatments, the United States did not send any representative Thus, inequality has also been prolonging the course of the pandemic. And, it is in this backdrop that the creation of a Global Pandemic Treaty was proposed at the Special Session of the World Health Assembly (WHASS). The underlying logic was that as global governance had failed during the pandemic, we needed political commitment to mitigate future challenges.
India’s lead role
India’s response to the COVID-19 pandemic and reinstating global equity by leveraging its own potential has set an example to legislators worldwide. India produces nearly 60% of the world’s vaccines and is said to account for 60%-80% of the United Nations’ annual vaccine procurement — “vaccine diplomacy” or “vaccine maitri” with a commitment against health inequity.
India was unfettered in its resolve to continue the shipment of vaccines and other diagnostics even when it was experiencing a vaccine shortage for domestic use. There was only a brief period of weeks during the peak of the second wave in India when the vaccine mission was halted. As of 2021, India shipped 594.35 lakh doses of ‘Made-in-India’ COVID-19 vaccines to 72 countries — a classic example of global cooperation. Among these, 81.25 lakh doses were gifts, 339.67 lakh doses were commercially distributed and 173.43 lakh doses were delivered via the Covax programme under the aegis of Gavi, the Vaccine Alliance. Further, the long tussle with the pharma majors over vaccine patents, especially in the African countries, held back the global vaccination drive. But India stood as a global leader, moving a proposal with South Africa in October 2020 to ask the World Trade Organization (WTO) ‘to allow all countries to choose to neither grant nor enforce patents and other intellectual property related to COVID-19 drugs, vaccines, diagnostics and other technologies for the duration of the pandemic, until global herd immunity is achieved’. Even though this proposal was stonewalled by some of the leading countries, it was only in June 2022, that the WTO finally decided to water down intellectual property restrictions in manufacturing COVID-19 vaccines after rigorous efforts.
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Lessons learnt, path ahead
In the COVID-19 pandemic, we have seen a multitude of initiatives to address the pandemic and to do better in the future such as the Vaccine Alliance. These are all valuable, but a treaty under the umbrella of WHO would, as highlighted by the journal BMJ, build coherence and avoid fragmentation. For example, as a document by the University of Groningen shows, among high-income countries and low- and middle-income countries, while the difference between the number of reported cases was relatively similar until late March 2021 (65.3 and 61.2 million, respectively), high-income countries shared on average 16.5–fold more sequences per reported case (1.81% and 0.11%, respectively).
Thus, as mentioned in the BMJ, such a treaty should cover crucial aspects such as data sharing and genome sequencing of emerging viruses. It should formally commit governments and parliaments to implement an early warning system and a properly funded rapid response mechanism.
Further, it should mobilise nation states to agree on a set of common metrics that are related to health investments and a return on those investments. These investments should aim to reduce the public-private sector gap.
Finally, a global pandemic treaty will not only reduce socioeconomic inequalities across nation states but also enhance a global pandemic preparedness for future health emergencies. India must take the lead in this.
Amar Patnaik is a Member of Parliament, Rajya Sabha from Odisha, a former Principal Accountant General, and currently, an advocate