Covid-19: Event debates vaccines as global public goods

The Fiocruz Global Health Center (Cris/Fiocruz), the National School of Public Health (Ensp/Fiocruz), the Network of Public Health Schools in Latin America (Resp-AL), the Latin American Alliance for Global Health (Alasag), the Argentine Network of Public Health Schools and the International Network of Health Technicians (Rets), which usually act in partnership, promoted the international seminar Vaccines and medicines for Covid-19 as global public goods.

Conducted online, the meeting aimed to reflect on access to vaccines and medicines against Covid-19 by developing countries. The speakers were the advisor to Costa Rican Health Minister Albin Chaves; the researcher of the Ifarma Foundation (Colombia), Francisco Rossi; the director of the Institute of Technology in Immunobiologicals (Bio-Manguinhos/Fiocruz), Maurício Zuma; Cris/Fiocruz researcher and Executive Secretary of Alasag, Sebastián Tobar; and Fiocruz researcher Jorge Bermudez.

Tobar, who was the mediator of the seminar, recalled that access to vaccines and medicines against the new coronavirus should be global public goods, as recommended by the World Health Organization (WHO) at its last General Assembly. "The virus does not respect borders. And by immunizing one person we also benefit others. However, we are told of the immense difficulties in ensuring access to all, especially in the poorest countries, which concentrate most of the world's population. There are great asymmetries between countries and even within countries. In this sense, in view of the many limitations we face, we need to have the responsibility to ensure access to all. International cooperation will serve exactly this purpose: to make efforts so that everyone can be immunized. It is not permissible for large global pharmaceutical conglomerates to develop a vaccine and limit access, charging very high values for the product, making it impossible for the poor to be immunized."

Tobar recalled a phrase spoken in 1955 by virologist Jonas Salk, who had just discovered the polio vaccine, about who would have the patent. Salk responded with a question that went down in history: "There is no patent. Could you patent the sun?"

Then there was the intervention of Fiocruz researcher Jorge Bermudez. He said the pandemic impacted the entire world, but the responses were different, making global inequalities even clearer and even deepening them. "Homeless people, street walkers, people who inhabit poor communities, indigenous people... all these groups are on the margins of access to treatments and may be left out of immunization. That is why we have an effort to prevent this situation from coming to fruition."

For Bermudez, the false dilemma between saving lives or saving economies cannot allow for a shutdown of initiatives. "There is a difficulty in tackling inequalities, but we have seen meetings of the UN, WHO, the G-20 health ministers and also other international forums, aligned with the 2030 Agenda. A global public health action plan is needed, covering innovation and intellectual property, regulation, adequate pricing, access, coverage, joint procurement and supply so that we can respond to the level of this unique challenge."

Bermudez warned, however, that the solidarity shown so far by many leaders may not come out of the paper. "We see a race of some rich countries to appropriate and buy everything, leaving the poor to the fore. After all, we live in a predatory and exclusionary society. It is revolting and frightening to know that there is talk of a vaccine that, according to some international manufacturers, can cost up to $ 40 a dose! This is the denial of solidarity and reflects a selfish and cruel conception of a world."

"An Ibero-American progressive parliamentary group has been created to build a regional proposal that allows access to Covid-19 treatments for all. In addition, we need to be willing to fight for a 'new normal', with a more supportive and welcoming world that shares knowledge and blocks monopolies. And we have to promote greater equity in this region of 570 million inhabitants."

Bermudez ended his participation by recalling a phrase that the then Prime Minister of India, Indira Gandhi, delivered at the UN General Assembly in 1982. "The idea of a better-ordered world is a world in which discoveries will be patent-free and there will be no profit from life and death”.

Then there was the intervention of the advisor to the Minister of Health of Costa Rica, Albin Chaves. He discussed the health system of his country, which has the lowest mortality rate for Covid-19 in Latin America. This reality is due much to the performance of the Basic Teams of Comprehensive Health Care (Ebais), which are at the forefront of the fight against the pandemic in the Central American country. Ebais are more than 1,000 health centers throughout the country, with doctors, nurses, technical assistants and pharmacists. Chaves narrated the operations of the Costa Rican Social Security Fund (CCSS), which maintains a dozen hospitals. The country invests more than 6% of its Gross Domestic Product in health and almost 100% of the population has piped water at home. "Our principles are equity, solidarity and universality."

"The country invests massively, within its means, in prevention. We have clear public policies on vaccines and medicines. At the international level, the Costa Rican government has proposed to the UN a plan that provides for international collaboration, partnerships and access to knowledge. There are difficulties, of course, because not everyone has the same intentions. But this is the way." Costa Rica is the country in Latin America with the highest life expectancy at birth: 77.75 years old. And one of the countries with the lowest mortality rate: 10.82%

The researcher at the Ifarma Foundation (Colombia), epidemiologist Francisco Rossi, who also worked at WHO and PAHO, then intervened. According to him, the battle for access to vaccines and medicines against Covid-19 is one of the main agendas of Ifarma's action at this time. Rossi, however, was categorical in making his position clear: "if we are going back to the 'old normal' it is better not to have a vaccine. That's because what we had, and we continue to have, when we see the exclusionary nationalism of countries like the United States, was an unequal world with deep iniquities. It is necessary to overcome this reality."

For Rossi, the pandemic is a global problem that needs global and humanitarian responses, detached from the idea of profit. "And it's also a great time to discuss the issue of patents. In the case of medicines, they should not exist. Intellectual property represents a barrier to access to medicines." According to Rossi, the tensions that arise between human rights and the commercial rights of pharmaceutical companies are a relevant situation for the countries of the region. He added that pharmaceutical multinationals are looking for ways to generate monopolies in the distribution of medicines. "The hope lies in the development of legal instruments such as opposition to patents, mandatory licensing and local production, among others."

Maurício Zuma, director of the Institute of Technology in Immunobiologicals (Bio-Manguinhos/Fiocruz), was the next participant. Zuma presented to the public of the event, largely Latin American, the trajectory of Fiocruz, with its successes and achievements, and its presence in all regions of Brazil. It also addressed the Foundation's international activities and the many partnerships with research institutions from various countries on all continents. He said the concept of health as everyone's public good has been at the heart of Fiocruz since its creation 120 years ago.

Zuma also presented the work of Bio-Manghinhos and its production of vaccines, diagnostic kits, biopharmaceuticals, vaccines, clinical studies and also the qualification of human resources. "In the last five years the Institute has produced 517 million doses of vaccines, 47 million vials of biopharmaceuticals and 32 million diagnostic kits. We have exported yellow fever and meningitis ACW vaccines to more than 70 countries and are building the Health Biotechnology Industrial Complex (Cibs), which will expand the supply of vaccines and biopharmaceuticals to meet not only public health programs but also external demand (WHO, PAHO, UNICEF) and quadruple production capacity, in addition to allowing the introduction of new products." The director also commented on the partnership with AstraZeneca to produce the vaccine against the new coronavirus and said Fiocruz is committed to access. According to him, the cost of each dose, for the government, should be less than US$ 4.

Then, brief comments were made by previously chosen participants regarding the presentations. Cris/Fiocruz coordinator Paulo Buss said the Group of 77 requested a meeting of the UN General Assembly to discuss access to vaccines against Covid-19. The Group is a coalition of developing nations whose goal is to promote the economic interests of its members and create greater joint negotiating capacity at the UN. "Defending fairness is a difficult political struggle, but beyond necessary, urgent. In the case of Fiocruz we have showed that the institution can be an important player at the international level and the quality of the public servant was further proven." Buss, however, sees beyond national borders. "We will meet the needs of Brazilian citizens. But we will also stand in solidarity with our Latin American brothers and Portuguese-speaking African countries."

The next comment was from lawyer Mirta Levis of the Argentine Association of Public Health, director of the Center for Global Health Studies at Isalud University and former executive director of the Latin American Association of Pharmaceutical Industries. She took a quick look at the situation of the countries in the region and noted that most countries in the subcontinent do not have the capacity to produce the Covid-19 vaccine, which makes international cooperation even more important. "We cannot maintain this system that always leaves developing countries as the last in line. And unfortunately there are chances that this will happen again if the concentrating trend is confirmed." Then it was the turn of the director of the National Institute of Health of Peru, Pedro Riega. He lamented what he called the "chronic precariousness" of his country's health system, which worsened in this pandemic. He said there is an articulation of Peruvian academic institutions with others from neighboring countries to alleviate this problem, exchange experiences and learn about successful initiatives.

Finally, there was the comment of the advisor of the Coordination of International Cooperation of the Polytechnic School of Health (EPSJV/Fiocruz), Helifrancis Condé Groppo Ruela. According to him, it is important not to naturalize this moment, especially from a critical perspective that comes from collective health, political epidemiology and social determinants of health. "Covid-19 is the result of a destructive and predatory mode of production," Ruela said. For the advisor, it is necessary to focus not only on the necessary treatments and the appropriate vaccine, but also to discuss the inequities and structural inequalities of health systems. "The pandemic has also shaken formative processes, as students are without access to health services. It is a generation that will not be able to graduate properly."

At the end of the event the participants accompanied a special presentation of several Latin American musicians. They performed the song Latinoamerica, by the Puerto Rican band Calle 13, which preaches the union of the peoples of the region.

The webinar is avaible in Portuguese and Spanish.