The Center for International Relations in Health (Cris/Fiocruz), the National School of Public Health (Ensp/Fiocruz), the Network of Schools of Public Health in Latin America (Resp-AL), the Latin American Alliance for Global Health (Alasag), the Argentine Network of Schools of Public Health and the International Network of Health Technicians (Rets), who usually work in partnership, promoted the international seminar Vaccines and medicines for Covid-19 as global public goods. The event, held on JUly 30, can be watched (Portuguese/Spanish) in full on the VideoSaúde Distribuidora YouTube channel.
Held online, the meeting aimed to reflect on access to vaccines and medicines against Covid-19 by developing countries. The speakers were the adviser to the Costa Rican Minister of Health, Albin Chaves; the researcher at the Ifarma Foundation (Colombia), Francisco Rossi; the director of the Institute of Technology in Immunobiologicals (Bio-Manguinhos/Fiocruz), Maurício Zuma; Cris/Fiocruz researcher and Alasag's executive secretary, Sebastián Tobar; and Fiocruz researcher Jorge Bermudez.
Tobar, who mediated the seminar, recalled that access to vaccines and medicines against the new coronavirus must 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 aware of the immense difficulties in guaranteeing access for 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 that we face, we need to have the responsibility to ensure access for 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 prices for the product, making it impossible for the poor to be immunized”.
Tobar recalled a phrase said 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 had an impact on the whole world, but the responses were different, making global inequalities even clearer and deepening them. “Homeless people, street vendors, people who live in poor, indigenous communities ... all of 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 materializing”.
For Bermudez, the false dilemma between saving lives or saving economies cannot allow a stoppage of initiatives. “There is a difficulty in tackling inequalities, but we have seen meetings of the UN, WHO, G-20 ministers of health and other international forums, in line with the 2030 Agenda. A global public health action plan is needed, covering innovation and intellectual property, regulation, adequate prices, access, coverage, joint purchases and supply so that we can respond to this unique challenge”.
Bermudez warned, however, that the solidarity shown so far by many leaders may not go off the record. “We see a rush by some rich countries to appropriate and buy everything, leaving the poor in a state of poverty. After all, we live in a predatory and excluding society. It is revolting and frightening to know that there is talk of a vaccine that, according to some international manufacturers, could cost up to $ 40 a dose! This is the denial of solidarity and reflects a selfish and cruel worldview”.
“A progressive Ibero-American parliamentary group was created to build a regional proposal that would allow everyone to have access to treatments against Covid-19. 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, uttered at the UN General Assembly in 1982. “The idea of a better ordered world is a world in which discoveries will be free of patents and there will be no profit from life and death ”.
Then there was the intervention of the adviser to the Costa Rican Minister of Health, Albin Chaves. He spoke about his country's health system, which has the lowest Covid-19 mortality rate in Latin America. This reality is largely due to the work of the Basic Comprehensive Health Care Teams (Ebais), which are at the forefront of combating the pandemic in the Central American country. Ebais are more than a thousand health centers spread across the country, with doctors, nurses, technical assistants and pharmacists. Chaves narrated the performance 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 practically 100% of the population has running water at home. "Our principles are equity, solidarity and universality".
“The country invests heavily, within its possibilities, in prevention. We have clear public policies regarding vaccines and medicines. At the international level, the Costa Rican government has proposed a plan to the UN 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 of age. And one of the countries with the lowest mortality rate: 10.82%.
The Ifarma Foundation researcher (Colombia), the epidemiologist Francisco Rossi, who also worked at WHO and at PAHO, then intervened. According to him, the battle for access to vaccines and medicines against Covid-19 is one of Ifarma's main guidelines for action at this time. Rossi, however, was categorical in making his position clear: "if we are to go back to the 'old normal' it is better not to have a vaccine. This is because what we had, and continue to have, when we see the exclusive nationalism of countries like the United States, was an unequal world with profound inequities. It is necessary to overcome this reality ”.
For Rossi, the pandemic is a global problem that needs global and humanitarian responses, disconnected from the idea of profit. “And it is also a great time to discuss the issue of patents. In the case of drugs, 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 countries in the region. He added that pharmaceutical multinationals are looking for ways to generate monopolies in drug distribution. "The hope is in the elaboration of legal instruments such as opposition to patents, mandatory licensing and local production, among others".
The director of the Institute of Technology in Immunobiologicals (Bio-Manguinhos / Fiocruz), Maurício Zuma, was the next participant. Zuma presented to the audience of the event, mostly 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 operations and the many partnerships with research institutions from different countries on all continents. He said that the concept of health as a public good for everyone 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 past five years, the Institute has produced 517 million doses of vaccines, 47 million vials of biopharmaceuticals and 32 million diagnostic kits. We export ACW yellow fever and meningitis vaccines to over 70 countries and we are building the Industrial Biotechnology in Health Complex (Cibs), which will expand the supply of vaccines and biopharmaceuticals to meet not only public health programs but also external demand (WHO, Opas, Unicef) and quadruple production capacity, in addition to allowing the introduction of new products”. The director also commented on the partnership with the pharmaceutical company AstraZeneca to produce the vaccine against the new coronavirus and said that 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, about the presentations. Cris/Fiocruz coordinator Paulo Buss said that the Group of 77 requested a meeting of the UN general assembly to discuss access to Covid-19 vaccines. The Group is a coalition of developing nations that aims to promote the economic interests of its members and create greater capacity for joint negotiation at the UN. “Defending equality is a difficult political struggle, but, in addition to being necessary, urgent. In the case of Fiocruz, we have shown that the institution can be an important player at the international level, and the quality of public servants has been further proven”. Buss, however, sees beyond national borders. “We are going to meet the needs of Brazilian citizens. But we will also be in solidarity with our brothers from Latin America and from Portuguese-speaking African countries”.
The next comment was made by lawyer Mirta Levis, from the Argentine Public Health Association, director of the Center for Studies in Global Health at Isalud University and former executive director of the Latin American Association of Pharmaceutical Industries. She made a quick assessment of the situation in the countries of the region and noted that most countries in the subcontinent do not have the capacity to produce the vaccine against Covid-19, 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 deplored what he called the “chronic precariousness” of his country's health system, which worsened in this pandemic. He said that there is an articulation of Peruvian academic institutions with others from neighboring countries in order to alleviate this problem, exchange experiences and learn about successful initiatives.
Finally, there was the comment of Helifrancis Condé Groppo Ruela, coordinator of International Cooperation at the Polytechnic School of Health (EPSJV / Fiocruz). According to him, it is important not to naturalize this moment, especially from a critical perspective that starts from collective health, critical epidemiology and social determination of health. “Covid-19 is the result of a destructive and predatory production method”, stressed Ruela. For the coordinator, it is necessary to focus not only on the necessary treatments and the appropriate vaccine, but also to discuss the structural inequities and inequalities in health systems. “The pandemic has also shaken training processes, as students are without access to health services. It is a generation that will not be able to form properly ”.
At the end of the event, participants attended a special presentation by 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.