Why civil society is central to the response to the pandemic.

A conversation with Sangeeta Shashikant, Legal Adviser, Third World Network (TWN)

TWN is an independent non-profit international research and advocacy organisation that works on behalf of people in developing countries on a wide range of development issues, including health, economics and the environment. Sangeeta’s current focus is on the critical issue of fair access for people in developing countries to new COVID-19 vaccines and medicines.

Sangeeta, can you tell us about the impact of the virus on the communities you represent?

It’s had a huge impact. Hearing the stories about how people have lost their livelihoods and are facing huge upheaval in their lives as a result — it’s tragic and quite shocking.

We’ve seen how the pandemic is wreaking havoc economically, but less visible is the damage to society, as well, and the health impact outside the immediate risks of infection with the virus. What is going to be the mental health impact of months and months of lockdown? What will be the impact on health services, on services for people living with HIV and tuberculosis? And what about all the children who are missing out on vaccinations as a result?

How important is the work of civil society during this pandemic to support people at grass roots level?

More important than ever, because we are seeing so many people now losing their livelihoods, so people who could previously access health services may not be able to access them now because they have lost their means to pay.

In many places, people on the ground rely fully — even outside a pandemic — on the wide range of services civil society offers, including health services, information, support and advice. They already faced huge barriers in getting the health services they and their communities need. Now things just got much worse for them.

How involved has civil society been in the global response to the virus so far?

At the start there was a big disconnect. When the WHO launched its Access to COVID19 Tools -Accelerator aiming to deliver new medical tools, civil society were not involved at all in the process. So, in a way, civil society have come into the whole process at a very late stage.

Civil society is also largely absent from the design of the WHO’s Equitable Allocation Framework — set up to ensure fair access to the new COVID medical tools — and is also absent from the design of Gavi’s COVAX Facility, created to develop and distribute vaccines. The impression we have is that civil society is not being given the full information as to what is being planned, is not being consulted, and is being excluded from contributing to the entire process.

What has your organisation been doing specifically to push for fair access to any new COVID-19 vaccines and medicines?

My expertise lies in advising governments and others on intellectual property rights and how to ensure they don’t stand in the way of people getting fair access to lifesaving medicines by creating unfair monopolies on medicines and vaccines.

That’s why we’re involved right now in lending our expertise and providing technical support to governments on how to use the legal flexibilities that are available in the World Trade Organization (WTO) agreement on intellectual property, which is known as the TRIPS agreement (Agreement on Trade-Related Aspects of Intellectual Property). These flexibilities will allow governments to bypass monopolies on new COVID-19 medicines and vaccines, making space for affordable generic production of these medical tools. To meet the global demand at affordable prices, we are going to have to use every tool in our access toolkit, and affordable generic medicines are a key part of any plan to ensure equitable access.

Can you describe your work around any specific medicines to ensure fair access?

Yes, we’ve been involved in challenging some of the patent monopolies that might stop people from getting access to medicines to treat the virus — for instance, we’ve filed a patent opposition in the case of the drug remdesivir You’ll remember the US has effectively bought up the whole global supply of this drug from the company Gilead. We urgently need to see space opened up so that many more generic manufacturers can make the needed medicines and vaccines to meet global need and at affordable prices. It’s something we’ve done before to open up access to more affordable treatments for HIV, TB, and hepatitis C.

There’s been the suggestion in some quarters that civil society should just stand aside to allow things to proceed quickly — what do you think?

When civil society is absent from the table, you will find a lack of transparency, a lack of accountability, and this inevitably leads to an inequitable outcome for people in terms of access — there’s going to be a lot of disparity. We’re already seeing that happen in terms of access to masks, personal protective equipment, diagnostic kits.

Look at the story of inequity around access to remdesivir already: The United States has seized control of most of the global supply for the next few months. We and others in civil society have raised this specific issue very loud and clear and also more broadly that we are not doing what is needed to address this global challenge.

So, if you do not have civil society participate and engage in this process, then a lot of these issues are not going to be highlighted, and neither will measures be taken to address them.

We’re hearing a lot of world leaders talking about global cooperation and collaboration during this pandemic, do you believe it?

The ‘race’ for vaccines and for therapeutics, as we have seen already with remdesivir and the vaccines bought up unilaterally by rich countries, shows that each country is still out for itself.

That said, I do think deep down everybody does believe that there needs to be global solidarity and international collaboration. It is unfortunate we have not seen this really happening. It is not too late. I think measures can still be taken to ensure that there is collaboration and solidarity especially with respect to sharing of knowledge, technology and related intellectual property. Without that, we will find it very difficult to meet global needs and to contain COVID-19 in a very short time frame.

Building back better — is this pandemic a crisis that can be turned in to an opportunity?

I think civil society are already pushing for things to be done differently, recognising that we are in a once-in-a-lifetime pandemic and we need to do things differently. Because if we do the same things, we are not going to handle this pandemic — or, critically, any others down the road — very well.

This blog is a place to reflect on our experiences working for access to medicines. For the official MSF Access Campaign website please visit msfaccess.org.