On tackling the COVID-19 pandemic and taking heart with the latest observations from Bill Gates, I can appreciate his point that it is « not timely » to engage in a blame game. The pandemic is still not under control. We are in the midst of so much – saving lives, staying healthy, easing back into productive activities, avoiding a second or third wave, finding a vaccine or a cure, helping those who are in dire straits to have access (both to health care and to livelihoods generally), halting the looming famine where the pandemic has just taken off. So much needs to be done! We are advised that our attention is urgently needed to be focused in this time of crisis through what Mr. Gates describes as a “scientific” lens”, and not a “political” lens. Our resources, too.
I have great respect for Bill Gates and do agree with him that a full review of what has gone well and what has gone not gone well in the COVID-19 pandemic so far is better conducted at a much later date. Even the scientific lens on which we are relying is gathering such rapidly changing knowledge about the nature and impact of this virus that one really should wait for any critical scientific assessments until the pandemic is better controlled. Nonetheless, I would argue with the choice of descriptors. A “political” lens is urgently needed to complement the “scientific” one – not in terms of the “transmogrification” of the political world that we are enduring with ignorant populists like the current US or Brazilian presidents. But we need the perspectives of the political scientists, the philosophers, the ethicists, the humanists, if not also the globalists, the multilateralists and even the transcendentalists to guide us along with the scientists. We need this now. Not in some kind of future retrospective examination of how this pandemic has altered our sense of normalcy and decency.
One can identify a multiplicity of issues where such a political lens is urgently needed, even as we defer to and support the freedom for scientists to collaborate both globally and domestically in the search for COVID-19 vaccines, diagnostics and therapeutics. Here are four areas that call for our immediate attention: the human rights implications in contract tracing, the institutional framework for globally mobilizing the resources needed for a collaborative effort, the tension between intellectual property and access in determining how to share the innovations, and the accommodation for new combinations of multi-stakeholder collaboration. These issues are inter-related, but they arise in a cascading degree of urgency. All need to be viewed through a political lens as well as the scientific one.
Human Rights and COVID-19
The most obvious example of why we need a political lens today is in the unfolding debate and array of tools for “contact tracing”. Yes, we do need to consider using the technologies of today that are being refined to help us with this formidable task. Indeed, some of the abuses of privacy that are involved in these technologies are already widespread in places like Facebook and Google. But we are running the huge risk of legitimizing the public policy application of these tools and practices for their “scientific” value in containing the spread of the virus. It’s one thing to manage and regulate business practices (which are clearly needed), but it is yet another to translate these invasions of privacy into a governmental setting. There is no need to delve further into this here. Instead, one should listen to the warning calls from groups like Human Rights Watch or the High Commissioner for Human Rights.
It is a bit shocking how eagerly we hear that the Australians have embraced one of these tracking devices, the COVIDsafe app, on their phones, and we know that variations have been applied effectively in places like China or Korea. It is encouraging that in France, where the unusually freedom-loving French have adapted to confinement, the electronic monitoring of contract tracing has been put on hold. There are obvious human rights implications in the very nature of contact tracing and its implications for quarantining people who have come into contact with someone who has fallen ill with the virus. All aspects of this need to be managed with a political/human rights lens, but the new technologies are especially concerning. So let us focus that political lens on the kinds of testing and tracking programs that are being developed by our governments to protect our privacy and our human rights – the basic underpinnings of a democratic society.
A Global Framework for Resource Mobilization
A second unfolding debate revolves around the absence of a suitable global framework for mobilizing collaborative resources. It is good that efforts are still being made to promote collaboration through the United Nations, but it seems that more attention is being directed to the smaller configurations of the G7 or the G20. These configurations are in themselves archaic or non-functional, but no one seems ready to construct a new configuration. Or is that really the case? The latest iteration of this debate is the launch of a new coalition to accelerate access to COVID-19 tools, the ACT (Access to COVID-19) Accelerator.
At first, I thought this was great news – building on what the signers of “A Letter to G20 Governments” had urged to be done through the G20. This “letter” calls (again urgently) for more collaborative action on global health initiatives to address COVID-19 led by the WHO but also on emergency measures to restore the global economy. The G20 might not be the best alternative for global action – why not the UN, after all? But one can set that aside for now, with an appreciation for the inadequacy of the UN’s governance structure (both its General Assembly and its Security Council) to channel the kind of global political will that is needed for this coronavirus crisis. The G20 it is, then. Its health ministers did, after all, issue a lukewarm endorsement of shared concerns following a virtual summit on 19 April.
The letter, meanwhile, asked for a lot more from the G20. It came out of something known as the “Project Syndicate”, and was spearheaded by three coordinators – Gordon Brown (the most visible, a former UK Prime Minister) along with the head of the LSE Institute for Global Affairs Erik Berglöf, and the head of the Wellcome Trust Jeremy Farrar. Project Syndicate, by the way, is a well-established service for distributing articles from “the world’s leading thinkers”, although with somewhat of a left-of-center and “Anglo”, if not exactly an “Anglo-American” orientation.
The long list of signators to the letter, though, reached beyond this orientation to include former heads of state or government (Gordon Brown, of course, and Tony Blair, too, but also Gro Harlem Brundtland, Helen Clark, Ruth Dreifuss, Joyce Banda, Thabo Mbeki, Ellen Johnson-Sirleaf, Ernesto Zedillo and Fernando Henrique Cardoso, among others. It also included the well-known American economists Dani Rodrik, Joe Stiglitz, Laurence Summers, as well as the former American heads of the World Food Programme, Ertharin Cousin and the Global Fund, Mark Dybul. So the list was impressive. And, more importantly, I did like the letter’s platform for immediate as well as longer-term solutions, calling for a G20 Executive Task Force and a G20 Action Plan.
A few days later, on 24 April 2020, the WHO Director-General co-hosted the launch of the ACT Accelerator initiative, mentioned above, with co-hosts Emmanuel Macron, Ursula van der Leyden and Bill and Melinda Gates. The WHO press release describes it as a “landmark collaboration”. Its purpose is to “accelerate the development, production and equitable distribution of vaccines, diagnostics and therapeutics for COVID-19”. This appeared to be the kind of initiative that the Project Syndicate group had been calling for. After all, it had a lot of G20-like participants on the program for the launch event – from Saudi Arabia (this year’s G20 host), Germany, Italy, the UK, South Africa. It was also announced that a pledging summit to raise a targeted $7.5 billion would be held on 4 May 2020, to be hosted by the EU. And, finally, it looked good from a multi-stakeholder perspective, too: the International Federation of Red Cross Societies, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), UNITAID, GAVI, the Coalition for Epidemic Preparedness Innovations, (CEPI), the Wellcome Trust and many others. The group also had recruited two “Special Envoys”, Sir Andrew Witty, the former CEO of GlaxoSmithKline and Ngozi Okonjo-Iweala, the former Nigerian Finance Minister.
What struck me about this announcement was to see who was NOT there. Obviously, of course, one would not expect the US to attend – or China either, for that matter. In fact, Gordon Brown, in interviews publicizing his letter and his G20 proposal, acknowledged that it was problematic to portray his proposal as a G20 initiative without these two. But he seemed to think that they would eventually come around once they saw how the rest of the G20 membership was mobilizing for collaborative action. One has to wonder, though, about the other missing G20 countries – Japan, India, Russia, Turkey, Argentina, Brazil (well, okay, not surprising there), Mexico, even Australia or Canada. Representatives of these countries were not listed at the 24 April launch event, but perhaps they will all show up at the 4 May event. One can hope. The main missing actors, though, have to be the two giants who are at loggerheads with each other, the US and China. Can there be a G20-like initiative without them?
This initiative is clearly very much in flux, and the ways in which it might build on the G20 for a different kind of global collaboration has my own political lens very much in focus. The urgency in this instance might not be as immediate as it is for the contact tracing issue, but the pledging summit on 4 May gives it an urgency, nonetheless. Thus the issue is very timely, and we should all be encouraging global collaboration and whatever institutional framework it requires.
Intellectual Property and Access
Meanwhile, a complicating factor has emerged in the sightings through the political lens that is being promoted here. This is the third issue in our list of four in this commentary. As expected, the WHO will be announcing that the May 2020 World Health Assembly, which usually runs for some 10 days or thereabouts, will be convened as a one-day “virtual” WHA on 18 May 2020, with the agenda largely limited to the COVID-19 pandemic. Thanks to reporting from Health Policy Watch, we hear that the European Union is circulating a draft resolution for consideration at this virtual summit to create a “voluntary patent pool of new COVID-19 health technologies”. Aha! And of course! The access-to-medicines issue is integral to any genuinely global collaboration on vaccines, diagnostics and therapeutics, as clearly envisioned in the ACT Accelerator initiative. Given that the EU, the WHO, France and the Bill and Melinda Gates Foundation have divergent non-state actors like the IFPMA and UNITAID in their coalition, two groups that have been on opposite sides of the intellectual property issues in global health, would suggest that they have worked up some kind of compromise.
Not surprisingly, then, one sees the likes of Médecins sans Frontières and Knowledge Ecology International popping up to support the proposal but to push for the proposed patent pool to have even more control of intellectual property rights. And, on the other side of the debate, one sees both the World Intellectual Property Organization and the World Trade Organization arguing that maybe a patent pool is not necessary since existing international rules on TRIPS flexibilities, compulsory licensing and patent law principles are there to guarantee both innovation and access. Ah well, this could be an interesting debate. Even if the US and China stay out of the ACT Accelerator initiative, it would be foolish for either one to stay out of the WHO debate on 18 May. The political lens is clearly showing us how contentious policies – and even international rules – can be transformed by responses to the COVID19 pandemic. And just as with the previous two issues on contact tracing and a global framework for collaboration, the opportunity for action is upon us, .
New Combinations for Multi-Stakeholder Collaboration
A fourth and final point for using a political lens takes me back more comprehensively to my long-standing advocacy for multi-stakeholder and multi-sectoral collaboration. It actually ties in with the nature of the new coalition that is helping to set the stage for the debate on intellectual property. That is to say, there is a growing phenomenon of mixed public/private partnerships, of which the ACT Accelerator is a very recent example. Without resorting to a long historical narrative, I will draw on the examples of the Global Fund and GAVI, with a few observations also about the role of the UN Foundation in supporting global health initiatives.
When the Global Fund was established in 2002, there was a lively debate about the role of the private sector in its operations. It was eventually worked out to have both private sector and NGO representation on its board. The early support from the Bill and Melinda Gates Foundation and the Wellcome Trust also expanded to include other private (i.e. not public) financing sources, most significantly through the initiative known as Product (RED). Of course, there have been numerous entertainment-related initiatives that have helped fund AIDS, poverty eradication, and other global health concerns, and the latest Lady Gaga initiative for COVID-19 is just a latest example of that. But the Global Fund’s revenue sources continue to be primarily public – at approximately 93%, with the largest contributors being the US and the UK.
The Global Alliance for Vaccines and Immunizations, now known at GAVI, the Vaccine Alliance, was established in 2000. Again the main inspiration came from the Bill and Melinda Gates Foundation. Somewhat smaller than the Global Fund (whose 2020 to 2022 pledged funding is at $14 billion), GAVI has grown to garner pledges for the next six-year period (2020 to 2026) of some $20.9 billion. The public share of this is 79%, with 21% from the private sector. The point it that not only is GAVI growing, but it is also attracting a larger proportion of private sources than the Global Fund. In addition to the Bill and Melinda Gates Foundation, there are multiple sources, including the Children’s Investment Fund Foundation, Lions Club International, but also individual companies like MasterCard, Orange and Unilever! We have often drawn on GAVI’s experiences with multi-stakeholder and multi-tiered governance as a model for other initiatives. So both the Global Fund and GAVI are precursors for new multi-stakeholder governance models.
On COVID-19, one might also want to look at more comparable initiatives for emergency funding, such as the Ebola epidemic rather than the Global Fund or GAVI. That effort raised close to $500 million for the WHO over the 2014 to 2016 period. Both Gates and the Wellcome Trust were the largest private sector sources, but the WHO report doesn’t provide a public/private comparison of sources. What is worth noting, though, is that the UN Foundation, a private sector initiative at the UN itself, played an instrumental role in consolidating other private funds to the effort. In today’s COVID-19 crisis, the UN Foundation is even more visible. This is where we need to apply the political lens for what is happening on resource mobilization with regard to COVID-19.
The COVID-19 Solidarity Response Fund was launched on 13 March 2020 by the WHO in collaboration with the UN Foundation and the Swiss Philanthropy Foundation to raise private sector sources for the WHO’s Strategic Preparedness and Response Plan. In just six weeks’ time, the Fund has raised over $200 million from over 280,000 donors! This is a striking contrast to anything that has preceded it and shows the wide array of private sector entities that have responded. Top of the list are Facebook, FIFA (yes, football), FluLab, Google, GlaxoSmithKline and TikTok. One could indulge in speculation about motives, but suffice it here to say that the response is awesome. There are a number of health sector industries on the list – Johnson & Johnson, Merck (MSD), Medtronic are ones we have worked with in the past. But others are from the automotive industry, the food and beverage industry, clothing, banking, sports (even the NBA) – and high-tech’s old guard types like Cisco or SAP or SONY and newcomers like Spotify or Zoom. The fund is growing day by day. The turnout suggests a dramatic broadening of stakeholder interest in working together and with the WHO on this crisis.
So in addition to the need for a political lens on immediate issues like contact tracing or IP versus access, or on targeted initiatives like the ACT Accelerator, putting a political lens to the crisis is showing a massive upsurge in a diverse array of stakeholders. The examples given here may mostly be from the private sector, but they are truly diverse, and many are hybrid groupings of different kinds of non-state actors. Lady Gaga spearheaded the online extravaganza “One World: Together at Home” with the powerful message that we are all in this together. We should be exploring ways to convert this upsurge into new kinds of multi-stakeholder collaboration, possibly modelled on the Global Fund and GAVI.
This is the time to appreciate the political lens as well as the scientific lens. This commentary has touched on four issues. First, we need to be concerned about our privacy and human rights. We know that we need to contain the virus until the scientists find the vaccines, diagnostics and therapeutics we need to stop it. But we also need to carry out any containment (and decontainment) measures with an appreciation for their effect on our human rights – and on our democratic systems of governance. Second, without dwelling on US obstructionism, we are witnessing dramatic signs of change in global governance frameworks. These signs merit our scrutiny and support for innovations going forward. Third, we are challenged to refine our approach to intellectual property and access. We can appreciate the need to ensure an equitable distribution of what may become available, and this clearly includes a new understanding of the interplay between intellectual property and access at the virtual World Health Assembly on 18 May. And fourth, we are witnessing a massive upsurge and mixing of resources from different stakeholders. The enthusiasm is there for all of us to be engaged, and the opportunities are there for new arrangements of multi-stakeholder collaboration.
These four issues are among many others that call for us to speak up about the ways in which our responses to the COVID-19 pandemic will define our future. They are actually issue areas where we have opportunities to improve our lives and our ways of living together. We know, too, that this pandemic caught most of us unprepared but that more pandemics are possible, and even likely in the future. We can’t let the solutions for today’s pandemic depend entirely on science when they will also define how we govern ourselves in future pandemics. So let’s not ignore that political lens!