In discussion with the Global Health Centre at the Graduate Institute, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Winnie Byanyima spoke about the various disparities between rich and poor countries, highlighting Covid’s exacerbating effects.
In a video that went viral at 2019’s World Economic Forum, Winnie Byanyima, then still Oxfam’s executive director, made headlines with her fiery critique of growing wealth inequalities, pointing out that “billionaire wealth was rising six times faster than the salaries of ordinary workers.”
Last week, in conversation with the Global Health Centre, she reiterated the persistence of these inequalities and this time explained how the pandemic has accentuated these. To illustrate, “the world’s workers have lost $3.7 trillion earnings since Covid hit,” Byanyima said, citing figures from the International Labour Organisation (ILO).
This is backed by a recently published report at the virtual World Economic Forum in January by Oxfam showing “the world’s ten richest men have seen their combined wealth increase by half a trillion dollars since the pandemic began —more than enough to pay for a Covid-19 vaccine for everyone and to ensure no one is pushed into poverty by the pandemic.”
At the same time, the pandemic has “ushered in the worst jobs crisis in over 90 years with hundreds of millions of people now underemployed or out of work.” Byanyiama says that whilst billionaires reap the benefits from Covid-19, ordinary people “sink.”
Beyond the generalised wealth inequality divide, there are layers that need to be addressed. For example, the Oxfam report finds that “Afro-descendants in Brazil are 40 per cent more likely to die of Covid-19 than White people, while nearly 22,000 Black and Hispanic people in the United States would still be alive if they experienced the same Covid-19 mortality rates as their White counterparts.”
Covid-19 and the vaccine race, the height of inequality? The heads of the World Health Organization (WHO) and the UN Children’s Fund (UNICEF) were once again appealing for scaled-up Covid-19 vaccine production and equitable distribution, with the current distribution noted as the height of inequality, according to Byanyima.
On Monday, the WHO gave the Oxford-AstraZeneca vaccine the go-ahead for emergency use, making it the second vaccine approved for Covax, a facility aimed at distributing shots equitably worldwide.
The Oxford-AstraZeneca makes up the largest of the Covax portfolio at the moment as the other approved vaccine for the facility, Pfizer-BioNtech, only made 1.2 million doses available in the first part of this year.
Only 10 countries account for 75 per cent of the vaccine doses distributed so far, “meanwhile, almost 130 countries, with 2.5 billion people, have yet to administer a single dose,” WHO director-general Tedros Adhanom Ghebreyesus said last week.
Monopolising intellectual property in a time of need. Although Covid-19 is hitting every country in the world, Byanyima notes “today, three companies, American and European, are holding on to their technology and intellectual property, and people are dying.” She continued: “We’ve calculated that the three biggest vaccine companies in the world are currently planning to produce vaccines for just 1.5 per cent of the global population this year. That’s all. 1.5 per cent of the global population.”
As the World Trade Organization (WTO) named its new director-general last week, the imminent priority of Nigeria’s Ngozi Okonjo-Iweala could see her faced with what she has been battling with in her capacity as former chair of Gavi, the Vaccine Alliance. As head of the world’s biggest trade arbiter, Okonjo-Iweala is likely to face the dominant pharmaceutical companies currently holding onto the vaccine technology required to battle the Covid-19 pandemic worldwide.
South Africa and India last October approached the WTO calling for a suspension of the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) during the crisis to ensure “timely access to affordable medical products including vaccines and medicines or to scaling-up of research, development, manufacturing and supply of medical products essential to combat Covid-19,” a joint statement read.
An intellectual property (IP) waiver would have made it easier for low-middle income countries to produce Covid-19 vaccines and medication. However, wealthier countries opposed this.
Byanyima reprimanded rich countries mentioning that while these IP rules can change “some governments seem to think that they are God-ordained and that these rules cannot change.” The proposal was vehemently rejected by the likes of the US, UK, and the European Union on grounds of ‘stifling’ the pharmaceutical companies’ innovation, which is deemed a pertinent incentive.
This however just further widens the inequality gap and reinforces the ‘vaccine apartheid’, says Byanyima. In a recent article, she expressed her disdain for inequalities particularly during the pandemic. She said she was ‘sickened’ by the news that “South Africa, a country whose HIV history should have taught us all the most appalling life-costing consequences of allowing pharmaceutical corporations to protect their medicine monopolies, has had to pay more than double the price paid by the European Union for the AstraZeneca vaccine for far fewer doses than it actually needs. Like so many other low and middle-income countries, South Africa is today facing a vaccine landscape of depleted supply where it is purchasing power, not suffering, that will secure the few remaining doses.”
The pricing of the vaccines remains “so opaque and un-transparent these companies can get away with opaqueness and can charge different prices,” said Byanyima. With the “Oxford AstraZeneca vaccine, South Africa is going to pay $5 per dose. My country Uganda, which is poorer than South Africa is going to pay $7 per dose and here in Europe, it costs $2 per dose,” she mentioned.
Lessons learned? According to Byanyima, this is by no means the first instance of health inequality and says the world has witnessed this in the case of HIV/AIDs, where the response showed clear demarcations between the responses of rich and poor countries.
During the conversation Byanyima was asked how this income inequality we are currently experiencing for Covid-19 is similar to the HIV response. She responded that “it was the same rules that underlined the lives of people living with HIV, we must not forget that. In the 90s, when antiretrovirals were first discovered in America and Europe, again, the price was too high. And for the next six years, when people in rich countries could get the medicine, and live long, healthy, productive lives, nine million people in developing countries died because they couldn’t afford it.”
A report released last year by UNAIDS demonstrated that countries grappling with Covid-19 are using the experiences of and infrastructure from the AIDS response to ensure a more robust to both pandemics.
“We are so proud that this is what we from the HIV movement have brought that, because this disease had no cure, no vaccine, and the responses depended on communities,” said Byanyima.
As executive director of UNAIDS, Byanyima, explained the importance of community health workers in the HIV response, and how important this has been for the Covid-19 response. “The base is community health activities, community health workers, working with scientists and their labs.” Adding that in “South Africa, it is the community health activists who fought HIV, who were first mobilized to go to the contact tracing [for Covid]. These groups are now being mobilised to work on the vaccination campaigns, through behaviour change communications, the monitoring people and will help people to come for a first jab and a second jab.”
This is by no means the last global health outbreak the world will face. Byanyima hopes we can address these inequalities to tackle health difficulties, including Covid-19.