#49 The G|O Briefing, April 14, 2021

A WHO senior official under investigation - New variants bring urgency to finding a way to vaccinate the world. Fast!

This is an onsite, slightly edited republication of the complete G|O Briefing newsletter

Today in The Geneva Observer, an Italian investigation of a senior WHO official reveals the extent of what appears to be a concerted cover-up by the Italian health authorities and WHO’s higher echelons in Copenhagen and Geneva—possibly all the way to Dr Tedros himself—to suppress a damning WHO report on Italy’s unpreparedness in reacting to the pandemic. With new revelations coming out daily in the Italian press and media, Dr Francesco Zambon, the lead coordinator of the killed report, and now a former WHO employee turned whistleblower, says he realizes now that it’s no longer an Italian or a personal story, but that is goes to the very independence of the organization vis-à-vis its Member States. If the WHO caves to pressure from Italy, how can you imagine it will resist pressure from countries like China? he asks.  Among the pieces of evidence uncovered, a WhatsApp exchange that seems to implicate the WHO’s boss himself. He may not have had a direct hand in killing the document as the organization claims, but at the very least, he might be hard pressed to deny complete knowledge.  

Plus, the WTO’s Ngozi Okonjo-Iweala has taken the highly unusual step for the agency of organizing an invitation-only closed-door meeting which gathered trade ministers and representatives of Big Pharma. The meeting’s goal: solving the very problem that she recently warned of in The Geneva Observer when writing: “In tackling COVID-19, we must avoid a repeat of 2009, when a small number of rich countries bought up most of the global supply of H1N1 flu vaccine, leaving the rest of the world with none.” She was writing these prescient words as president of the GAVI board a few months before assuming her new position.

Read on, it’s all below.

What was until now an essentially Italian affair is turning into an international story whose shock waves are being felt in International Geneva

A senior official at the WHO, until recently one of the organizations 11 deputy directors, is under investigation by the Italian authorities. The 67-year-old Ranieri Guerra is accused by the authorities of having provided misleading information about his role and the extent of his efforts to squash a WHO report denouncing Italy’s unpreparedness in responding to the pandemic.

On March 8, 2021, two prosecutors from Bergamo sent a request for judiciary assistance to WHO in Geneva via the Italian foreign ministry. Neither the existence of the request nor the investigation of one of its senior officials were made public by the WHO. And while the organization says it will cooperate with the Italian authorities, the Italian magistrates explicitly accuse WHO of having made it difficult to conduct their enquiry. “The WHO has requested of the Ministry of Health that it be particularly vigilant about our investigations,” remarked Bergamo prosecutor Maria Christina Rota on RAI, the Italian public broadcaster. Their interest in finding out why the report was killed is part of a larger investigation into the circumstances that made Bergamo and its region the epicenter of the pandemic in February and March of last year.

Answers to these questions were contained in a WHO report called “An Unprecedented Challenge.” Published on May 13, 2020 on WHO’s website, the 102-page document written by 11 European researchers under the lead coordination of Francesco Zambon was unexpectedly taken down 24 hours later. It revealed, among other facts, that the country’s pandemic preparedness had not been updated since 2006. Year after year, the Italian health authorities—including Guerra when he worked at the health ministry—had simply copied and pasted the old version in their reporting to WHO. Italy was not the only country to have obsolete preparedness plans, but WHO’s suppression of the report is revelatory of WHO’s modus operandi and susceptibility to influence.  The rogatory letter and other pieces of evidence reveal a concerted effort between the Italian health authorities and the WHO to suppress the report. A decision made, it should be noted, a few days after Italy had contributed €10 million to WHO.

Leaked WhatsApp exchanges between Ranieri Guerra and some of his Italian interlocutors tell the story of these frantic efforts: “I was brutal with the idiots in the Venice document,” Guerra wrote to Silvio Brusaferro, the president of the Italian Public Health Institute, adding “I have profusely apologized to the Health Minister.” To the Minister’s chief of staff, who hopes the report “will disappear into thin air,” Ranieri Guerra suggested that, should it not be the case, they rewrite it. That the report had been approved  by the WHO European director, Hans Henri Kluge,  and the agency’s main scientists seem to be of lesser importance to Guerra than politics and Italy’s position towards the WHO: The “idiots in Venice”—a reference to the WHO’s Venice office where Zambon works—he lashes out “are putting at risk a very serious discussion in anticipation of the next G20 summit and a special relationship between Tedros and Italy. Were I the minister, I’d send them all to hell!"

One of the more significant sentences in Ranieri Guerra’s WhatsApp exchanges, written to Silvio Brusaffero on May 14, 2020 at 15:42, and the one that no doubt will be subject of further examination is this one: “In the end, I went to Tedros and I made him pull the document.”

Through its communication office, WHO maintains that WHO Director-General Tedros “was not involved himself in the development, publishing or withdrawal of the report” and that “all decisions were made in Copenhagen,” the seat of WHO’s European Regional Office.

The reference to Dr Tedros was taken out of context, Ranieri Guerra told the Corriere Della Sera in an interview published Monday, April 12, like all the quotes used by the Bergamo magistrate. “I did not lie,” and did not pull down the report. That decision he says “was taken by Hans Henri Kluge who obviously deemed that the report should not be republished” after its inaccuracies had been corrected.

As for Francesco Zambon, who resigned from the WHO and is now unemployed, he told The Geneva Observer that his trust in the leadership of the organization he worked for 13 years is gone. "The law of silence prevails. It is part of this absurd lack of communication and transparency. The very problem I tried to alert them to, telling Tedros himself in an email that at some point, silence was bound to bring discredit to the organisation. One year later, I am proven right."

He never got an answer.


Global quibbles around a global plan for COVID vaccination, and the US still the linchpin

Sixteen months into the COVID-19 pandemic, the planet is struggling to cope, and there are no signs it will fade away any time soon. On the contrary, the surge in new infections and deaths—both in upward trajectories and driven by more contagious variants—is also increasing calls for world leaders to put aside their differences and address head-on the glaring gaps in the availability of life-saving vaccines, therapeutics, diagnostics, and other medical supplies, especially for the world's poorest nations but also in middle-income and advanced economies.

“It’s not a great time for dialogue but there is no other option. We need to overcome both the technical challenges and the political obstacles. There is an urgent need for more international coordination and cooperation,” a Geneva-based senior international official, speaking on the condition of anonymity, told The G|O.

“We need to instill a sense of urgency.” The official also deplored the short-sightedness of “vaccine nationalism” and the duplication and wastefulness of “regulatory nationalism,” which has added to the impediments that have delayed the rollout of new vaccines.

Some health diplomats have even declared Covax “a failure,” and have pointed the finger at efforts by powerful vested interests that have undermined the original pivotal role of WHO.

Geneva-based international agencies and public-private entities, including the World Health Organization (WHO), the World Trade Organization (WTO), the World Intellectual Property Organization (WIPO), GAVI, the Vaccine Alliance, and the International Organization for Standardization (ISO) are expected to be at the forefront of global efforts to boost vaccine production and production capacity, as well as to enhance an equitable availability and distribution of vaccines.

With the delivery of only 38% of vaccine doses out of 100 million that was expected in the first quarter of 2021, the Covax Facility shows clear signs of being an insufficient instrument, triggering some of the main international actors to return to the negotiating table to seek a new pact that will prevent further “vaccine apartheid.” Some health diplomats have even declared Covax “a failure,” and have pointed the finger at efforts by powerful vested interests that have undermined the original pivotal role of WHO.

Last week, the new director-general of the WTO, Ngozi Okonjo-Iweala, toured the US administration in the hope of forging an agreement whereby a greater transfer of technology and vaccine doses would be established between rich and developing countries.

It is understood that after vaccinating a large part of the population, the US government will initiate an ambitious plan of “vaccine diplomacy,” with donations and distribution of doses around the world.

The gesture serves three purposes: to guarantee greater protection against COVID-19 and its variants, to reopen the world economy, and to put into practice Biden's statement that “America is Back.” The first step of this commitment will be displayed on Thursday when the US government will host an event in support of Covax.

The new pact would also be a way to avoid the idea of an intellectual property waiver, as suggested by more than 50 developing countries.

At the WTO on Wednesday, Dr Okonjo-Iweala held a virtual closed-door meeting with most of the key players. They included Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Piyush Goyal, Minister of Commerce and Industry of India, Ebrahim Patel, Minister of Trade and Industry from South Africa, Valdis Dombrovskis, the EU's Trade Commissioner, and Katherine Tai, the US Trade Representative.

The consultations also included representatives from Pfizer, Moderna, Novavax, and Novartis, IFPMA, as well as WIPO, the IMF, EMA, GAVI, and CEPI and from prominent health advocacy groups such as Médecins Sans Frontières (MSF). From developing countries the list included Incepta (Bangladesh), the Russian Direct Investment Fund,(RDIF), Sinopharm (China), BioCubaFarma, SK Bioscience (South Korea), and Aspen Pharmacare (South Africa).

If the meeting and the idea of a new pact are aimed at finding a short-term solution for vaccine distribution, another initiative taken by the WHO is the creation of a Task Force that will present a plan to expand global vaccine production. In this case, however, the impact would only be felt in 2022.

The WHO plan foresees increasing the supply of ingredients and needles, as well as ending export restrictions.

The blueprint also foresees an agreement for pharmaceutical companies to expand technology transfer, allowing vaccines to be manufactured in developing countries as well. “It will take time to increase global production, as that requires training and technology transfer,” said Soumya Swaminathan, WHO's chief scientist.

So far, 87% of all doses distributed are benefiting rich countries and large emerging economies. Africa, for example, has received only 17 million doses as yet, 10% of what the US has already distributed to its own population.

But ahead of the WTO event, 243 international, regional, and national health, human rights, labor unions, and religious organizations—including Amnesty International, MSF, Oxfam International, People's Vaccine Alliance, Health Action International (HAI), Public Citizen, Save the Children South Africa, IndustriALL Global Union, and Sisters of Charity Federation (US)—sent a letter to Dr Okonjo-Iweala, copying  WHO's Dr Tedros and members of the WTO, in which they aired their concerns about the constraints in global vaccine production and supply shortages.

The proponents, while encouraged by Dr Okonjo-Iweala's determination to address the inadequate supply and inequitable access stressed, however, that her call for a “Third Way,” appealing to pharmaceutical corporations to take voluntary actions, has limitations as such measures have been proven to be “insufficient” in this pandemic.

The way forward, the letter states, “should be to remove barriers towards the production and approval of vaccines, therapeutics, and other medical technologies...” and calls for temporarily waiving relevant WTO intellectual property rules that reinforce monopolies.

According to some UN health experts on the pharma sector, what corporations have been doing has been largely “non-transparent exclusive licensing.”

However, another top international expert, who declined to be identified, placed quite a bit of the blame for the vaccine crisis on governments. “Many have supported Research and Development of COVID vaccines without any strings attached, such as access guarantees.”

Pharma industry sources point out that they have been doing their level best—despite the production challenges—to ramp up production and distribution of vaccines and claim the criticism leveled at them has been unfair. “This is a complex issue, and there will be bumps along the way.”

According to the consultancy Airfinity, total anti-Covid global vaccine production as of April 5 stood at 898 million doses and is projected to increase to 1.5 billion by the end of April, reaching 9.5 billion by the end of 2021.

GAVI chief Seth Berkley said recently that capacity could even reach 12-14 billion doses this year.

But experts at the South Centre estimate that if all the excess vaccine capacity in developing countries was enabled, global capacity in 2022 could reach 20 billion doses.

With a groundswell of public support mounting by the day, senior diplomatic sources say the outcome of the political logjam over the waiver very much hinges on whether the administration of President Joe Biden shifts its position on the issue.

In the last few days, USTR Tai has held separate consultations in Washington with health and human rights advocacy groups, labor unions, and the US pharma industry. According to sources familiar with these deliberations, the administration “is in a listening mode.”

The WHO's Tedros has consistently called for the use of WTO-TRIPS flexibilities and the waiver of certain intellectual property provisions, along with exploring every other option to increase vaccine production including voluntary licenses and technology pools.

“There remains a shocking imbalance in the global distribution of vaccines,” Tedros told a summit of African Union leaders on vaccine manufacturing on April 12, and noted that while more than 700 million vaccines have been administered, low-income countries have “received just 0.2%.”

“The pandemic has shown that global manufacturing capacity and supply chains are not sufficient to deliver vaccines and other essential health products quickly and equitably where they are needed most.”

Similarly, Winnie Byanyima, UNAIDS Executive Director, on April 13 told leaders at the same venue, delays in the supply chain and the competition between countries resulted in Africa “being shut out from these products.”

“We saw this first with PPE availability, and we now see this in terms of huge inequality in access to COVID-19 vaccines, and the unfolding ‘vaccine apartheid’ in front of our eyes.”

Today's Briefing: Philippe Mottaz - Jamil Chade - John Zarocostas

Edited by: Paige Holt