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

Today in The Geneva Observer, Shashi Tharoor, former UN Under-Secretary General and a well-known figure here in Geneva, offers a contrite piece, below, about the dramatic situation facing his country, India. “It is humbling when a columnist must retract his words soon after penning them,” he writes in a candid admission worth noting.  It’s the substance of his piece that matters, however. What, in his eyes, brought India to its knee? Well, choosing symbolism over substance is one reason, he argues, and discrediting science as Narendra Modi did—like Donald Trump and Jair Bolsonaro did with the same catastrophic consequences—is another one. You’d think this was enough? Tharoor’s grieving “J’accuse” is even longer.

Jamil Chade reports on a draft resolution currently circulating at the WHO obtained by The G|O. Strangely—or maybe not given how polarized the debate has become—the draft text explicitly omits any reference to the idea of temporarily waiving the intellectual property rights on vaccines being debated at the WTO TRIPS council. It circulates as the situation is grim. Ramping up the production of vaccines, big pharma’s preferred position, appears increasingly difficult as India, a major actor in that effort, is now halting deliveries to address its own surge. As our colleagues at Health Policy Watch write, that might make China the biggest global supplier of COVID-19 vaccines. A situation which is not without significant economic and political implications.

-PHM

Draft resolution on vaccines a blow to waiver proposal

By Jamil Chade

A draft resolution on COVID-19 vaccines at the WHO (World Health Organization) omits any explicit reference to the idea of a patent suspension or waiver. The text will be submitted to a vote at the 74^th session of the World Health Assembly (WHA), the decision-making body of the WHO.

In the draft document dealing with the expansion of local production of vaccines for low- and middle-income countries, governments address issues such as technology transfer and agreements between countries and vaccine producers.  But the text makes no mention of the joint South African and Indian initiative to suspend patents on vaccines for the duration of the pandemic.

Diplomats from developing countries tell The Geneva Observer that the draft resolution comes with a sense of defeat, but without surprise, as negotiators admit that in the face of the industry and the rich countries' opposition, little progress was being achieved.

In October last year, South Africa and India caused a political and diplomatic earthquake when they pushed the idea of a waiver, arguing that these vaccines were developed thanks to public funding and that, under the Trade Related Aspects of Intellectual Property (TRIPS), pharmaceutical companies would still be entitled to royalties. More than a hundred developing countries came out in support of the idea.

Earlier versions of the WHO resolution, which will be voted on when the WHA meets starting on May 24, contained references to the waiver “as an avenue to be pursued” to fight the pandemic.  In the final draft of the resolution, however, the reference was dropped altogether.  

Elsewhere in the ecosystem

Back to the WHO Bergamo Files –

Previous episodes here and here to better understand the significance of what follows:

Until now, the WHO has never wanted to disclose which “inaccuracies” had led to the withdrawal last year of its document about Italy’s response to the pandemic.  Italian Health Minister Roberto Speranza had no such scruples and, last week, he helped us fill in the blanks. Answering questions during a parliamentary debate, he declared: “The WHO has stated that the report has been withdrawn due to ‘factual inaccuracies.’ Among the significant errors, the one relating to the timeline of the epidemic in China.” We will take his word for it.

Top staff picking at the WTO

Director-General Ngozi Okonjo-Iweala announced her four deputies today.
“I am very pleased to announce the appointment of four new Deputy Directors-General at the WTO. It is the first time in the history of our Organization that half of the DDGs are women. This underscores my commitment to strengthening our Organization with talented leaders whilst at the same time achieving gender balance in senior positions. I look forward to welcoming them to the WTO,” DG Okonjo-Iweala said in her statement.

According to WTO insiders, one surprise was the choice of Angela Ellard, currently the Chief Trade Counsel for the Republican side in the US House of Representatives. “A good move by the DG,” one source tells The G|O. “Dr Ngozi is looking for a relationship with US Trade Representative Katherine Tai,” adds another one.  Well informed sources said Tai also reached out to Angela Ellard who she knows well from her days on Capitol Hill.

Tai praised the nomination: “Director-General Okonjo-Iweala’s appointments reflect her commitment to bringing new voices to the WTO at a time when the organization faces real challenges and opportunities for reform and renewal. For the first time, half of the Deputy Directors-General at the WTO are women and the selection of Angela Ellard from the United States brings a proven negotiator and trade expert to this critical role."

The Gates come crashing down

Shock waves were felt in the philanthropy and global-health world yesterday with the announcement that Bill and Melinda Gates are divorcing. While they maintained in a statement that the Foundation will continue to be run by both of them, many in the ecosphere wonder just how deep those pockets will continue to be. Much of Bill’s Microsoft fortune has yet to be donated, and whether it goes to charities of his or her picking might depend on how friendly the break up will be.

-PHM

India’s COVID Tsunami

By Shashi Tarhoor*

It is humbling when a columnist must retract his words soon after penning them. Just two months ago, after India rushed millions of doses of COVID-19 vaccines to over 60 countries, I praised the country’s “vaccine diplomacy.” India’s aspirations to be recognized as a global power had been given a real boost. Now, with more than 300,000 new cases a day and the death toll evidently much higher than reported, India is no one’s idea of a global leader.

In my own defense, I was worried that India had exported three times as many vaccines as it had administered domestically. The country was clearly lagging behind its own target of immunizing 400 million people by August, after vaccinating some three million healthcare workers in a campaign that began only on January 16. “[M]ounting concern about rising case numbers, the emergence of COVID-19 variants that may not respond to existing vaccines, and an economy that has not yet fully recovered,” I noted, “will intensify the challenge India confronts in fulfilling its obligations to developing countries while also meeting domestic demand.”

At the time, I did not realize the scale of the challenge. The number of infections surpassed 17 million in recent days, and the official death toll now exceeds 190,000. Hospital beds are now overflowing, oxygen supplies have dwindled, vaccination centers have run out of doses, and pharmacies are unable to meet the demand for antivirals. India is reeling.

How did everything go so wrong so soon after India recovered from the first wave of the pandemic last year, resumed normal life and economic activity, and started exporting vaccines? The list of errors is long.

Begin with symbolism over substance. On national television, Prime Minister Narendra Modi urged Indians to bang plates together. Two weeks later, he instructed them to light lamps at a specific moment. Superstition replaced science-based policies in confronting the pandemic.

Modi also enlisted Hindu nationalism in the fight against COVID-19. Just as the epic Mahabharata war was won in 18 days, he claimed, India would win the war against the coronavirus in 21 days. At no point was this based on anything more than wishful thinking.

Another error was ignoring the World Health Organization’s advice. From the start of the crisis, the WHO recommended a containment strategy that required testing, contact tracing, isolation, and treatment. While a handful of states, like Kerala (which recorded India’s first COVID-19 case on January 30, 2020), initially implemented such measures successfully, the Modi government’s ham-handed response resulted in their uneven application in several states.

Then there was over-centralization. From the first nationwide lockdown, announced by Modi in March 2020 with less than four hours’ notice, the central government managed the pandemic under obscure provisions of the Epidemic Diseases Act and the Disaster Management Act, which allowed it to ride roughshod over India’s federal structure. Instead of delegating India’s 28 state governments the authority to design strategies tailored to local conditions, the central government tried to manage COVID-19 by decree from Delhi, with calamitous results.

And, no surprise, the initial lockdown was mismanaged. State governments, the public, and even central government officials were caught unprepared. Chaos resulted, with some 30 million migrant workers, stranded without work in cities, forced to walk home, sometimes for days. It is estimated that 198 people died along the way. Some five million micro and small enterprises closed, unable to recover from the shutdown. India’s unemployment reached the highest levels ever recorded.

As the crisis began to slip out of control, the central government, following then-US President Donald Trump’s precedent, passed off more and more responsibilities to state governments, without adequate funding. The state governments struggled to mobilize doctors, nurses, health workers, testing kits, personal protective equipment, hospital beds, ventilators, oxygen cylinders, and medicines to fight the pandemic. The government mobilized a huge amount of funds for a new relief entity called “PM-CARES,” but to this day there is no public accounting of how much money is in the opaque PM-CARES Fund and where its resources have been allocated.

When the pandemic seemed to have waned, the authorities settled into complacency, taking no precautions or preventive measures against a possible second wave that many warned could be more devastating than the first. Testing, tracking, and isolation of infected people and their contacts fell rapidly into disuse by the end of 2020. And just when people stopped following appropriate behavioral guidelines, the virus evolved an extremely infectious variant. Super-spreader events proliferated: election rallies and religious festivals packed together unmasked throngs. The contagion raged.

Although India produces 60% of the world’s vaccines, the government took no steps to scale up production of the two COVID-19 vaccines cleared for manufacture in the country. Nor did it permit the import of foreign vaccines, help expand available manufacturing facilities, or license other Indian firms to produce doses. India launched its vaccination drive nearly two months after the United Kingdom, but by April, only 37% of health workers, and barely 1.3% of India’s 1.4 billion people, had been fully vaccinated. Only 8% had received at least one vaccine shot.

Here, too, the authorities initially bet on centralization, and its refusal to grant emergency-use approval to vaccines from abroad led to a nationwide shortage of vaccines by mid-April. It was only at this point that the government delegated the vaccine roll-out to state governments and public and private hospitals and permitted the import of vaccines approved by the United States, the UK, the European Union, Russia, and Japan. Even then, the central government failed to distribute vaccines equitably to the various states, resulting in some of the worst-affected (like opposition-ruled Maharashtra and Kerala) running short of vaccines as cases peaked.

Like India’s government, I was prematurely self-congratulatory about the country’s vaccine diplomacy. At a time when Indians were unable to access the vaccines that might have protected them, India’s “Vaccine Maitri” program was not smart, but hubristic. Global leadership must begin at home, and today home is a country whose mortuaries, graveyards, and crematoria are running out of space.

Shashi Tharoor, a former UN under-secretary-general and former Indian Minister of State for External Affairs and Minister of State for Human Resource Development, is an MP for the Indian National Congress.

©Project Syndicate

Today's Briefing: Philippe Mottaz - Jamil Chade

Guest essay: Shashi Tharoor

Edited by: Paige Holt