Daniel López Acuña
Doctor. Epidemiologist. Former Director of Health Assistance in Crisis Situations at the World Health Organisation. Associate Professor at the Andalusian School for Public Health
If the COVID-19 pandemic has taught us one thing over the past twenty-one months, it is the inadequacy of European and world mechanisms to guarantee common health security, beyond national borders, to not only respond effectively and in coordination to a pandemic we have all had to deal with, but also to turn COVID-19 vaccines into public assets above market logic.
Of particular concern has been the short-sightedness and lack of effective devices to attain equal universal access to vaccines, which, to date, are our most important resource for preventing serious illness, suffering and death after catching SARS-CoV-2.
We are still a long way from attaining what should have been built in recent decades: European and global public assets in terms of public health care which enable us to move beyond the selfish limits of a nation state logic, and the limitations imposed by a commercial logic when we face a threat that transcends borders, national sovereignties and the particular interests of individual countries.
We lack instruments and mechanisms of European and global governance to make collective supranational action viable so that it constitutes an exercise in health authority beyond purely national spheres. Moreover, the pandemic has hammered home how ineffectual we are without them, how easily the virus can defeat us, and how there is a need to introduce deep-seated changes into the European sphere and into the global conversation, otherwise history will repeat itself should a new pandemic emerge because we will still be ill prepared.
Unquestionably, the advance in sequencing the genome of the virus was swift and promptly allowed responsive and specific diagnoses to be developed, even if they were subject, from the start, to a commercial race and a chiefly market-led logic. The sequencing obtained early on and the heavy public investment by numerous States certainly helped efforts around developing vaccines to progress in record time, which in turn led to half a dozen or so effective and safe vaccines being created just a little over a year after the start of the pandemic, making it possible to progressively protect people against serious illness and the risk of death caused by COVID-19.
However, the logic that has reigned is one of commercial production, not the creation of a public asset with production and distribution that are adequately orchestrated through a mechanism of co-governance by States. As a result, there is still a shortage of doses to meet vaccination requirements, and vaccines are still not attainable for all countries, nor are they distributed equally, while priority has not been given to a logic of gradual protection for the world’s most vulnerable populations, irrespective of whether they belong to one country or another.
For science and public health, this pandemic has been hit and miss. It has engendered rapid and major advances in scientific research, but we still lack knowledge and still have a lot to learn to digest knowledge and translate it into effective actions in a broad social spectrum around how to contain the virus and how to move beyond market logic when there is a need and public interest.
Reality has exceeded imagined scenarios for possible pandemics and the initial predictions related to COVID-19. In a globalised world, with its vast flux of people, a serious and highly contagious epidemic of airborne transmission spreads at unimaginable speed. What is also obvious is how this requires drastic actions -both effective and early- to stop the spread. We need a greater capacity of anticipation, more binding collective actions, better pandemic preparation, better contingency plans and better international, European and national governance for these kinds of situations.
World health security -and European, closer to home- is a process which leads us to obtain a result in being able to keep health risks under control and guaranteeing “the health order”. This entails Europe’s and the world’s ability to detect disruptions (alert) and correct them actively and rapidly (response); therefore, there must be binding collaborative agreements, worldwide and regional, which enable collective action beyond the national sphere.
This is why we speak about a global public asset and, when applicable, European, which transcends national sovereignties and has to be clearly accepted by constituent States. Furthermore, it must be of an intergovernmental and multilateral nature, but most importantly it must enable relevant information to be gathered, shared and analysed, and without filters and secrets led by a myopic focus on “national security”. Most notably, fast and decisive supranational actions must be carried out to tackle the problem over and above the national sphere.
Nevertheless, the scope of the current International Health Regulation is insufficient for fulfilling these essential requirements, given that the States involved in this international convention have not ceded national sovereignties, thereby rendering supranational collective action impossible. As a result, the problem does not lie in the instrument itself, be it this International Regulation or a new International Treaty on Pandemics Prevention and Preparedness, for instance that which a number of world leaders and the director-general of WHO have suggested. If national sovereignties do not yield, no instrument will be sufficiently effective.
In the sphere of the EU, there is also a need for a coordinated and converging focus. This is yet to exist and consequently has made it difficult to stop the different waves of COVID-19 in time. The lack of coordination of restrictive measures and health actions, in addition to the erratic control of borders, causing an irregular flow of people, has not managed to interrupt, neither in a timely manner nor effectively, the transmission chain of infection of SARS-CoV-2, nor has it given the regional health security situation any degree of stability. It has not been possible to harmonise decisions regarding the use of vaccines approved by the European Medicines Agency, the regulatory body established, in theory, to act in concordance with all countries in the Union related to the use of medicines and vaccines. This calls into question the effectiveness of health action on a European scale given that many countries in the region have gone their own way.
Countries are moving in different directions and adopt measures that lack coordination and are bereft of a unified focus to respond to the new challenges that re-emerge from COVID transmission, producing an increased number of cases. There is an urgent need to adopt, at the heart of the EU, concerted action; the Commission and its different relevant organisms must duly lead and arrive at a common framework of action to orientate the efforts that each Member State must carry out to negate the transmission of the virus. Otherwise, we will continue to move backwards.
The digital healthcare certificate, as it has been formulated, creates a false sense of security and does not guarantee the health security that must accompany the re-establishment of international travel and the resumption of tourist flows. It is an interoperable information platform, which records whether people are vaccinated, have a negative PCR test or have antibodies against SARS-CoV-2 after suffering from the illness in the previous six months. But little more. It has not been joined by uniform provisions in the European sphere to regulate travel and entry and exit in countries, which is absolutely key.
There is still so much to do in terms of coordinating measures associated with the closing and opening of borders, quarantines, carrying out diagnostic tests to travel, travel advice and restrictions, and people’s movement in the region.
The vaccines issue warrants particular attention since they constitute a key instrument for controlling the pandemic in the medium term, but will only work if they are driven forwards as a public asset both in the European sphere and as part of the world conversation. Nevertheless, neither the actions of WHO, GAVI and the World Bank on a global scale, through the COVAX facility, nor the Accelerator platform, nor the measures taken by the EU in their area of responsibility have been up to the task of what is required. More decisive steps are beginning to materialise around the possibility of G7 countries and other advanced economies, particularly in Europe, including Spain, ensuring developing countries have access to vaccines. These were announced at the Summit on COVID-19 convened by US President, Joe Biden, shortly before the UN’s General Assembly in September 2021. For the moment they are promises that have arrived late and are not yet enough to close the vast gap of world inequality in relation to vaccination against COVID-19.
More decisive action from the outset would have seen more commitment to consolidating actions for developing vaccines collaboratively and to centralising regulatory roles to approve vaccines and their review in terms of security and efficacy. Conversely, what has been allowed is the proliferation of competitive efforts tainted with an absurd vaccine nationalism, ultimately “accommodating” commercial agreements with the pharmaceutical companies producing approved vaccines, instead of instigating a faster production with processes of outsourcing, whereby pharmaceutical organisations with the capacity to produce vaccines around the world and particularly in different European countries could have been involved.
The COVAX facility is not enough to support poor countries in purchasing vaccines, nor is a consolidated European purchase which initially did not guarantee a sufficient supply of vaccines to vaccinate the populations of EU countries at the required rate. They are vicariant mechanisms which do not remedy the base structural problem and turn vaccines into a private, not public, asset.
Both the EU and WHO should have called the pharmaceutical industry together to develop a “crash plan”, with a war economy logic, to move towards an intensified production of the number of necessary vaccine doses, and with the full backing of governments from Member States. There was a need to set up “compulsory licensing”, which was approved almost two decades ago at The Doha Round of the World Trade Organisation and allowed patents to be more flexible when there is an international public health priority -for instance at that time with antiretroviral treatments to fight against AIDS-. This would have made the production of required vaccine doses for the entire world cheaper and more dynamic.
A concerted effort to reduce world and European fragmentation, and to promote coordination, would be particularly useful and is key to ensuring more effective international health cooperation. The leitmotif of this effort should be the collective focus to slow down upticks in infections, a coordinated and solidary approach in controlling the pandemic and in mitigating its economic and social effects, and collaborative action in the production and distribution of vaccines, given that it is not exclusively an individual issue for each country. “No man is an island”, the English poet John Donne said. In this case, no country is an island and all Member States are in the same common boat and must drive forward rapid, collaborative and concerted action, of which Spain must be a leading light.