Shared Reflections on Dr. Ngozi’s Third Way and the Opportunities for a New Direction at the WTO

Congratulations once again to Dr. Ngozi Okonjo-Iweala of Nigeria for her appointment as the WTO’s 7th Director-General of the World Trade Organization. How thrilling it was a couple of weeks ago to know that the barriers to her appointment had come down. In anticipation of the beginning of her tenure on the first of March, I would like to focus here on one of the reasons her leadership of the WTO is so important – her clear grasp of the pandemic crisis and of what the WTO can do to make a significant difference in fighting its global consequences. I am convinced that the WTO is an ideal forum to mobilize a global response to shift the world away from the vaccine nationalism that has proven so difficult to resist. This may not be the only  issue on a very full agenda of WTO reform challenges, but it is excellent timing for a person with Dr. Ngozi’s qualifications to arrive on the scene with this as the most immediate crisis for her to manage.

First, with regard to the formalities, it was refreshing that at her first press conference on 15 February, immediately following the General Council’s unanimous decision to appoint her, the new DG-designate let it be known that she prefers to be called “Dr. Ngozi”. We are quite comfortable with this – easier to pronounce and remember than the tongue-twisters in her full name of “Ngozi Okonjo-Iweala”.  And it sets the stage rather handily to balance this with the shortened title of “Dr. Tedros”, the Director General of the World Health Organization who also has a hard to pronounce and easily forgotten name of “Tedros Adhanom Ghebreyesus. (I have to look this one up each time I write it.)

At this same press conference, Dr. Ngozi quickly revealed both her warmth and her inclusive leadership style as she outlined her immediate priorities for the WTO when she starts her term on 1 March 2021.  As I had expressed in my previous commentary, this unique style is what had attracted me to her in the first place. And it fits with her well positioned expertise for steering the WTO into the turbulent pandemic policy waters.

Responses to my last commentary were also supportive of this perspective and chimed in with their own observations on the good news of Dr. Ngozi’s appointment.  One reader pointed out that the debt cancellation for Nigeria that she had negotiated with creditors also included provisions for investing the debts in education and health programs there. This was an early good sign of her commitment and grasp of the importance of social priorities. Several other readers picked up on the importance of her work specifically on the COVID-19 pandemic as a crucial stepping-stone to guiding the WTO’s most immediate need to tackle pandemic-related actions. And with reference to the urgent nature of this issue, another reader offered an in-depth analysis on the disconnect between the contractual framework of trade policy and the growing moral consensus on bringing normative ideals, like the equitable distribution of vaccines, into trade agreements. One suggested, even more specifically, that we should all be looking to the prospects of her working with both the WHO and WIPO on the vaccine/IP issue associated with the pandemic. Thanks to all for your excellent insights and suggestions!

Finding a Third Way for a Global Response to the Pandemic

This brings me to the timeliness of delving more deeply into Dr. Ngozi’s immediate challenges on the vaccine issue at the WTO. It is, of course, an issue that has been on my mind for some time and about which I have written a whole series of commentaries on why a political lens, and not just a scientific lens, needs to be applied to supporting a truly global response to the pandemic. We need to be making major policy decisions based on the political and democratic values of equity and fairness and inclusiveness. Not just the scientific evidence of how to control the pandemic or how intellectual property protections are essential for innovation in vaccine development in a global health crisis.

The European Commission and the World Health Organization have been instrumental in promoting a global response, but the political pressures of vaccine nationalism have even been felt in Europe. And the US, even with a welcome return to multilateral diplomacy under President Joe Biden, has continued to distinguish between a generous financial contribution to the global response and a domestic priority of vaccinating everyone in the US first before sharing any of the short supply of available vaccines with anyone else.

A striking example of this need for an inclusive and value-defined political lens with a truly global focus was Dr. Ngozi’s reference in both her acceptance speech and press conference to a “third way” on the main pandemic issue facing the WTO, the IP and health nexus with trade that has divided the WTO membership for years. I won’t go into the technical details of this divisive issue other than to note it has to do with the Agreement on Trade-related Intellectual Property Rights (the TRIPS Agreement) that became part of the WTO legal framework in 1995. Under the TRIPS Agreement, developed countries have been able to protect the export of patented health products from having to compete with unauthorized generic versions of these products from developing countries. Some extra flexibilities for “compulsory licensing” of patented medicines were negotiated for the TRIPS Agreement in 2003, but many developing countries are currently supporting a waiver of key provisions above and beyond these flexibilities.

When journalists asked Dr. Ngozi about how she expected to resolve these divergent positions on intellectual property and health in the WTO’s trade policy framework, the phrase she used to describe her approach was a search for a “third way”. And as Dr. Ngozi described her commitment to this “third way” on the divisive IP and health issue, it suggested that she clearly understood the historic divisions among the membership of the WTO and the need to channel these divisions into common ground. I sincerely hope that this “third way” strategy will prove to be Dr. Ngozi’s legacy and the WTO’s salvation, not only on the IP and health issue but across the whole briar patch of WTO issues.

The Contrasting Positions

What is the current nature of this particular division on IP and health? And what might a “third way” look like? The main vehicle for this at the global level, backed up by the WHO, has been the Access to COVID-19 Tools (ACT) Accelerator and its four pillars on testing, therapeutics, vaccines and health systems strengthening. And on the vaccine front, the main path has been the establishment of the COVAX Facility for a global distribution of COVID-10 vaccines. And in those commentaries on the ACT-A initiative and the COVAX Facility, I have hammered away at the importance of both multi-stakeholder and multi-sectoral collaboration to bring this global collaboration into fruition. And yet, the momentum has not yet occurred on making this the centerpiece of a global response.

Critics of the ACT-Accelerator and COVAX have been claiming that the whole effort there is biased against developing countries and even against civil society. Many representatives of developing countries have been calling for a different approach, both at the World Health Organization, through a Technology Access Pool, and at the World Trade Organization, through a waiver of intellectual property rules to enable developing countries to manufacture generic versions of patented vaccines. It is this latter proposal for a waiver that challenges the existing arrangements in the COVAX Facility to negotiate purchase agreements with patented vaccine manufacturers, upholding their intellectual property rights (and their profit-making potential) rather than opting for the pooling of patented information.  Even the head of UNAIDS, Winnie Byanyima, has called for “a #People’sVaccine, not a profit vaccine” (available here), and several major NGOs have joined together in a Peoples Vaccine Alliance. (See their new website here, subsidized by Oxfam.) This was no different today, as reflected in the press release from Amnesty International (available here) which accused the G7 (in anticipation of its meeting earlier this week) of “shooting themselves in the foot by failing to ensure the equal distribution of coronavirus vaccines globally.”

On the other side of the issue, on 19 February 2021, UK Prime Minister Boris Johnson convened this first G7 summit that enabled President Joe Biden to make his debut G7 appearance (virtually). The summit agenda had the pandemic as the lead issue, including the related concerns about economic recovery and health security, and it was featured in the formal statement coming out of the meeting (available here). (Interestingly, the statement also contained specific endorsement for a safe and secure holding of the Olympic and Para-Olympic Games in Japan this summer.)  Consistent with his earlier commitments on the ACT-A initiative and the COVAX Facility, President Biden confirmed a pledge of $4 billion to the COVAX Facility, an amount that had already been appropriated by Congress in the second relief bill that they had passed in December. As reflected in the G7 Leaders’ Statement, this brought the total commitment, from all the G7 countries to COVAX, to an impressive $7.5 billion.

But the statement made no new commitments on vaccine doses. On the day prior to the G7 Summit, President Macron had tossed out the idea of each G7 country donating up to 5% of its acquired vaccine supply to meet the most urgent care-giving and high-risk populations in developing countries. He raised it again during his appearance (video available here) at the Munich Security Conference on the same day, but he didn’t seem to push it at the G7 itself.  In fact, the G7 statement had only the following commitments. The G7 will

  • accelerate global vaccine development and deployment;
  • work with industry to increase manufacturing capacity, including through voluntary licensing;
  • improve information sharing, such as on sequencing new variants; and,
  • promote transparent and responsible practices, and vaccine confidence.

Further, while the statement touched on access and even the concept of a global public good, the phrasing was a reaffirmation of improving access but not a redistribution.  “We reaffirm,” said the G7, “our support for …

  • affordable and equitable access to vaccines, therapeutics and diagnostics,
  • reflecting the role of extensive immunisation as a global public good and
  • increasing support to ACT-A, including to increase developing countries’ access to WHO-approved vaccines through the COVAX facility.

It would seem that these commitments are not yet where they need to be to reach a truly global response to the pandemic. And it does nothing to alter the WTO’s agenda on TRIPS-related issues. There is, to be sure, a commitment in the G7 statement for a “reformed” WTO, as well as for “exploring the potential value of a global health treaty” for a more far-reaching approach to future pandemics as well as global health security more broadly. But one can only conclude that there is no support at this G7 level for either a redistribution of available vaccines in their possession or for a waiver of the TRIPS Agreement for the duration of the pandemic.

Dr. Ngozi’s Third Way

Returning then to Dr. Ngozi’s “third way” to address what she describes here as a “global commons problem”, one can hope that she can do something more about this. Vaccine nationalism, she has repeatedly confirmed, just doesn’t pay. She stated that her first step at the WTO will be to work hard to use all the flexibilities possible under the TRIPS Agreement to allow countries to manufacture as much as possible as quickly as possible. Journalists at the press conference persisted in asking her to clarify her position on this. She confirmed that “we can break the deadlock”, that it is possible to reach agreement from each side on how to get access quickly and at affordable prices. Again, she emphasized her commitment to “broker what I call a third way” but clearly, she further stated, “without infringing on IP licensing”.

Another journalist then followed up by referring to the reports that some developing countries are ending up paying more than the developed countries are paying for the same vaccines. Her response to this was that the demand for greater volumes and going back to the manufacturers to expand their capacity should eventually make a difference in the prices. AstraZeneca, she observed, has done this with the Serum Institute in India, and J&J is contracting to manufacture its vaccine in South Africa and is also talking about the possibility of a voluntary licensing agreement there.  The situation, she emphasized, is to deal with the current and absolute shortage in supply, and an immediate objective has to be an expansion in manufacturing capacity. The expansion, she explained, will depend on the extent to which we can work with developing countries with the space and capacity to manufacture additional quantities at affordable costs.

The dilemma, of course, is that the expanded capacity is unlikely to happen right away – if it ever could get up to the desired levels. Several developing countries are expressing an interest and availability of manufacturing space, while skeptics are questioning their readiness to handle the complexities of the new vaccines. And, in any case, the more immediate needs are to work with the quantities that are currently in the pipelines. These immediate needs suggest that Dr. Ngozi should find some way to enable a redistribution of this existing supply, at least to the populations most at risk throughout the world.  In this respect, at least President Emmanuel Macron has been hitting the right message – let’s all redistribute up to 5% of what we have already purchased for our own populations, rich countries, to at least vaccinate the health care providers and most at-risk populations in the poorer countries of the world in Africa and elsewhere.

From Dr. Ngozi’s point of view, a new “third way” should look for ways to reach beyond the commitments from the one side or the other of the IP and health debate. It may well be that a waiver of the IP provisions of the TRIPS Agreement for the duration of the pandemic is not a realistic piece of the “third way”, but one can at least hope that Dr. Ngozi can actually rally more manufacturers and pharmaceutical companies to facilitate increasing their own manufacturing capacity and/or more accommodation of affordable and equitable access. Perhaps there is room for the WTO under Dr. Ngozi to do this kind of outreach to the private sector. And there are, of course, related actions that can be taken to mobilize enhanced cooperation among pharmaceutical companies and manufacturers to endorse principles of equitable access and socially responsible pricing strategies. While these actions might not be within the direct mandate of the WTO, Dr. Ngozi can certainly be the magnet for a comprehensive “third way”.

Multi-Stakeholder and Multi-Sectoral Opportunities

It is encouraging that Dr. Ngozi did refer in her acceptance speech (available here) to ways that this kind of outreach can happen in the WTO setting. “Looking beyond this pandemic,” she said, “the WTO must be proactive in strengthening cooperation with other multilateral and bilateral partners, the private sector, and civil society to set a framework for dealing with problems of the global commons such as this pandemic.” This is music to my ears, as everyone reading this commentary well knows. She sent on to state, “The private sector, civil society, and parliamentarians are important partners of the WTO with whom collaboration will be further nurtured going forward.” One can even hope that preliminary outreach can happen in the immediate future and serve as the first test of a new kind of multi-stakeholder collaboration at the WTO as part of Dr. Ngozi’s “third way”.

And by the way, there is the matter of multi-sectoral collaboration, too. Most importantly on the pandemic issue is Dr. Ngozi’s collaboration with Dr. Tedros at the WHO. But, as one reader of my last commentary pointed out, the health and IP issue also includes the World Intellectual Property Organization (WIPO). The trilateral collaboration on this issue has been operational for several years, dating way back to the Doha Declaration and access to medicines issue. This collaboration could certainly be expanded in response to the challenges of this global pandemic, although the complexities of the newer technologies that are being applied to COVID19 vaccine development would suggest that more is needed than IP flexibilities to broaden the manufacturing base. Dr. Ngozi’s third way, then, should actually involve a wider range of sectoral links than just with WHO and WIPO, although the trilateral collaboration may contribute to new thinking about how to improve both incentives and access to innovation. But again, Dr. Ngozi is well positioned to reach across her established networks with the World Bank and the International Monetary Fund and her skills to work with the UN system across the board. I wish her well!

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