Health equity in economic and trade policies

Do international trade and investment agreements generate regulatory chill in public health policymaking? A case study of nutrition and alcohol policy in South Africa
Milsom P; Smith R; Modisenyane S M and Walls H: Globalization and Health 17:104, 1-17, 2021

This study identified barriers to setting regulation (regulatory chill) and implementing regulation related to nutrition and alcohol as a result of trade or investment dispute measures in South Africa. The work was implemented through semi-structured interviews with 36 policy actors, analysed using thematic analysis. Trade obligations were found to generate a significantly greater anticipatory-type chilling effect on nutrition and alcohol regulation than investment treaty obligations, and investor-state and WTO state-state disputes affected implementation of regulation. No cases were reported of trade threats an investor disputes but there were reported cases of these actors using arguments related to South Africa’s trade obligations to oppose policy action in these areas. The risk of policy action was related to the perceived legitimacy or bias of the dispute system, costs involved in pursuing and capacity to pay costs of regulation/defending disputes and social views and confidence in a successful dispute outcome. The authors observe that currently, South Africa’s trade obligations have a more prominent role in inhibiting nutrition and alcohol regulation than investment treaty-related concerns, but that strategies to protect public health policy space in the context of both international trade and investment treaty and dispute settlement contexts remain important.

Feminists for a People’s Vaccine
Development Alternatives with Women for a New Era (DAWN) and Third World Network (TWN): 2021

DAWN and TWN are facilitating the Feminists for a People’s Vaccine Campaign (FPV) for equitable, accessible, and affordable COVID-19 vaccines, drugs, therapeutics, and equipment and access to Medicines. The campaign brings the perspective of feminists from the Global South and partners and allies in the North to challenge the causes and consequences of extreme inequalities in access to medicines. Geography, wealth, income, gender, race, caste, ethnicity, disability, sexual orientation, gender identity and other factors shape who has access and who has not, who will live and who will die. The FPV Campaign analyses the changing pandemic panorama and initiatives such as the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS) Waiver proposal, the COVAX Facility and South versus North imbalances in global trade, investment and financing affecting access to these technologies.

Nutrition related non-communicable diseases and sugar sweetened beverage policies: a landscape analysis in Zambia
Mukanu M; Karim SA; Hofman K; Erzse A; et al: Global Health Action, 14:1, 1-11, 2021

This study identified opportunities to strengthen policies relating to sugar-sweetened beverage taxation in Zambia, through: (1) understanding the policy landscape and political context in which policies for nutrition-related non-communicable diseases are being developed, particularly sugar-sweetened beverage taxation, and exploring the potential use of revenue arising from sugar-sweetened beverage taxation to support improved nutrition. The authors conducted a retrospective qualitative policy analysis and key informant interviews with 10 policy actors. Increased regulation of sugar-sweetened beverages was a priority for the health sector, in conflict with economic interests to grow the manufacturing sector, including the food and beverage industries. The authors suggest that this conflict between public health and economic priorities, poor public information and incoherent policy objectives might have contributed to the adoption of a weakened excise tax. The authors suggest that the fact that it did not prevent the introduction of a differential sugar tax on sugar-sweetened beverages implies that there are opportunities to strengthen the existing taxation of sugar-sweetened beverages in Zambia, especially if backed by inclusive in policy formulation and comprehensive monitoring of risk factors.

Waiver from certain provisions of the TRIPS agreement for the prevention, containment and treatment of COVID-19
Third World Network: TWN, 2021

TWN provides gathers a list of interventions by the co-sponsors, statements and op-eds supporting the waiver proposal and news reports about the proposal made by India, South Africa and others (IP/C/W/669) to the World Trade Organization seeking a waiver from certain provisions of the TRIPS Agreement (patents, trade secrets, copyright and industrial designs) in relation to the containment, prevention and treatment of COVID-19. This proposal is now co-sponsored by 62 developing countries (the Africa Group, the Least Developed Country Group, Bolivia, Fiji, Indonesia, Pakistan, Mongolia, Vanuatu and Venezuela) and has received global support from most of the other developing countries and the international community, but still faces opposition and counter measures from some high income countries, elaborated on the TWN website.

Botswana pays equivalent of $15 a dose for Sinovac's COVID-19 vaccine
Reuters: Gaborone, Botswana, July 2021

Botswana's health minister Edwin Dikiloti said on Friday in an address to parliament that the government was paying the equivalent of $15 a dose for the COVID-19 vaccine developed by China's Sinovac Biotech and almost $29 a dose for U.S. company Moderna's vaccine. The minister added that the COVAX facility co-led by the WHO had only delivered 82000 doses despite an upfront payment the government had made as a self-financing participant, in the hopes of securing far more doses. An AU arrangement is expected to deliver over 1.1 million doses of Johnson & Johnson's vaccine in the third and fourth quarters. Apart from the vaccines paid for, the Indian government donated 30000 doses of the COVISHIELD vaccine manufactured by the Serum Institute of India and China donated 200000 doses of Sinovac's vaccine, while Botswana is in talks with Pfizer about a possible 2 million dose deal. In 2019, Botswana had a total population of 2.3 million people.

New consortium working to boost vaccine production in South Africa
World Health Organisation: WHO, Geneva, 2021

The Medicines Patent Pool and the World Health Organization, Afrigen Biologics Limited, the Biologicals and Vaccines Institute of Southern Africa (Biovac), the South African Medical Research Council and Africa Centres for Disease Control and Prevention have signed a letter of intent to bring together partners to establish the South African mRNA technology transfer hub to enable greater and more diversified vaccines manufacturing capability, to respond to the current COVID-19 pandemic and future pandemics.

Profiteering from vaccine inequity: a crime against humanity?
Hassan F, Yarney G, Abbasi K: BMJ, 374:n2027, 2021

The rich world is refusing to share vaccines with poorer countries speedily or equitably. Whereas 60% of the population in the UK is fully vaccinated, in Uganda it is only 1%. The 50 least wealthy nations, home to 20% of the world’s population, have received just 2% of all vaccine doses. The authors argue that the rich world should be ashamed. They present evidence of the corporate profits being made on vaccines and posit that pandemic profiteering is a human rights violation that demands investigation and scrutiny. The Universal Declaration of Human Rights states that everyone has the right “to share in scientific advancement and its benefits. The excess of deaths in Africa, Latin America and Asia is attributed to: a free market, profit driven enterprise based on patent and intellectual property protection, combined with a lack of political will. Contrary to claims, it is possible to make enough vaccines for the world and state that the moral scandal, enabled by corporate and political permission of mass death, is tantamount to a crime against humanity.

Tobacco supply and demand strategies used in African countries
Crosbie E; Defrank V; Egbe CO: Bulletin of the World Health Organisation 99(7), 539-540, 2021

The number of smokers in Africa is anticipated to rise from 15.8% in 2010 to 21.9% by 2030, the largest projected increase in the world. The authors examine the role of the main tobacco companies operating in Africa: Philip Morris International, British American Tobacco, Imperial Brands and Japan Tobacco International, in this rise, and in the illicit trade in tobacco to force market entry into new and emerging markets. The authors point to the tactics used, including: preventing policy measures designed to control illicit tobacco trade by entering into voluntary partnerships with law enforcement and custom agencies, with governments not effectively enforcing existing laws; and using promotional tactics, including price reductions, coupons and giveaways to increase the demand and usage of tobacco. Tobacco companies consistently claim on their websites, in the media and in policy circles that they aim to stop illicit tobacco trade and only market to adult smokers. However, the authors raise that these tactics are recruiting a new generation of smokers in Africa.

Bayer breathing life into Gates’ failed GM drought tolerant maize: Agrarian extractivism continues unabated on the African continent
Masinjila S; Zendah R: African Centre for Biodiversity (ACB), South Africa, 2021

This paper alerts to the implications of a Gate’s funded project, Water Efficient Maize for Africa (WEMA), now known as TELA, for sub-Saharan countries. Bayer, with a stated aim of solving smallholder farmers’ poverty woes, is stated by the authors to be using South Africa’s permissive biosafety regulatory environment to multiply obsolete and deficient genetically modified (GM) seeds, for export to the countries in the project, despite lack of success with drought tolerance and insect resistance in South Africa. The paper indicates that the industry’s claims of the insect resistant trait’s ability to combat the now persistent fall armyworm in Africa have been invalidated with the emergence of resistance in countries in North and South America, including Brazil. The authors question why African countries are allowing the dumping of these obsolete technologies into their countries and urge African governments to reject the imposition of outdated GM technologies and to adopt workable and holistic solutions, including to support food systems.

Door opens for TRIPS waiver textual negotiations
Third World Network (TWN) Info Service on Health Issues: TWN, issue 6, 2021

With the Biden-Harris Administration taking the United States out of the "blocking" countries, all eyes are now on Europe and Japan among others as momentum grows for text-based negotiations on the temporary TRIPS waiver for combating the Covid-19 pandemic. The World Trade Organisation director-general Ms Okonjo-Iweala met with German Chancellor Angela Merkel and the TRIPS waiver is likely to have been included in the talks cannot be ruled out in the wake of a global call from 100 former leaders, including half of the US Democratic Congressmen and women, Nobel Laureates, and around 400 international civil society organizations, to agree to the TRIPS waiver. The EU's evolving positions seem to be focused on a "third way" approach—promoted by the European Union and several members of the Ottawa Group- that seeks to address issues such as export restrictions, more bilateral and other licensing agreements, and ensuring the supply of vaccines by countries which have huge stocks of unused vaccines. The authors note that the insistence on a "360 degree view" on the waiver could involve a payment from the waiver co-sponsors, as powerful pharmaceutical companies have also stepped up their campaign against the waiver.