The TRIPS Waiver -- In The Round

"Back in March, the president of Tanzania, John Magufuli, died, very likely due to complications from COVID-19. Ironically, the autocratic ruler of the east African nation had been a staunch COVID-19 denier, refusing to vaccinate his country’s population and instead recommending traditional cures and prayer."

"Tanzania is by no means a basket case, nor is it embroiled in civil war, as some other African countries are, and it has a relatively high literacy rate of 77 per cent. Yet, at present, only 1.5 per cent of Tanzanians are fully vaccinated. Their former leader routinely refused offers of vaccine doses for his country, only grudgingly accepting that COVID-19 was a reality shortly before his own death."

"No sensible observer would say that Tanzania’s low vaccination rate is due to “global vaccine inequity,” yet many advocates for global social justice would have you believe that the large disparity in vaccination rates around the world is driven by hoarding in the global north, thus making doses unavailable in the global south. The Tanzania case and others like it disprove this simplistic narrative."

Rupa Subramanya, National Post

A health-care worker administers the Johnson & Johnson vaccine to a woman in Soweto, South Africa, on Nov. 1. Photo by Michele Spatari/AFP

"[The patent waiver would remove one barrier to] more companies being able to produce more vaccine doses in different parts of the world which should lead to greater availability of doses and greater access to them."

"All along, we and many other public health experts have been saying that it is absolutely essential that the world scales out access to COVID vaccine."

"[Both because it is the] morally correct thing to do [and because when it comes to public health] we know that vaccinating people helps to reduce transmission, and that should decrease the chances of the variants emerging from an unvaccinated unprotected population."

Jason Nickerson, humanitarian adviser to Canada, Doctors Without Borders

Getty, OlivierLemoal

The World Health Organization is fond of excoriating the wealthy nations of the world for its selfish behaviour in focusing on inoculating their populations against the SARS-CoV-2 virus, insisting that the stock of vaccines available must be shared. The sharing program, COVAX, set up by the WHO as a method of equalization to be administered by the UN health body accepts donations from wealthy countries both in cash and kind. It also permits those countries to draw from its store of vaccines when needed, even while what it stockpiles is meant to be distributed among the less-advantaged nations of the world.

WHO director-general Tedros Adhanom Ghebreyesus has nagged first-world countries to forestall administering third, or 'booster' doses to address the issue of waning vaccine potency over time, in favour of sending those 'extra' doses to Africa and India. Now that a problematical COVID strain has been identified in South Africa that is rapidly spreading around the world, given its high transmissibility rate, and as-yet unknown virulence, the world community is anxiously awaiting word on what its outcome may spell.

 

After a recent meeting of the World Trade Organization it announced "members expressed unanimous support for maintaining the momentum of the discussions on a common intellectual property response to COVID", referring to a proposal by India and South Africa requesting a patent waiver for COVID vaccines to enable them to produce the vaccines to serve their public, bypassing the pharmaceutical companies' distribution and sales in reflection of a formula they created, patented, and have financially gained from.

In Canada, South African High Commissioner Sibongiseni Diamini-Mntambo spoke to The Canadian Press, stating that the Omicron variant emerged in South Africa as a direct result of vaccine inequality, emphasizing that in South Africa, less than a quarter of the population is fully vaccinated. Any who fail to support a patent waiver, she averred, would "rather protect the profits of pharmaceutical companies than help in the global battle against the pandemic".

"I call on the nations gathering next week for the World Trade Organization ministerial meeting to meet the U.S. challenge to waive intellectual property protections for COVID vaccines, so these vaccines can be manufactured globally", U.S. President Joe Biden said prior to the WTO meeting. The Council for Trade-Related Aspects of Intellectual Property Rights took on the issue. "Members expressed unanimous support for maintaining the momentum of the discussions on a common intellectual property (IP) response to COVID-19".

"[Delegations are] committed to continue engaging in various configurations in the coming weeks to try and harvest any outcome that may still be possible." 

 

In the Canadian House of Commons, a letter was circulated signed by Members of Parliament representing all parties; an open letter calling on support for the waiver: "Opponents of the waiver proposal argue that patent monopolies are necessary to allow firms to recover their investments in research and development. However, given that COVID-19 vaccine development was primarily financed through public investment and advanced market commitments, we strongly believe this justification does not apply."

 

According to the details examined, appraised and published by Rupa Subramanya, vaccine hesitation among populations, alongside denial of COVID threats manifest as one of the reasons for low vaccination rates in India and Africa. Where South Africa, the epicentre of the Omicron variant had a stockpile of vaccine doses it was unable to administer since vaccine hesitancy resulted in a slow rollout. At that juncture, South Africa postponed delivery of new Johnson & Jonson and Pfizer vaccines in a country where distrust of vaccines is nothing new.

 

She points out that Europe, particularly Austria, Germany and Switzerland are struggling with a fourth wave that has devastated their populations and their hospitals' ability to cope. Since the advent of vaccines, Austria has distinguished itself for, out of desperation, being the first developed country to fully lock down. Those three countries are among the wealthiest in the world and though they possess more than ample vaccine doses, they are also reflective of a high degree of vaccine hesitancy among their populations, resulting in low vaccination rates.

 

Not vaccine inequity, but the results of vaccine hesitancy, a situation reflective of that which pertains to the poor countries where the West is being informed their performance in protection of their populations is one of selfish disregard for the well-being of others on the planet without their wealth and accessibility to vaccines.  Two days ago it was announced that the White House spokesperson revealed that South Africa turned down an offer by the US to provide it with additional COVID-19 vaccines.

 

White House Press Secretary Jen Psaki speaks during a daily news briefing at the James S. Brady Press Briefing Room of the White House November 19, 2021.

Alex Wong/Getty Images

 

Vaccine Hesitancy = Burgeoning Case Load

"This wave is far worse than the others -- it is like a war."

"The only real reason anyone is here is because they did not get vaccinated."

"Fear is the only thing that got the attention of the general population."

Dr.Anca Streinu-Cercel, Bucharest Hospital

 

"Fake news has a  huge influence on our population, and in Eastern Europe in general."

"[Under leaders like Nicolae Ceausescu] nobody trusted their neighbours, nobody trusted the authorities, nobody trusted anybody."

Colonel Valeriu Ghorghita, coordinator, Romania's vaccination drive

A Romanian woman, who recovered after being in severe condition, is helped by a nurse to prepare for moving in a normal section form the intensive care unit saloon, at the Covid-19 section of National Institute of Pneumology 'Marius Nasta', in Bucharest, Romania, 15 October 2021. [EPA-EFE/ROBERT GHEMENT]

Romania recently reported one of the highest per capita death rates from COVID-19, in the world. Making physicians like Dr.Streinu-Cercel sigh in weary exasperation in the knowledge that it could all have been avoided, with a strong uptake of vaccine from among the general population. Instead, hospital entries for COVID are burgeoning, and so is the death toll. 

In Romania, as has proven current elsewhere in the world, it is mostly the rural population that deigns not to be inoculated against the SARS-CoV-2 vaccine causing COVID-19. They are named as the crux of the pandemic's surge and are considered to be vaccine-hesitant. Just as a new wave of the coronavirus began suffocating Eastern Europe, word came down from On High to evade vaccination.

On the authority of the powers vested in him by the Orthodox Church, Bishop Ambrose of Giurgiu in the small Romanian town of Copaceni reassured his parishioners that there really is nothing to be concerned about over COVID. "Don't be fooled by what you see on TV -- don't be scared of     COVID", he soothed them, telling worshipers: "don't rush to get vaccinated".

This not the view of Patriarch Daniel in Bucharest, however. He instructs the faithful to sensibly listen to doctors. At the very time that local clerics denounce vaccines for the damning reason that they represent the work of the Devil. A message that is hugely influential in rural areas in particular which realize a vaccination rate half that of the cities.

In the capital Bucharest, there are signs with grisly photographs depicting seriously ill patients, representing a deliberate effort to shock people to face the reality of the situation. As a result of 'vaccine hesitancy', Romania  distinguishes itself with the second-lowest vaccination rate in Europe; roughly 44 percent of adults with at least one dose, behind only Bulgaria. The European Union's overall vaccination rate is a sturdy 81 percent. 

 

Colonel Ghorghita who leads his country's vaccination drive, does so in the hope that the army's influence in the matter would help the authorities succeed in increasing vaccination numbers to a safer overall level, because of all state institutions, the military in the country has the greatest respect. And following that institution is that of the Orthodox Church, so whatever the army advocates seems to be undone by the lower echelons of church authority.

People in the country are suspicious. "Everyone is suddenly an expert, and fake news is everywhere, 24 hours a day", explained Silvia Nica, head emergency doctor at Bucharest University Hospital. In the current crisis the hospital has erected a treatment tent and turned the hospital lobby into a COVID ward.

Bucharest communications professor Alina Bargaoanu notes that people spreading wild theories on social media initiated COVID disinformation, to eventually create a more widespread movement. Diana Sosoaca, an elected member of the country's upper house of Parliament denounces the pandemic is "the biggest lie of the century". She suspects a Russian hand in spreading alarm over vaccines.

And then turns her attention toward the United States where many conspiracy theories originate, which acts as a validating factor for the anti-vaccination movement happy to discredit Russia, and happier yet to trust anything coming out of the United States, because as Ms.Bargaoanu stated: "Romania is a very pro-American country".

"There was no [government] communication strategy whatsoever, and no education strategy. The only people communicating, and very effectively, are the anti-vaxxers and the negationist movements." 

"The truth is that this pandemic wave was left to peak completely unmitigated — and the whole burden was put on the hospitals."

Octavian Jurma, doctor and health statistician

Medical personnel in protective suits push a Corona intensive care patient from the a Romanian Air Force C-27 plane into a Bundeswehr intensive care ambulance on the tarmac at Hamburg Airport in Hamburg, Germany, Tuesday, Nov. 2, 2021. (Gregor Fischer/dpa via AP)

 

 

Vaccine Hesitancy versus Vaccine Envy in the Medical Community

Dr. Jessica Kent-Rice, an emergency medicine resident in Toronto, posted this photo on Twitter, writing she was "extremely grateful to have had the opportunity to get vaccinated." Photo by @jessicakentrice/Twitter

"I've never had people request a photo when they've gotten a vaccine before. I think it points to how terrible the pandemic has been and what a historic moment it is ... I'll be very excited and enthusiastic for when my turn comes up."

"One of the personal support workers I was vaccinating said her mom who lives in the Philippines was  told by her local public-health official that she wouldn't be getting it [inoculated] until 2023."

Monika Winnicki, dermatologist, Toronto, vaccine volunteer administer

 

"When we are on the front lines and seeing, on social media, vaccinations being given to child psychiatrists doing Zoom meetings or doctors on maternity leave ... it gives us the message that we've been forgotten."

Alan Drummond, emergency physician, Perth, Ontario

 

"I feel like the urban centres are getting covered. I feel like rural Canada is being missed."

"Every time I see a friend posting, I'm happy for them but feel incredibly anxious."

"We were told [a vaccine] is three months away. There is no vaccine rollout where I'm working -- no one has received a vaccine."

"I'm just disappointed. My hospital covers several different communities and there are outbreaks and we definitely see COVID-positive patients ... Rural lives matter too." 

Sarah Giles, rural family and emergency physician, Kenora, Ontario

Photo: Michelle Morais

"As selfies continued to show up, the emotions turned a little bit complex. I caught myself in a more envious state, and then feeling guilt around feeling envy."

"It's never about individuals; it's more about feeling [the rollout] should be going faster than it is."

"I think it's a normal feeling. But I think it's important to acknowledge the feelings of envy and guilt."

Audrey Marcotte, emergency medicine resident, Montreal

"We haven't really seen a ton of cases ... My life hasn't really changed a whole lot in the past year ... I've had Thanksgiving and Christmas dinners with my family. Birthday parties have been celebrated."

"I haven't posted anything for fears of how it would make my deserving colleagues who haven't gotten theirs yet feel. Seeing their anxiety on social media has made me realize that posting a picture ... might not help their morale."

Aleisha Murnaghan, emergency doctor, Charlottetown, P.E.I.

"When Ontario Public Health put out its guidelines for vaccinations, they excluded pregnant and lactating women."

"About eight to 11 percent of pregnant women who acquire COVID19 will end up sick enough to be admitted to hospital, and two to four percent end up in ICU with severe complications, including being on a ventilator for weeks to months and [with] long-term effects from COVID."

"The risk for non-pregnant women is one to two percent by comparison, so we're looking at a two to four times higher rate of severe disease in the unvaccinated."

"Pregnant doctors are posting to show people that they feel it's safe enough to get it themselves."

Constance Nasello, chair, Ontario Society of Obstetrics and Gynaecology

In a sense, the medical community, comprised of individuals from all backgrounds and beliefs and walks of life in their private lifestyles is no different than the general public in their concerns, their likes and dislikes ,their distrust of systems. People from outside the medical community likely think that those within it have some kind of insider knowledge and confidence the general public lacks. A general public among whom a substantial contingent of people view the prospect of being vaccinated askance, not willing to trust medical science when it says the vaccines are safe and effective. 

People in the medical community have their own groups of medical professionals unwilling to chance taking a vaccine they feel has been inadequately tested and researched, much less the time it has taken to develop the vaccine; they view it with distrust. So much for being a medical insider; those job descriptions don't automatically come with an app to instill confidence and trust. And so, from within the medical community itself a campaign was initiated to persuade their unwilling collegial peers that all is well -- look, I've taken the vaccine and I'm fine!

Photo: Michelle Morais

As part of their convincing campaign, medical personnel have been taking selfies of having their vaccination and posting them on social media sites for the benefit of their colleagues in medical practise. And those selfies have garnered some surprising results. One emergency doctor in Vancouver who happens also to be an outstanding athlete was amazed to see her vaccine selfie acquire more likes than a Facebook post showing her finishing an Ironman competition. "I think it speaks to how everyone is looking forward to the light at the end of the tunnel".

There are, however, critics of the vaccine-selfie campaign, those who feel the new social media campaign has been the cause of anxiety, envy and frustration at a time that many physicians still await their turn in a slow-motion rollout across the provinces. Dr.Drummond the emergency physician in Perth as an example, feels the postings to be "tiresome" and "demoralizing". 

Dr.Giles in Kenora has had experience working with Doctors Without Borders in Sierra Leone, Pakistan, South Sudan and Myanmar and her concern is the effect the vaccine postings of photographs may have on people living in lower-income countries: "My friends in those countries are not posting vaccines selfies", she said of countries where vaccines are not in circulation and most certain not to be for years to come in an unequal world of access and non-access. 

Many other doctors are convinced the selfies have a useful purpose; to educate and motivate those who remain vaccine-hesitant within health care to be convinced inoculations are the best course of action for themselves personally, their families and their communities at large. "There's a lot of mistrust and conspiracy theories around 'Big Pharma'", explained Jennifer Chu, a St.Michael's Hospital emergency physician in Toronto. "A lot of people also don't understand how drugs are made and think that the vaccine can't be safe because it was rolled out so quickly."

In Canada, the South Asian population is notorious from within the medical community for its suspicion of vaccinations. Kashif Pirzda, a Toronto emergency doctor who works with Canada's South Asian COVID Task Force, posted a selfie with captions in Hindi and Urdu meant to turn the situation of false information around. "Usually the same claims will come up, such as that the vaccine will change your DNA, or that it hasn't been properly tested, or that it contains pork products, which would make it forbidden for Hindus or Muslims", he said.

 

As well, a situation of vaccine hesitancy has emerged among health-care workers at long-term care facilities where some centres in Ontario see vaccination rates of a mere 20 percent. Since many of those workers are of South Asian heritage working with vulnerable elderly and infirm residents, it's critical for them to accept inoculations. 

"I think we have an obligation as medical experts to spread sound medical knowledge and facts to our non-medical friends and family."

"I think the time to address and remove vaccine hesitancy is now ... as physicians, we are highly mindful of staying in our own lane when it comes to various societal issues."

"This is our lane."

Kavitha Passaperuma, oncologist, Richmond Hill, Ontario