Transcript Sustaining the Response: Vaccine Access, Diplomacy and Soft Power Professor David Heymann CBE Distinguished Fellow, Global Health Programme, Chatham House, Executive Director, Communicable Diseases Cluster, World Health Organization (1998-2003) Professor Helen Rees OBE Executive Director, Wits Reproductive Health and HIV Institute, University of the Witwatersrand Professor David Ellwood Senior Adjunct Professor of European and Eurasian Studies, John Hopkins SAIS Europe Chair: Emma Ross Senior Consulting Fellow, Global Health Programme, Chatham House Event date: 28 April 2021 The views expressed in this document are the sole responsibility of the speaker(s) and participants, and do not necessarily reflect the view of Chatham House, its staff, associates or Council. Chatham House is independent and owes no allegiance to any government or to any political body. It does not take institutional positions on policy issues. This document is issued on the understanding that if any extract is used, the author(s)/speaker(s) and Chatham House should be credited, preferably with the date of the publication or details of the event. Where this document refers to or reports statements made by speakers at an event, every effort has been made to provide a fair representation of their views and opinions. The published text of speeches and presentations may differ from delivery. © The Royal Institute of International Affairs, 2021. 10 St James’s Square, London SW1Y 4LE T +44 (0)20 7957 5700 F +44 (0)20 7957 5710 www.chathamhouse.org Patron: Her Majesty The Queen Chair: Jim O’Neill Director: Dr Robin Niblett Charity Registration Number: 208223 2 Sustaining the Response: Vaccine Access, Diplomacy and Soft Power Emma Ross Good afternoon, and thanks for joining us again for the Chatham House COVID-19 webinar series, with our Distinguished Fellow, Professor David Heymann. Today, we’re going to be talking about what’s going on with access to vaccines, with a different focus than we had when we talked about the COVAX facility a few months ago. We’re going to cover a broad range from what countries are doing outside of COVAX to buy or make their own vaccines, how that’s going, and what’s getting in the way, to vaccine nationalism and vaccine diplomacy. With us to share their insights into these issues are Helen Rees and David Ellwood. Helen’s a Professor at the Witwatersrand University in Johannesburg. She’s one of South Africa’s powerhouse women Scientists, and the list of her senior advisory roles and board appointments in global health is huge, so I won’t go into that, but what I do want to highlight here is that she’s been actively involved in the COVID response at the national, regional and global level and is involved in almost all levels in the development of the vaccine. [Audio cuts out – 02:27] European and Eurasian Studies at Johns Hopkins University, based in Turin. He is a Historian who specialises in the politics of modernisation in Europe and in the last decade, in the study of soft power. During the pandemic, he’s been looking at how countries are using their vaccine supplies as geopolitical instruments to exert influence around the world. So, welcome to you both, this should be a really great discussion. Thank you so much for joining us. Professor David Ellwood Thank you. Emma Ross I’ll deal with the housekeeping first, the event’s on the record, as always, and if you’d like to ask questions, please write them in the ‘Q&A’ function on Zoom. Upvoted questions are more likely to be selected. You can put the questions in at any time you want, and it can be on any topic, it doesn’t have to only be on this topic, so if you have science questions or anything, please do go ahead. So, Helen, I was hoping we could start with you by getting an overview, access to vaccines has been a major focus of discussion at the highest levels around the world and we have the COVAX Initiative, which we are told is the game in town for global access that everyone should get behind as the vehicle. But what’s actually happening in reality on the ground, with people’s experience of accessing, countries that didn’t do advance deals, and is COVAX the only thing that’s going on, what else is going on, and how are we doing? Professor Helen Rees OBE Well, you’re quite right, I mean, COVAX is very important, but COVAX hasn’t gone at the speed that it would have really liked to go at, because of being able to access the vaccines, and also, some of the complications, such as the liability requirements that countries are required to satisfy. So, at the moment, COVAX had only got as far as 39 million, but, I mean, the prospects remain good, but there are problems there. There are several problems. One is the impact of something that we’re seeing at the moment in India where this huge surge of infections has meant that the Indian Government has said, “Look, we need to close our borders to the export of vaccines.” So, the issue of exporting vaccines and vaccine manufacturers, we saw it right at the beginning of the pandemic, when the US wanted to prohibit and buy up products that were made, both 3 Sustaining the Response: Vaccine Access, Diplomacy and Soft Power vaccines and other products, that were made in the United States, thus limiting access to other countries. So, that is one of the problems. Secondly, you’re quite right, that because countries are scared, even low middle-income countries, that they’re not going to get access in the way that they really feel they need, there’s a lot of bilateral negotiations going on and the problem with those is that they’re often shrouded in secrecy. So, we don’t know what the cost of the vaccines are when there are bilateral negotiations, but we do know, in one case, for example, the AstraZeneca purchased in South Africa was more expensive than that negotiated by the European Union. So, it doesn’t necessarily follow, in bilateral deals, that if you’re a low middle-income country that you’re going to get a more competitive price, that that is, sort of – and that’s really not clear. The third thing is, and we often neglect this, I think, is that it’s one thing to buy the vaccines and to get the vaccines into the country, through whichever route, but the third thing is how – what is the ability of countries to be able to rollout a programme? These programmes are very different to the childhood immunisation programmes that many countries are familiar with and are good at doing, the EPI programmes. These are to adults, to specialised groups, to target populations, perhaps over 60s, these are not people that people have traditionally targeted in many settings, and the cost of those programmes is very expensive. In some cases, it can be as much as actually purchasing the vaccines, if not more, because you’re putting in place just a new, sort of, infrastructure. So, I think countries’ readiness and countries’ abilities to rollout, not only in low middle-income countries where this is just starting, we’ve seen it in Europe, the struggles to actually rollout the vaccines, even if you have the vaccines. So, I think that at the moment I would say, on a score of one to ten, ten being very good, where is the world? I think we’re about three. Some countries have done extremely well, as we know, but I don’t think that we’re anywhere near yet where we want to do, and just to reinforce what you said, COVAX is incredibly important for low middle-income countries. Emma Ross Thank you, Helen, that’s quite sobering and quite a poor score. David Heymann, would you agree with that, or what’s your take on where we are and whether the world in general is delivering on, you know, what we’ve said we all commit to? Those who have committed, not everyone’s committed, I guess. Professor David Heymann CBE You know, Emma, if you look throughout history, in recent years, the world has rallied behind access to vaccines for those who need them. This happened first in the smallpox eradication programme, which was the first real programme to get 100% access to a vaccine that was necessary for the risk groups. And then the polio eradication programme came along, and then there was a glitch in the getting the availability to pandemic influenza vaccines and a group at WHO, a, intergovernmental group, developed the Pandemic Influenza Preparedness Framework, which has provided vaccines for pandemic influenza, which will provide them, from companies to WHO at no cost, about 10% of their production capacity, to use in developing countries. So, we’re making progress and, of course, routine childhood immunisations have always been available through an effort of UNICEF and WHO and many donor countries, including the UK, which has been one of the major contributors to getting vaccines out to children in need. So, the world has always rallied behind, and I believe that they will rally behind again vaccines for COVID, but it’s not easy. Production capacity, as Helen said, is quite low. We’re not able to get the production that we need because there have been pre-purchase commitments already by many countries to get that vaccine. So, 4 Sustaining the Response: Vaccine Access, Diplomacy and Soft Power production is having trouble meeting global needs, but I think that gradually, as time goes on, people are going to see that countries are taking advantage of getting vaccines to people for one of three reasons.