Fatima Hassan: Global vaccine equity and health justice

0:00:02.5 Shobita Parthasarathy: Good morning, everyone. At least good morning in Ann Arbor, Michigan. My apologies for the slight delay. My name is Shobita Parthasarathy. I'm Professor of Public Policy and the director of the Science, Technology and Public Policy Program, known as STPP here at the Ford School of Public Policy. STPP is an interdisciplinary university-wide program dedicated to training students conducting cutting edge research and informing the public and policy makers on issues at the intersection of technology, science, equity, society and public policy.

0:00:40.0 SP: If you'd like to learn more about it, you can do so at our website, stpp.fordschool.umich.edu, and we will drop that link into the chat. Before I introduce today's event, I wanna make a couple of quick announcements. First, for those of you who are interested in our graduate certificate program, the next deadline is March 1st of next year, and we'll be holding an information session about it on Tuesday, February 15th at 4:00 PM. You can access registration details on our website, it will be held via Zoom. Second, the next event and the STPP lecture series during this academic year will feature Kumar Garg, managing director at Schmidt Futures and the former assistant director in the White House Office of Science and Technology Policy. That event will be on Wednesday, January 26th, at 4:00 PM, and you can also register for that on our website. And now for today's event. We are hosting an important and timely conversation about global vaccine equity and health justice. Our featured guest today is social justice activist and human rights lawyer, Fatima Hassan, who is the founder of the Health Justice Initiative in South Africa, an expert in human rights, especially in the context of HIV/AIDS. Hassan has provided services to the AIDS Law Project and the Treatment Action Campaign, and was former co-director and founding trustee of Ndifuna Ukwazi.

0:02:45.8 SP: She has also served on the boards of the Raith Foundation, South African Medecins Sans Frontieres, the International Treatment Preparedness Coalition and the South African Council for Medical Schemes. She has a BA and LLB from the University of Witwatersrand and an LLM from Duke University, and clerked for Justice Kate O'Regan of the Constitutional Court of South Africa. She also served as Special Advisor to former minister Barbara Hogan. Over the last two years, she has been a fierce campaigner, advocating for Global Health Equity through relaxing intellectual property restrictions on the COVID vaccines and increasing sharing and manufacturing capacity to low and middle income countries. And as you can imagine, just in the last week or so, she has become even busier than that. Yesterday, she gave... She did an interview with Fareed Zakaria on CNN, and she just joined us this morning from speaking with the WHO. In conversation with her will be Dr. Abdul El-Sayed, Harry A and Margaret D Townsley Foundation Policymaker in Residence at the Ford School of Public Policy here in University of Michigan. Dr. El-Sayed is a physician, academic and public servant, who served as Executive Director of the Detroit Health Department and health officer for the city from 2015 to 2017.

0:03:37.5 SP: He was previously assistant professor in the Department of Epidemiology at Columbia University. In 2018, following a bid for Governor of Michigan, he founded Southpaw Michigan, a political action committee aimed at helping elect progressive candidates. And in 2020, he served on the Biden-Sanders Unity Task Force on Health Care. He's currently a political contributor for CNN, and the author of two books: Healing politics: A doctor's journey into the heart of our political pandemic and Medicare for All: A Citizen's Guide, which he co-authored with Micah Johnson.

0:04:12.6 SP: He also hosts a podcast about politics and health called America Dissected with Dr. El-Sayed. Before we begin, I'd like to thank our co-sponsors at the African Study Center, the Office of Global Public Health and the Center for Global Health Equity for making this event possible. I also wanna thank our STPP staff, Mariam Negaran and Molly Kleinman. Ms. Hassan and Dr. El-Sayed will talk for about 30 minutes and then there'll be time for audience questions and engagement afterwards. Please submit any questions through the Q&A function on Zoom. Ms. Hassan, Dr. El-Sayed, I'm so looking forward to your conversation and I will turn it over to you.

0:04:54.0 Dr. Abdul El-Sayed: Thank you so much, Shobita. It's a privilege and honor to be here with you and grateful for your leadership of... In this area. Really excited to be in conversation with Ms. Fatima Hassan, and really looking forward to what I know is going to be an important conversation, particularly in this moment. I wanna just jump right in. First actually, I'm not seeing Ms. Hassan here, so I just wanna make sure that she is here with us.

0:05:32.3 SP: It looks like she is not... Oh, you are here.

0:05:38.4 DE: Just a minute, we've gotta figure out audio and video.

[pause]

0:06:02.1 Fatima Hassan: Okay, I think we've succeeded.

0:06:11.1 DE: There it is. Alright [chuckle]

0:06:14.8 FH: What a day.

0:06:18.8 DE: Sometimes those days happen, but we're really grateful that you're here with us now. Let's jump right in. So obviously, the world was turned upside down last week. I can't believe it's been only a week with the recognition of the emergence of the Omicron variant of the coronavirus, and it was discovered in large part because of South African scientists and epidemiologists focus on the capacity for genomics surveillance and doing the good work of telling the world about what they had identified, although it remains unclear exactly where the variant emerged. Can you give us a picture of what has transpired over the last week, we know the cases have started to skyrocket there. What is the situation on the ground as you all are experiencing right now? 

0:07:07.8 FH: Thanks. And thanks, Abdul, and the rest of the team for organizing this webinar. And sorry for all the technical problems, it's been a day of internet and internet access. Coupled with an increase in infections because of the new variant, and like you've mentioned earlier that South African scientists as well as scientists from Botswana first alerted the world to the variant. The variant wasn't discovered in South Africa, it was just first reported from parts of Southern Africa. It's now transpired as you would have seen it, I think the irony of the Dutch Authority basically holding a plane from South Africa on the tarmac for multiple hours and requiring everybody to test themselves and then either quarantine or there were other measures implemented, but the variant was actually circulating in the Netherlands a week before it was actually discovered in the Southern parts of Southern Africa. The mood on the ground is basically one of real anger I think, because on the one hand, our scientists have played a significant role because of the advanced genomic surveillance systems we have in sharing data, not being secretive and being transparent.

0:08:22.1 FH: But the response has been frankly one that smacks of racism, immediate travel ban, that has included most Southern African countries. It's so laughable if it wasn't so incredulous, but not countries where the variant has already been found and where the variant is circulating. What we know so far is that... You would know this better, you're an epidemiologist is that there's already community transmission. And it's now found in multiple parts of the world and its certainly not limited to Southern Africa, but I think that the response to the disclosure of information and the increase in the number of transmissions in other parts of the world has been the response of the world from the beginning of this pandemic, which is we will talk left and we'll walk right.

0:09:14.5 FH: So, it's a language of double-speak, that we'll offer you your solidarity, but instead what we'll do is we'll either isolate you, we'll either unfairly discriminate against your countries or we'll deny you access to life-saving vaccines at the same time as the rest of you would get access to, and so the worst thing that could have happened is we get the travel ban and then we find out that more booster shots have actually been administered in the last four months in the global North than first shots have been actually administered in Southern Africa and the rest of Africa and I'm sure we'll talk about that later. So you wanna understand why people in Southern Africa and particularly South Africa and Botswana are furious, that's just some of the context for where we're at.

0:10:06.3 DE: I really appreciate that point. And I think the point about context is an important one, and I think sometimes when we talk about COVID-19, we act as if this was the first global pandemic in our lifetime, and it was not, in fact, the one that we should often be paying attention to, to understand the circumstances that are arising here at the meeting point between global geopolitics and economics is HIV/AIDS. It's just we don't call it a pandemic simply because we undervalue the lives that it infected, whether it was LGBTQ people here at home or black folks abroad, and can you give us a sense of the way that HIV/AIDS as a global phenomenon has sort of set the stage for the public understanding of this moment and what lessons we can glean as we get into the particularities of this particular pandemic and the vaccine? 

0:11:03.5 FH: Thanks. Good question. The most obvious similarity between the HIV/AIDS crisis and this pandemic has been one of inequity, and so the HIV/AIDS response was characterized by a delay or a refusal to acknowledge the seriousness of the epidemic first in white gay men in the US and then later on, black and brown people, both LGBTQI communities as well as heterosexual communities, and particularly black women in Africa that was towards the early 2000s and late 2000s. But the one common characteristic between the two pandemics, when I talk about inequality is just the lack of access, and so you will find that the people who have been working on access to HIV/AIDS treatment, affordable supplies, timely supplies, greater manufacturing, the same things that we've seen in COVID, similar group of people have re-joined basically to fight for access to... To equitable access of tests, to self-diagnostics, to equipment and vaccines in those pandemics because one of the reasons we did that was because we saw what impact that could have.

0:12:13.5 FH: The stranglehold of intellectual property, inability to be able to access life-saving technologies on a timely basis. It basically costs you lives, forget the money and forget the economies, but you just have needless suffering and you have needless deaths. We've seen this in this pandemic that already at least 5 million deaths. We think that that's an underestimate. We think that there's an underestimate of global cases as well, because that requires testing capability and capacity. But the similarities are so much so that it's the same companies, the fights that we're having almost feels like deja vu for me of what we had to deal with 20 years ago. It's the same practice manual of the CEOs of the pharmaceuticals companies, maybe the individuals may have changed, but it's the same argument, it's the same tactic, it's the same racist tropes that have been flying about. And the most recent thing is that...

0:13:06.4 FH: In the minds of CEOs, which is what they told us in HIV/AIDS, that there isn't an issue with supplies or scaling up manufacturing or that it's not their fault, that there's this uneven access to vaccines around the world, that it's our fault, that we don't wanna take the vaccine, that we are hesitant, that we are anti-vaxxers. Without understanding the global context in which we're in, many of the anti-vaxx movements that are live and well in South Africa, have their roots in the US, have their roots in groups... You saw what happened in Germany in the last 24 hours. So there's a real far right-wing fascist movement around individual liberties about people who are opposed to mask mandate, people who are opposed to vaccine mandates, and so the issue of systemic power, the issue of politics, the issue of racism, issue of keeping out black people through travel bans, I don't know if you saw both the German and Spanish newspapers had this really racist cartoons about keeping black people out because of the new variant.

0:14:08.8 FH: Like I mentioned earlier, the irony was it was actually circulating there before. So I could speak to you for hours about the similarities but let me just basically say that the same issues that we had around Intellectual Property being the greatest barrier to timely access and timely supplies or the thing that could take you out of a pandemic is the same thing we're seeing in this pandemic. And I just wanna emphasize the word timely, because if you're getting your vaccine in January and I'm getting my vaccine in December, that's 11 months apart. This is why we have variants, this is why we've created the fertile ground for variants to emerge and for them to circulate. And this is what we were trying to emphasize from last year already as the People's Vaccine Alliance globally, that timing in this pandemic is so important, otherwise, you're gonna have a situation like HIV-AIDS where you wait 10 years, five years, three years for access to the same things that you can benefit from in the rich North, which in the meantime, basically not just cost you lives but it's costing us in new variants.

0:15:24.0 DE: I wanna... There's a lot of really important, very rich analysis that you just offered here, and I wanna break that down a little bit. I just wanna start first with the role of Intellectual Property and the way that this debate has yet again, fallen on the question of control and the question of profit. You've been a leader in trying to get COVID-19 vaccines distributed more widely, more equitably in particular to low and middle income countries. And toward that end, as a mechanism, you've supported waving intellectual property rights for the corporations that hold on to these patents. And that implies sharing the know-how and then also building manufacturing facilities in low and middle income countries. Can you speak to the role of the TRIPS waiver in particular? Explain what that is, and why waving TRIPS is the best approach here? 

0:16:25.5 FH: Thanks. So I think it also links to your previous question about the HIV-AIDS crisis and the lessons we learned in that pandemic, that If you don't actually deal with the systemic issues and the rules of the global trade system, which is basically contained in something called the TRIPS agreement, which is part of the World Trade Organization, a global trade body with member states, and most states are members of the World Trade Organizations, so that they can basically trade, as supposed with equal trading partners. The idea with the TRIPS waiver was that quite early on, because of the lessons of the HIV-AIDS crisis, quite early on in this pandemic, there was a recognition that if you don't address the issue of IP barriers and it's not just patents, its copyrights, trade secrets, there's a range of elements that make up Intellectual Property Protection. If those are not suspended, just temporarily, just for the duration of this pandemic, just for essential COVID-19 technologies, then you're going to have greater obstacles to be able to scale up access and to be able to scale up manufacturing.

0:17:31.3 FH: It relates to PPE, it relates to ventilators, it relates to diagnostic test kits, there's a lot of focus on vaccine but that's just one part of it. So in October, of last year, already before the vaccines were even approved for use or were given emergency use authorization, there was a proposal made by the South African and Indian government to ask member states to temporarily suspend Intellectual Property Protection so that you could create an equal playing field that you wouldn't have worry in each country about possible IP or patent infringement of a particular company's technology and will come to whose technology it is. Because there's a huge debate around, does Moderna own the IP, does the US government own it, does AstraZeneca own the IP or does Oxford University own it, given the amount of public investment and in many cases we argue that the people of Britain and the people of the US actually own the vaccines, it's people's vaccine because public money was used to research it.

0:18:33.0 FH: That aside, the idea was to have a very quick, easy way so that we wouldn't all have to do Issue compulsory licenses and fight for voluntary licenses and apply for the right to scale up manufacturing. Using capacity that exists in Latin America, in Asia, in Africa to also scale up production so that you're not just reliant on a plant in Baltimore, ironically, which became one of the greatest Achilles heel on the Johnson & Johnson rollout because of the contamination issue. Or you're not just reliant on a plant in Maden, for example in Europe, but you could also then use other capacity. And it's been blocked, it's been blocked for over a year by the very countries...

0:19:15.2 FH: That wanted accelerated vaccine research, that are administering booster shots, that are promising donations to us but don't want to deal with the biggest systemic issue. So we've got what we had in the HIV/AIDS crisis, a crisis again, of equity and a crisis of power, because the people who are actually calling the shots and we've been very vocal about this are four white men, who are the CEOs of these pharmaceutical companies who come from the rich North. They are deciding markets, they're deciding prices, they're deciding what indemnification they want, what liability protection they want, they're deciding whether the contract is open or not open. And if there's non disclosure agreements, they also decide where supplies go to first.

0:20:00.0 FH: So there's no transparency on delivery schedules. And when we call that delivery visibility and this is the reason why when we've had to rely on a handful of manufacturers without the IP relaxation, without the TRIPS waiver. While it's been a really difficult battle to be able to scale up manufacture, that has resulted in a drip-feed of supplies to Africa and parts of Latin America and South Africa. For the better part of the up until October, we had a drip feed of supplies. The data is on our website, it's Health Justice Initiative. So you can actually see based on the numbers, the Affinity has given this data, the Economist has provided this data, our world in data, it has all of the different tables. That evidence is the, of the drip feed of supplies of vaccines into low income countries and COVAX too has been unable to meet supplies.

0:21:00.0 FH: So at the heart of it, is... We would have been in a very different situation if that waiver had been approved in December that have been approved in January, February. In fact, even if it's approved right now, we could be in a different situation in two years time, because what's clear with the variant is, we all going to have to get booster shots, right? So the market for vaccines has just, I think, tripled [chuckle]

0:21:24.0 DE: I wanna jump into this right, because the opponents of the TRIPS waiver, include a number of high income countries, the Gates Foundation, obviously the pharmaceutical industry. They make a number of claims to defend their position here. They say, "Well, the capacity to manufacture vaccines is limited in low and middle income countries." They say that the real limitation to vaccine access isn't actually the vaccine supply. It's the last mile problem, as they say. They say that it would slow the capacity to address and pivot, if we needed to in the face of a variant. That's what they say. I'm hoping maybe you can respond to some of these assertions that they make and tell us why they really do oppose the TRIPS waiver.

0:22:25.1 FH: Sure. Okay, that's a lot of questions wrapped into one. Let me take them one at a time. So this assumption that the Global South can't make diagnostic kits or vaccines or treatments is, we believe, wrong. And it's wrong because we think it's rooted in a lot of racism and a lot of myths about what our true capacity for production really is. There's been an investigative piece done by Stephanie Nolan of The New York Times. Basically went around the world and spoke to all available manufacturing partners and showed that there's ample existing manufacturing capacity, even in Africa. The WHO invited expressions of interest from partners in the Global South as well as in the Global North to be participants in what's called, "The mRNA WHO hubs". One of which is actually been set up in South Africa, but Pfizer and Moderna are bypassing them. They refuse to cooperate and share their technology. They are companies in it...

0:24:00.0 FH: In Latin America, that would tell the same thing in the HIV/AIDS crisis, companies in Asia, companies in Africa. So we believe that they are companies around the world, including even a company in Canada, who said that they're willing to manufacture vaccine for a country like Bolivia. But the Canadian government refuses to take on the power of Johnson & Johnson and issue a license 'cause Johnson & Johnson refuses to voluntarily give a license to this company. So the one thing we've been dealing with is this myth that there isn't capacity and we've shown that there is and that this is an incorrect assumption.

0:25:00.0 FH: The second is that if you ask the company nicely, they'll give you a license. That's been the farthest from the truth. Every single effort has been attempted with the CEOs of these companies to voluntarily share their technology to transfer the knowledge, to participate in the mRNA hubs, they refute. So when I said earlier, the CEOs are playing God in this pandemic and they make all the decisions. They will bypass an mRNA hub that has been set up to scale up mRNA vaccines and instead, do bilateral deals with one or two companies which, which have limitations on, geography limitations on volumes. And usually those licenses are still unfinished. They're not even full manufacturing licenses.

0:25:35.0 FH: So the reason why we believe, coming to the second part of your question, why there is such an existential crisis in the pharmaceutical community and why they are lobbying so hard with the support of people like Bill Gates, because his foundation has now done a U-turn, and they've now said that they're in support of the relaxation of IP, but there are certain global philanthropists who unfortunately put a lot of money into global health. And they have had a chilling effect on the ability of people to speak out in support of the waiver, But not withstanding what Bill Gates has to think. I mean, the Vatican supports a relaxation of IP, Nobel laureates support that, 100 countries do, former world leaders do. So I really think that Bill Gates and people who believe what he does in relation to this waiver, he's called it the stupidest idea in [0:25:41.8] ____ inverted commas, he said it's naïve and foolish. Would one day be judged as being on the wrong side of history, but we believe that the real reason why the industry and a few global leaders, the US, the UK, Norway, Switzerland...

0:26:00.5 FH: And obviously, the EU particularly Germany and the UK, Boris Johnson, also opposed to the waiver. It's a handful of nations blocking what 100 countries, 110 countries now actually want... It's because if you allow this waiver, I think in their mind, then you're basically saying that intellectual property is secondary to human rights and to the right to life. And if you allow this in this pandemic, I think there is a fear on their part that they will never be able to claw back on the excessive protections and exclusivity that IP gives you on life-saving medicines. Because if you open the door in this pandemic on COVID-19 technologies, then the next we're going to want is flexibility on any other life-saving medicine and this is the battle we have had for the last 30, 40 years about the... What happened was really immoral and unethical to include medicines into the TRIPS agreement. It wasn't always like that, it was the role of Pfizer and its CEO at that time that basically brought intellectual property protections on pharmaceutical products.

0:27:08.9 FH: So the pharmaceutical industry is very powerful. It's more profitable than oil and gas. It's a really powerful industry, and you've seen the billions that all of these companies have made in the last year. The announcement of the variant actually made the stock value of Moderna shoot up. There is the bottom line reason for why these companies and their lobbyists and they bought congress to even... The US Congress to say that they don't support the waiver. I think that, for them, this is an existential crisis. And finally, I think linked... It's what we saw with HIV/AIDS, if you waive IP, you give up control and you give up power, you can't then choose which partners, which country, which market, and our observation of the industry at the moment is they want absolute control and that manifests in the way in which they've given these partial licenses as well. But let me stop there, if you wanna delve into that a bit deeper.

0:28:06.7 DE: No, I really appreciate that and I think folks who have been thinking about prescription drug policy in this country see an obvious set of parallels. The prescription drug industry has spent 4.3 billion, that's with a B, in lobbying alone over the past 20 years, and we're having a robust conversation right now, in the course of the Build Back Better package about whether or not Medicare, the single largest buyer of prescription drugs, should have the right to negotiate prescription drugs on behalf of seniors in this country. Many of whom report, a third of whom report rationing their medications because they can't afford it, and it is the same kind of greed that we see, that focuses only simply on corporate bottom lines.

0:28:52.9 DE: That, despite the irony of the fact that we largely American taxpayers are investing in the research that then turns into these prescription drugs, and the thing that I think it's important to remember is that prescription drug companies spend more on marketing than they do on research and development of their product. And it's everything that you need to understand about what they are, these are large in effect private equity firms, they take investments in biomedical compounds and the ones that pan out end up paying for everything else, and some. And here we are, and it's keeping people in this country from getting access to their medications, and it's keeping people abroad from getting access to this vaccine in the context of a global pandemic. Where are we now on the TRIPS waiver conversation? Is there some light at the end of this very dark Greek alphabet ladden tunnel or are we right back where we were? 

0:29:56.5 FH: I think the next variant, they should call, "inequality" because I think that's where we're at.

0:30:03.4 DE: The iota variant.

0:30:07.6 FH: Yeah [chuckle] Vaccine apartheid is alive and well. So we were supposed to have the WTO ministerial meeting, it's called the MC12 about a week ago, but just on the eve of everybody actually getting on the plane to go to Geneva to have yet another meeting, which this time was going to be in person to trash out hopefully, the final text of the TRIPS waiver, the variant emerged and that's when everybody... Was banned... And basically, the meeting has been postponed indefinitely. Of course, the push by activists and advocates like us, in fact, and this campaign has really been led by people who work at the [0:30:48.7] ____ by the South Center, by MSF Access Campaign and obviously groups in the US like [0:30:53.4] ____ and [0:30:56.4] ____ who incidentally have also done a lot of the work around prescription meds in the US, and the issue of evergreening patents and have really been lobbying the US Congress around reforming the entire US patents and medicines regulatory and pricing system because that has an impact on us.

0:31:13.6 FH: Now, whatever happens in the US, with what Gilead does, or Pfizer, or J&J has a direct impact on us and our ability to access affordable medicine. So where we are at with the waiver is that the meeting that was supposed to trash all of this has now been postponed. We are saying that you don't need to have an in person meeting. You can have a virtual meeting on Zoom where you can pass this waiver. We're getting to the point where 110 countries support the waiver like we said there are a few blockers and we're trying to increase the pressure on these governments in relation to why they continue blocking it 'cause they really are on their own side of history. And if the blocking continues beyond the end of this year, then I think one, it tells us that the world priorities are really not about equity in this pandemic or global solidarity, even though they promised that. But It's more about prioritizing IP claims, but the second option is to actually call for a vote. The WTO operates on a model on consensus voting, but actually you can pass the waiver by going to vote. The...

0:32:18.9 FH: The spanning works is that your government, the Biden administration decided earlier this year, which was significant and not so significant, time will tell, whenever you or write books about this pandemic. We'll have to see whether Biden's move was strategic or whether it was really rooted in trying to actually save lives and the US indicated through caption time, the WTO, the trade investor, that they would support a partial waiver, but only in relation to vaccines, not in relation to all other medical technologies. And so that position, the US as somewhat kind of in the middle of, "We'll support you on some parts, but not everything." While the EU and the UK is holding out in the... EU in response, it's quite incredulous. The EU, particularly because of the position of Germany, Switzerland, Norway and then obviously, also the UK in the Boris Johnson administration has been about protecting pharmaceutical interests and protecting their technology has said that we shouldn't use the waiver as the mechanism.

0:33:27.6 FH: We should use something called the "Third Way" and the "Third Way" is the EU's supposed solution to dealing with the fast moving pandemic part. All of a sudden now, 25 years later, after we have been asking for compulsory licenses on HIV agents, to use compulsory licensing as a mechanism to try and deal with every single access issue, which is not feasible, compulsory licensing mechanisms have rarely ever been used successfully, when you see what's happening in Canada. And when you do try and invoke a compulsory licensing measure, then usually what happens is the pharmaceutical industry lawyers up and you basically spend years in court before you can even try and achieve that. So I'm not... I mean, on the one hand, I'm trying to be optimistic, but on the other hand, the situation is getting worse, more people are getting sick and dying. We really don't have sufficient supplies of vaccines. Let alone diagnostic kits... And we worried that next year, we're going to now start treatment about it, not just vaccine of update. As the FDA is looking at data around what Merck and Pfizer basically announces, the preliminary data on some of the antivirus.

0:34:43.2 DE: I wanna ask you, so on that front, we saw that Merck in particular, agreed to offer licenses for manufacturing abroad, in effect bypassing this TRIPS waiver question. Do you have... Do you feel like that is an effort to get ahead of this particular issue and then create sort of an alternative system that they can then game, or do you feel this is in good faith? 

0:35:14.8 FH: So, I'll never regard any action by a pharmaceutical company in the middle of a pandemic as necessarily one of good faith. And the reason why I say that is when you look at the terms and conditions of that particular license, which we believe is quite restrictive, and excludes multiple countries, and at least about 40% of the world's population. So the way we view that particular move is that one, it's around trying to get ahead, like you said, of the TRIPS waiver and the demand for the lifting of IP protections, to be in total control of the geographies, of the terms of the licensing and to try and control who the partners are in this particular configuration of actors. And it's not a universal, non-exclusive general access license. If it was, then I would be the first to say, "Well done Merck, you've actually done the first universal non-exclusive license," but that is not the case.

0:36:19.4 FH: Similarly with Pfizer, so they've... They pick and choose countries like you're picking fruits in a supermarket of which countries are in the territory, which countries are not in the territory. The issue, obviously, for Latin America is that Brazil, bizarrely, has been excluded from the territories of the licenses. So what it does, these licenses, if they're not done in a way, which is totally non-exclusive and universal, which says everybody can share the technology and everybody can use it everywhere, is it... Then creates domestic obstacles. So if you are territory that's been excluded, for example, in the one license that we got with Pfizer, they said only the South African public sector can be in the territory. Now a lot of people in South Africa use what's called the private sector, even low income workers because they are on low income medical schemes. So it then becomes even more difficult for activists in each country to be able to access a cheap generic version of those treatments, right? 

0:37:19.0 FH: Given what they estimate to cost in the private market, $700 for a [0:37:23.3] ____ division and for example. There's already warning bells around who's going to be able to access them, when and at what price? And this goes back to the battles we had for the HIV/AIDS problem. So, no, I don't necessarily see them in total good faith. And I think what they do is, they segment markets. And that is the problem with restricted licensing. If you create further segmentation, we create a further division in countries, within countries and across countries. But I can guarantee you that you'll get those treatments before we'll be able to get our hands on them. And it will take us years before we can access the same kind of treatment regimens, that you'll be able to. But in your own country, of course, you're gonna have communities that will never be able to access that treatment, they'll just be too expensive. And so what happens which is what usually happens in every epidemic and pandemic, the rich will be able to buy their way out of the pandemic and the poor will not.

0:38:28.4 DE: I wanna move to a couple of questions from the audience. First question is what role can scientists and academics play in advocating for vaccine equity and show meaningful support for something like the TRIPS waiver? 

0:38:44.5 FH: Yeah. Great question. So there's already been... As part of the CROI conference, there been something called the CROI declaration on vaccine equity, and there's been... Which is different from the HIV/AIDs pandemic is that within the space of a few months, we have scientists and academics, particularly IP academics who are also coming out on the side of activists who are calling for a TRIPS waiver. So I think there's two things that can be done. The one is to join the global calls for solidarity and signing onto the Doha Declarations which are really just words.

0:39:19.0 FH: But I think the more important thing that can be done is, in the relationship and the contacting and the ethical research that one has to undertake with these pharmaceutical companies. There has to be a greater questioning of why are we doing clinical trials and research for you, or at your request if you are not going to ensure global universal access, if there's no post trial meaningful access then what is the point of scientific research, if you can't benefit from fruit of scientific knowledge? 

0:39:48.2 FH: The irony of that [0:39:48.9] ____ to do is that we did four clinical trials in my country. My friends and family took part in the J&J, AstraZeneca, and Novavax trials and we were not [chuckle] guaranteed access upfront. In fact, other countries like Canada and Australia that maybe did less even on clinical research were able to benefit as priority customers on vaccine access. I think that is one of the questions of, we can't have a repeat of this with the treatment. We can't have a repeat of this now, as vaccines potentially come into the market as booster shots to deal with the multiple variants.

0:40:23.7 FH: And then as academics. I think the there's a movement of progressive academics that are doing two things, one, pulling from the TRIPS waiver, but secondly pulling out of the racism. And what's been surprising in the last week is that academics and scientists, for example, in South Africa have decided, like enough, they're just speaking out about the racism about being on the receiving end of two things, the travel ban vaccine inequity, which we believe has led to the situation of more variants.

0:40:53.1 FH: But then also what they're calling appropriation of data from the Global South. So we doing the work, doing the research presenting and sharing the data and then the data gets taken by the Global North. So I think, you know this pandemic... I think [0:41:07.1] ____ interesting about right, it's a portal to the systemic inequalities and global issues that we've always had to be dealing with. And the pandemic is... This pandemic, I think, is just bringing to the full, all of the issues that we've neglected for the last 25 years after the HIV/AIDs crisis, because we've got the Doha Declaration and we thought the world would never do this to us again. But here we are. We are in the exact same position, if not worse.

0:41:33.8 DE: I appreciate deeply that point, and it has been a scale-free accelerator of the mechanisms of inequity, and whether you're talking about inequity on a global scale or inequity on a local scale, we've watched as low income people and people who have been historically marginalized by colonialism and racism constantly be on the worst end of things, and not just on the healthcare side. We haven't even talking about the economic consequences and the impact that travel bans have on an economy. And disproportionately on the lowest income people in that economy.

0:42:06.1 DE: I wanna quickly... We've got about one more minute and I just wanted to ask you, we were honored to host Dr. Ghebreyesus Here at the university, and he expressed some really profound concern about the inequity of people in the United States, as you mentioned, getting their third shots before a lot of folks got their first shots abroad, in particular in much of Sub-Saharan Africa. And I wanna ask you if you could just comment on your perspective on the ethics of this issue in particular, the fact that people point to hesitancy, But hesitancy is a function of information, and the reality of it is that we gave disinformation a lot more of a head start because of the lack of access to vaccines earlier on. So I'd love to hear your perspective on this.

0:42:54.7 FH: I'm so glad you said that because that's the point we've been trying to convey. The timing matter so much in a pandemic, and so we are seven months behind you in vaccination, that's when you have hesitancy in the anti-vax movement growing. And I think that the WHO DG has been right on the money, and he's been calling out the inequity since day one, it's not just the booster shot. And I agree with him, its totally unethical to be doing the third and fourth shots, when most people, including healthcare workers in Africa haven't been vaccinated. We haven't even protected the front line, 7% vaccine rate in Africa is actually shameful.

0:43:30.7 FH: One in four healthcare workers in Africa have only been vaccinated. That means three out of every four people who are working in a hospital or in a clinical facility are not vaccinated. So I think that inequity is not just about the booster doses of the unethical parts, not just about the booster doses, it's the fact that all healthcare workers and people over 17, every part of the world have not been vaccinated. And we asked for that in February. He said this in January, February, already that before we administer even first shots to all... Somebody like you, or some like me, let's make sure that we reach the people who are most at risk, and people said they would do that. And then they didn't. And that is what we call vaccine nationalism.

0:44:13.4 FH: It's difficult, of course, because a lot of these countries are saying, but our people, people who voted for us have said that we've gotta protect our own first, but I think that's at the heart of the inequity is that the nationalism that we've seen has been of such epic proportions that of the 7.2 billion doses of vaccines administered in the world, the majority went to high income countries, that tells you that we really don't just have an ethics problem, but we also have an equity, a human rights, a systemic and IP it's... Everything has culminated, which is perfect breeding ground, I think for hesitancy, for new variants to circulate for irrational responses, which are couched in public health language. And then obviously for greater inequity, which is, all of the things that an anti-vax movement is thriving on right now.

0:45:12.8 DE: Well, I really, really appreciate this opportunity to engage in conversation. And I'm going to go ahead and thank you, and then hand it back off to Professor Parthasarathy, who's going to take it from here.

0:45:25.4 SP: Thank you so much Abdul and Fatima, that was just a wonderful, wonderful conversation. So important and I think you did such an extraordinary job of conveying the gravity of the situation and not just the gravity, but I think it's sometimes difficult to see how seemingly technical decisions... As you said, why are we doing this research in the first place? What is the point? If we are not ensuring access, is something that I think a lot of the folks on the Zoom, especially a lot of our community comes from the sciences and engineering and that's really what brought them to be part of this program. And so that's something that I think is very motivating for a lot of my students and a lot as I said in our community.

0:46:15.7 SP: But in addition to that, I think the... Your perspective from South Africa is something that is extremely important. And yet we don't hear enough in the west. And so I really appreciate that. And I am so thankful that you're out there fighting this fight, and I hope that you have... That we have something to be optimistic about [laughter] moving forward and Abdul, thank you so much for your wonderful provocations and inter... And being such a wonderful interocular. I think again, connecting the debates temporarily between the HIV/AIDs crisis and the current pandemic in South Africa.

0:47:04.8 SP: But then the global context in the US and the debate about drug prices is so important because I think there are lots of places where we can all intervene in addressing this nexus of health equity, intellectual property, and science, and hopefully that gave some of the viewers some ideas about how they might do that. So thank you both very, very much. I greatly enjoyed this. And thank you Fatima for managing all of the technical challenges to be with us today. I'm sure you have a super busy schedule. So we'll see you both soon I hope. Take care.