How financial shortfalls hold back HIV response in Africa

• UNAIDS says upper-middle-income countries pay more for HIV medicines, but price reductions can be achieved
• Stakeholders allege rich countries, pharmaceutical corporations are breaking their COVID-19 vaccine promises

According to the latest figures from Joint United Nations Programme on AIDS (UNAIDS), underinvestment in the Human Immuno-deficiency Virus (HIV) responses of low- and middle-income countries was a major reason why the global targets for 2020 were missed. Financial resource availability during the past five years was consistently below the resources needed, and in 2020 it was 29 per cent less than the US$ 26 billion targets for that year (in constant 2016 US dollars).

In western and central Africa, large resource shortfalls and continued reliance on out-of-pocket expenditures (such as user fees for health services) are associated with more modest declines in the incidence of HIV infection and the rate of Acquired Immune Deficiency Syndrome (AIDS)-related mortality compared to eastern and southern Africa, where a combination of domestic and international investments has fuelled the rapid expansion of HIV prevention, testing and treatment in areas with a high burden of HIV, resulting in strong and steady reductions in the rate of HIV infections and AIDS-related mortality.

Also, UNAIDS says upper-middle-income countries pay more for HIV medicines, but price reductions can be achieved.

The cost of antiretroviral medicines has a major effect on resource needs for HIV responses. Currently, the average prices for first- and second-line antiretroviral therapy are broadly similar in low- and lower-middle-income countries but are substantially higher in upper-middle-income countries.

For example, countries in Eastern Europe and central Asia and in Latin America tend to pay considerably higher prices for antiretroviral medicines compared with countries in other regions. Further price reductions for antiretroviral medicines and other key HIV commodities can be achieved through the strategic use of flexibilities under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and by rearranging procurement and supply management systems to take advantage of economies of scale. If these and other cost savings are made, a 17 per cent increase in resources for HIV testing and treatment can result in a 35 per cent increase in the number of people receiving treatment by 2025—enough to reach the 95–95–95 testing and treatment targets.

Meanwhile, developing countries have been hit with an endless tide of inadequate gestures and broken promises from rich countries and pharmaceutical companies, who are failing to deliver billions of doses they promised while blocking the real solutions to vaccine inequality, according to a new report published recently by the People’s Vaccine Alliance.

The report, “A Dose of Reality,” found that of the 1.8 billion COVID vaccine donations promised by rich nations only 261 million doses – 14 per cent – have been delivered to date, while western pharmaceutical companies have delivered only 12 per cent of the doses they allocated to COVAX, the initiative designed to help low- and middle-income countries get fair access to COVID vaccines.

At the same time, the European Union (EU) and other rich nations have refused to support the proposal of over 100 nations to waive patents on vaccines and COVID related technologies while leading pharmaceutical companies have failed to openly share their technology with the World Health Organisation (WHO) to enable developing countries to make their own vaccines and save lives.

Executive Director of UNAIDS, Winnie Byanyima, said: “Rich nations and corporations are shamefully failing to deliver on their promises whilst blocking the actual solution; ensuring developing nations have the ability to make their own vaccines.

“It is painfully clear that the developing world cannot rely on the largesse and charity of rich nations and pharmaceutical companies, and hundreds of thousands of people are dying from COVID-19 as a result. This is beyond appalling.”

The United Kingdom (UK) Government, which has been actively blocking calls from countries like South Africa and India to be allowed to make their own vaccines, has only delivered 9.6 million – less than 10 per cent – of the 100 million doses it promised to poorer nations. Meanwhile, it has itself taken half a million doses from COVAX, despite extreme vaccine shortages in developing countries and has already secured more than enough doses for British people from direct deals with the pharmaceutical companies.

Canada has taken over 970,000 doses from COVAX while delivering only 3.2 million – or 8 per cent – of the 40 million doses it promised. Germany, another country blocking the waiver, has delivered 12 per cent of the 100 million doses it promised and France has delivered just 9 per cent of the 120 million it promised. The US has delivered the most doses – nearly 177 million doses – however, this is just 16 per cent of the 1.1 billion promised.

The Alliance said that while COVAX failed to acknowledge that relying on pharmaceutical companies may not deliver doses, the companies have undermined the initiative, first by not allocating enough doses and second by delivering far less than they agreed. Of the 994 million doses allocated to COVAX by Johnson & Johnson, Moderna, Oxford/AstraZeneca, and Pfizer/BioNTech, only 120 million -12 per cent- have actually been delivered, which is fifteen times less than the 1.8 billion doses delivered to rich countries from these companies. Both Johnson & Johnson and Moderna are yet to deliver a single dose they promised to the initiative.

Oxfam’s Robbie Silverman said: “The failure of rich country donations and the failure of COVAX have the same root cause – we have given over control of vaccine supply to a small number of pharmaceutical companies, who are prioritising their own profits.

“These companies can’t produce enough to vaccinate the world, they are artificially constraining the supply, and they will always put their rich customers at the front of the line.

“The only way to end the pandemic is to share the technology, and know-how with other qualified manufacturers so that everyone, everywhere can have access to these life-saving vaccines.”

During the United Nations (UN) General Assembly in September, President Biden rallied support for the goal to vaccinate 70 per cent of people in every country by September of 2022. While this target is rightly ambitious, the People’s Vaccine Alliance says it should be achieved much more quickly, and there is still no plan to achieve it.

The WHO stated that it must be a global priority to get doses to developing countries by the end of this year, but the Alliance says rich countries are not listening and working to a timetable of delivering an inadequate supply of doses by some time in 2022, which is likely to lead to countless unnecessary deaths.

Maaza Seyoum, of the African Alliance and People’s Vaccine Alliance Africa, said: “Across the world health workers are dying and children are losing parents and grandparents. With ninety-nine per cent of people in low-income countries still not vaccinated, we have had enough of these too little too late gestures.

“Governments must stop allowing pharmaceutical companies to play god while raking in astronomical profits and start delivering actual action that will save lives.”

To deflect growing pressure to share their vaccine technology free of intellectual property restrictions leading western pharmaceutical corporations have consistently over-exaggerated their projected production volumes, claiming there will soon be enough for everyone while delivering the overwhelming majority of their stock to rich nations. Collectively, the four companies claimed they would manufacture an estimated 7.5 billion vaccines in 2021, yet with less than three months until the end of the year, they have only delivered half of these. Forecasts suggest the companies will produce 6.2 billion vaccines by the end of the year, a shortfall on their projections of more than 1.3 billion doses.

With a week to go before leaders meet for the G20 summit in Rome, The People’s Vaccine Alliance – which has 77 members including ActionAid, the African Alliance, Global Justice Now, Oxfam and UNAIDS – is calling on them to stop breaking their promises to vaccinate the world and to:

Suspend intellectual property rights for COVID vaccines, tests, treatments, and other medical tools by agreeing to the proposed waiver of the TRIPS Agreement at the World Trade Organisation.

Demand, and use all their legal and policy tools to require pharmaceutical companies to share COVID-19 data, know-how, and technology with the WHO’s COVID-19 Technology Access Pool and South Africa mRNA Technology Transfer Hub.

Invest in decentralised manufacturing hubs in developing countries to move from a world of vaccine monopolies and scarcity to one of vaccine sufficiency and fairness in which developing countries have direct control over production capacity to meet their needs.

Immediately redistribute existing vaccines equitably across all nations to achieve the WHO target of vaccinating 40 per cent of people in all countries by the end of 2021 and 70 per cent of people in all countries by mid-2022.
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