Stephen Lewis is fighting for his life. He has inoperable cancer.
I was privileged to document his heroic work as UN HIV/AIDS envoy to Africa, for three documentaries made for the CBC. I filmed as he set up the Stephen Lewis Grandmother to Grandmother Foundation, and as he relentlessly advocated for cheap and generic drugs for the 16 million Africans who were dying needlessly during that pandemic.
"Rapacious drug manufacturers are protected by patents and could charge whatever they wish," he said.
Today, even though he is sick, he is still speaking out about the rampant global inequality in access to vaccines for the COVID-19 pandemic which, once again, is created by the big pharmaceutical companies.
"What we are seeing with vaccines is a mirror image of what we saw with HIV and AIDS. The North is secure, the South languishes at the end of the line."
Will we never learn?
Mulroney put Lewis on global stage
In a twist of fate, Stephen Lewis started his illustrious second career -- this one on the international stage -- when Conservative prime minister Brian Mulroney shocked many by appointing the avowed social democrat as Canada's ambassador to the UN.
Mulroney and Lewis both abhorred apartheid in South Africa, but over time their differences would emerge.
Mulroney, "the greatest privatizer," sold off Canada's publicly owned Connaught Medical Research Laboratories, which, amongst many historic advances, organized clinical field trials and the worldwide rollout of Jonas Salk's polio vaccine.
When asked if he would patent his vaccine, Salk said: "Can you patent the sun?" Today, polio is all but eliminated around the world. If those labs had not been privatized, they'd be producing COVID-19 vaccines for Canada and the world today. Instead, our government is endlessly negotiating with big pharma, trying to import them.
Mulroney couldn't have known that Stephen Lewis would become one of the world's most eloquent voices opposing big pharma's huge profits, and the privatization of public health:
"The pharmaceutical industry has benefitted from billions of dollars of public money for research and discovery, and even greater billions in pre-purchase vaccine agreements. Why in the world should the pharmaceutical industry eclipse the role of governments?"
Biolyse, a small pharmaceutical manufacturer in St. Catharines, Ontario, echoes those remarks. Biolyse's vice-president, John Fulton, says that, if given the recipe, it could produce 20 million doses for nations in the global south. Neither AstraZeneca nor Johnson and Johnson nor the Canadian government have responded.
"We've been passed over. We have got this production capacity. If we had started last year, we could have shipped millions of doses by now. This is supposed to be a wartime effort, everyone in it together. But that doesn't seem to be the case," Fulton told The Guardian.
In the first film I did about Lewis, Race Against Time, in 2011, I struggled to keep up with his relentless pace as UN HIV/AIDS envoy to Africa.
He'd be in one country in the morning, with eight or 10 meetings on his agenda, with presidents, cabinet ministers, hospitals, organizations of people dying from AIDS, and sex workers. Then, by evening, he'd have moved to another country, and yet another set of urgent meetings.
Working alongside activist groups, his main aim was accessing affordable anti-retroviral (ARV) drugs, which turn the disease from a death sentence to a chronic condition. ARV drugs were available in developed countries for $10,000 to $12,000 per patient, per year -- but that price was way out of reach for Africa. As Lewis put it: "Rapacious drug manufacturers were protected by patents and could charge whatever they wished."
It was a historic fight against patent protections.
The South African government took 39 pharmaceutical companies to court, and huge demonstrations shamed the companies into reducing their prices. Then, in India, which had passed a law permitting the overriding of patents in a public health emergency, a company called Cipla started producing generic equivalents of antiretrovirals at $350 per person per year.
Fast forward, and today 92 countries have access to ARV drugs which cost just $75 per patient per year. Over four million South Africans are on ARV drugs which are available free from clinics. Treatment outcomes are as good as in Western countries.
But we haven't learnt much from this critical moment in global health. Today wealthy countries outbid each other, and order far more COVID-19 vaccines than they need.
Over 90 per cent of the Pfizer vaccines have been sold to a handful of rich countries. Only one per cent of worldwide doses have been administered in low-income countries, leaving millions vulnerable.
Profit reigns supreme for most big pharmaceutical companies, and the wealthy countries that back them.
Taking on patent protection for life-saving drugs
Though they receive huge government subsidies to develop drugs, big pharmaceutical companies are protected by the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, fostered by the World Trade Organization (WTO). Companies have negotiated secret vaccine deals with governments. A Belgium minister made the mistake of posting the secret prices the European Union pays on Twitter. Pfizer then complained: "The prices are covered by a confidentiality clause in the contract."
During the struggle for affordable antiretrovirals, the WTO eventually agreed that, if three-quarters of its 164 members voted for it, TRIPS could be bypassed for a limited time in a health emergency, so low-income countries could access and produce affordable drugs. At the end of last year South Africa and India called for such a vote over COVID-19.
But in March the wealthy countries voted it down, which means that 90 per cent of the population in dozens of poor countries could wait for the vaccine till at least 2024.
Talk about inequality.
South Africa has warned of "vaccine apartheid," and India is now suffering a COVID apocalypse, with 379,257 new infections and 3,645 deaths on April 30, 2021. Its hospitals are out of oxygen, and its crematoria overwhelmed.
The lesson for us all of India is that the emergence of ominous variants poses a huge global health risk without vaccines available everywhere.
"The mantra of global solidarity has been trashed," says Stephen Lewis. "What we are seeing at the World Trade Organization is the resurgence of a contemporary colonialism. Vaccine nationalism will triumph over global public health."
There is to be another vote at the WTO next week. A group of 100 nobel laureates and 75 former world leaders have called on U.S. President Joe Biden to take the "vital and necessary step to bring an end to this pandemic through a waiver," and there is serious discussion about this proposal at the White House.
On May 8 pop star Selina Gomez will host a star-studded concert, "VAX Live: The Concert to Reunite the World," to raise $22 billion from corporations and governments for countries with less access to vaccines. Strangely, given Canada's position, Justin Trudeau will be one of the speakers.
Canada did not vote against the WTO waiver; however, it has not agreed to it. And Canada has hoarded more vaccines than any other country, even though delivery is desperately slow.
"It is both astounding and appalling that Canada is refusing to waive patents," says Stephen Lewis. "We are on the wrong side of the debate. Waiving patents would mean massive reduction in prices and dramatic increase in generic manufacture. Canada has opted to protect the profits -- frankly obscene profits -- of the drug companies at the expense of global public health. In the face of a pandemic, it is unconscionable behaviour."
The World Health Organization's (WHO) Tedros Adhanom Ghebreyesus echoes Lewis's pleas for equal distribution of vaccines:
"We can't accept a world in which the poor and marginalized are trampled by the rich and powerful in the stampede for a vaccine. This is a global crisis. And the solutions must be shared equitably as global public goods, not as private commodities that exacerbate wider inequalities."
The WHO has set up an organization known as COVAX, through which rich countries can help finance vaccines for 91 low- and middle-income countries. But COVAX is also struggling.
AstraZeneca vaccines were being cheaply manufactured for COVAX by the Serum Institute of India but, given the present disaster, many have been commandeered for domestic use. Meanwhile, Canada, which invested $440 million into COVAX, is waiting for deliveries as part of the deal. Should we be taking vaccines from countries that desperately need them?
"It's morally wrong for Canada to procure 1.9 million vaccines from the international program," says Stephen Lewis. He feels Canada should be on side with countries voting to waive patents: "I think it would be very valuable to Canada given the delays in receiving doses it is currently experiencing."
Voices like Stephen Lewis' calling for change are being heeded.
The Biden administration has backed the initiative, proposed by India and South Africa, to waive intellectual property rights at the WTO for COVID-19 vaccines.
It is "a historical, monumental moment in the fight against COVID-19," says Tedros Adhanom Ghebreyesus, head of the WHO.
Pharmaceutical companies are opposed. Their stocks have fallen sharply.
In order for this to proceed, there needs to be consensus of the 164 WTO members.
Canada, the EU and the U.K. are still opposed. The Trudeau government has yet to respond.
Editor's note, May 6, 2021: This article has been updated to include the news of the Biden administration's support for the initiative to waive patents for COVID-19 vaccines.
Read part two of this series, on Stephen Lewis' work in Africa combatting the HIV/AIDS crisis, here.
Judy Jackson has made over 100 films about human rights and social justice in many countries. They've won many prizes, but the ones that make her happiest are those which bring ripples of change.
Image credit: Judy Jackson. Used with permission.
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