This year’s Martin Delaney presentation, usually one of the highlights of CROI and part of the young investigators pre-meeting, was for the first time highlighted in the opening plenary. As Jim Pickett of AIDS Foundation Chicago stated in his introduction, “We could not be more thrilled at this opportunity to feature the voices of community and activism during this opening plenary of virtual CROI 2021, something unusual for CROI that’s something I hope we carry forward.” Gregg Gonsalves, a 2018 MacArthur Fellow, co-founder of Treatment Action Group and an assistant professor at Yale School of Public Health, and Fatima Hassan, a South African human rights lawyer and social justice activist, and founder of the Health Justice Initiative, had a sobering and timely discussion about how vaccine nationalism is impeding access to COVID-19 vaccines in developing countries around the globe, and what needs to be done to ensure equitable access.
Vaccine nationalism is “hedging your bets, where you’re trying to get supply from... many different sources, with the result that many countries, over 130 countries in the global South, have very limited access to vaccines,” noted Hassan. Gonsalves pointed out that we will be chasing variants of the SARS-CoV-2 virus for the foreseeable future. “If you vaccinate one quarter of the population, and you leave the other unvaccinated, it just needs variants to spread.”
They also discussed the similarities and differences between the HIV/AIDS pandemic and COVID-19. Gonsalves, who graduated from high school in 1981, recalled that it took then-President Ronald Reagan seven years to say the word “AIDS” during his time in office. “As Larry Kramer said back then, AIDS was about disposable people, people who didn’t matter. They were gay men, they’re people who use drugs, they’re people who are engaged in sex work, they’re people of color across the United States. These were disposable people who really didn’t merit a full-scale research-prevention-treatment enterprise by the largest country on earth. And millions of people around the world suffered from those early decisions, which delayed the fight against AIDS many, many years ago. Now, for many of us, if you fast forward to the current moment, we see another set of disposable people in the United States, the impact of COVID-19 among communities of color in the United States, it’s just horrifying when you compare it with their European American counterparts.”
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‘...philanthropy will not buy you equality’ …All of these institutions that are meant to actually be scaling up supplies, need to act with a bit more force and a bit more pressure, not just a moral pressure.
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There is reason for hope, however. “The scientists and clinicians…who supported us, during the HIV/AIDS years, did two important things,” says Hassan. “They contributed to scientific knowledge, which they [are] doing right now. But secondly, they call it out. They call the nationalism out, they call governments out, they call pharmaceutical companies out, and they insisted that there be equitable access where public health is prioritized. And many of those scientists and clinicians are actually at the forefront of COVID-19 research in South Africa and in other parts of the world as well. And so we look to them again, for the leadership, for them to be the compass, to shine…a spotlight on the issues of inequity in relation to vaccine access for COVID-19.”
One potential solution is what’s referred to as the TRIPS waiver. According to Médecins Sans Frontières (MSF), “enabled by IP [intellectual property] monopolies, corporations continue to pursue secretive and limited commercial deals that exclude many low-and middle-income countries, even in the midst of the pandemic. The waiver proposal could help by removing legal uncertainties and risks for potential producers and governments to quickly start preparing to scale up production and supply of treatments, vaccines, and other essential medical tools.”
Other solutions were touched upon, including the transfer of technology, and collaboration between governments, pharmaceutical companies, and global entities such as WHO, COVAX (COVID-19 Vaccines Global Access), and Gavi, The Vaccine Alliance.
“We cannot wait for volunteerism, and for benevolence and for charity,” says Hassan. “Somebody a few weeks ago said it quite clearly—‘philanthropy will not buy you equality’…All of these institutions that are meant to actually be scaling up supplies, need to act with a bit more force and a bit more pressure, not just a moral pressure. But they also need to now insist on certain minimum norms and standards, because if this is the way we’re dealing with this pandemic, which we thought would be different after the HIV/AIDS pandemic, then what happens with the next pandemic? It means we’ll never get to a system where we actually have equitable health and where we actually decolonize public health.”
“We know what happens to infectious diseases left unchecked,” says Gonsalves. “That was the lesson of the AIDS epidemic, but we all learned too late to avoid a global catastrophe. We’re pleading, pleading with the attendees at CROI, to be activists with us again. Maybe you can’t march, but you can get on the phones, you can email, you can get on social media and ask for a people’s vaccine, so that we have access everywhere for everyone.”
View the entire presentation on YouTube.