The Covid-19 pandemic has widened the North-South divide. The poorest countries and the poorest people are always paying the highest price. Rich countries’ response is not up to the challenge: donations of vaccines are not enoughradical changes need to be undertaken!

Covid-19 has demonstrated how deeply a crisis can affect and threaten lives and economies across the globe. In the South, economies have collapsed, and the International Monetary Fund recently called for urgent mitigation measures. On the public health side, 12 months of crisis will have been enough to threaten 120 months of progress in tuberculosis screening and 15 years of fighting HIV-AIDS and malaria. While in the North we are starting to administer the third dose of vaccine, only 4 per cent of Africans have received two doses. This is not only outrageous but also counterproductive if we want to control the virus spread: in a globalised world, no one is safe until everyone is safe! Today, we need to accelerate and look forward: stepping up the fight against Covid-19 today will make us stronger to face the pandemic threats of tomorrow.

After a long period of hesitation and the temptation to withdraw into their national interests, developed countries have begun to multiply their donations of vaccine doses to low-income countries. Though this is obviously needed and more than welcomed, this is not enough! First of all, not all the donated doses have been injected. Second, a sustainable response needs to be given to a pandemic that will probably not disappear on its own. So, we need to change the game radically.  

First, we must support countries in strengthening their health systems. Screening, vaccination and treatment require structured community health care centres, trained professionals and organised hospitals. Any health intervention should now be designed to be effectively transformative for the organisation of care.

In addition, rich countries must engage in a demanding and transparent dialogue with companies from the health sector so that their innovations can be deployed to all those who need them. Health is a common good, and vaccines and medicines must be made accessible everywhere. This means that they must be manufactured in sufficient quantities and sold at an affordable price.

Unitaid, by creating the Medicine Patent pool ten years ago, succeeded in negotiating a drastic reduction in the price of treatments, particularly for HIV-AIDS and tuberculosis. An HIV-AIDS treatment sold for $10,000 a year in Europe, was negotiated for only $70 in many African countries. Massive amounts of public money have allowed laboratories to bring vaccines against the Covid-19 to market in record time and treatments will be soon authorised. This provides governments with a unique opportunity to negotiate accessible conditions for poor countries.

This kind of negotiation should have taken place from the start. However, it is still time to decide temporary and targeted measures that can increase voluntary licenses and promote and push technology transfer further. It is also not too late to invest massively in production platforms in the South. Innovation has a cost, which must be fairly rewarded. No one is proposing companies to become philanthropic organisations, but rather to engage in a sincere and transparent discussion about prices, and clearly agree to accessible prices for low-income countries. Should this negotiation fail, more binding options could be considered, as immunisation must now be accelerated everywhere.

This can only be achieved through the political commitment of the richest countries. The World Health Forum in Berlin, before the G20 in Rome, should be an opportunity to deliver this message. Since March 2020, international health organisations have been racing against time. But without financial support, without strong and tangible political will, they will not be able to meet all the needs.

It is now time for the richest countries to coordinate and for the political governance of global health to evolve. Technical solutions are not lacking, but financing and sustainable political organisation for the response to Covid-19 today and the inevitable health threats of tomorrow are missing. In the early 2000s, organisations were created to respond to the challenge of HIV-AIDS, tuberculosis, and malaria: the Global Fund and UNITAID. Today, we don’t need new institutions, but the political will for practical multilateralism.

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