TWN Info Service on Health Issues (Jun21/07)
23 June 2021
Third World Network

UN: Vaccines against COVID-19 must be considered a global public good
Published in SUNS #9372 dated 23 June 2021

Geneva, 22 Jun (Kanaga Raja) – Vaccines against COVID-19 must be considered as a global public good, and universal and equitable access and distribution of vaccines is likely the strongest determinant of whether and how soon the COVID-19 pandemic can be controlled.

This is one of the main conclusions highlighted by Ms Michelle Bachelet, the United Nations High Commissioner for Human Rights, in presenting a report by her office to the UN Human Rights Council on the central role of the State in responding to pandemics and other health emergencies.

The Human Rights Council is currently holding its forty-seventh regular session which began on 21 June.

In her presentation to the Human Rights Council on 21 June, Ms Bachelet said that over a year now, billions of people on the planet had their lives turned upside down virtually at the same time.

As of last week, there had been over 176 million confirmed cases of COVID-19 reported globally to the World Health Organization (WHO) with over 3.8 million deaths.

The pandemic continues to pose an extraordinary threat to societies worldwide, both as a public health emergency and a socioeconomic crisis with far-reaching consequences, she added.

Ms Bachelet said that COVID-19 has shown that the “failure to integrate human rights-based approaches into health emergency preparedness, response and recovery efforts has serious consequences for human rights and development.”

In addition to the incalculable loss in human lives, the economic cost of the pandemic has been catastrophic, said the High Commissioner.

Around 255 million jobs are estimated to have been lost during 2020, nearly four times the figures of the global economic crisis in 2008. Women have been more severely affected than men in all regions and all income groups.

The estimate is that the pandemic may have pushed up to 150 million people into extreme poverty by the beginning of 2021.

Global hunger is also on the rise. Over 130 million people have become more vulnerable to undernourishment last year, said Ms Bachelet.

Overall, the pandemic has either disrupted or reversed hard-won progress on achieving many of the Sustainable Development Goals (SDGs), she added.

In terms of health, this crisis has also had a catastrophic effect on other services, Ms Bachelet said, adding that there have been serious disruptions to the provision of sexual and reproductive health services and treatments for non-communicable diseases, as well as mental health care and routine vaccination.

She said States should ensure continued availability and accessibility of care, medicines and vaccines, protecting the primacy of public health over private profit.

“And, as I have said before, vaccines against COVID-19 must be considered as a global public good. The universal and equitable access and distribution of vaccines is likely the strongest determinant of whether and how soon we can control the pandemic,” the High Commissioner underlined.

If radical steps are not taken to protect economic, social and cultural rights and support low-income countries, the outlook remains bleak, said Ms Bachelet.

This involves respecting, protecting and fulfilling economic, social and cultural rights, prioritizing universal health coverage and universal social protection, she added.

According to the report by the Office of the High Commissioner for Human Rights (A/HRC/47/23) that was presented at the Council on 21 June, the central role of the State during pandemics and other health emergencies is to mount a robust health response while upholding human rights.

This involves respecting, protecting and fulfilling economic, social and cultural rights, paying particular attention to universal health coverage and universal social protection as fixed pillars in all response, preparedness and recovery efforts, it said.

“The resilience of health systems and national economies has been undermined, to a great extent, by the failure to adequately invest in meeting human rights obligations. States should step up investment in health and social protection systems backed by multilateral, joined-up approaches based on solidarity.”

These steps require renewed political will and leadership to honour the commitments made by States under human rights law and the 2030 Agenda for Sustainable Development, said the report.

Challenging the capacities of even the wealthiest countries to deal with soaring infection rates and ensure continuity of other essential health services, the COVID-19 pandemic unfolded against the backdrop of a human rights landscape marked by chronic neglect of economic, social and cultural rights, a situation which reached a low point with the global economic downturn in 2008, said the report.

Many countries resorted to fiscal consolidation, adjustment or constriction measures, incorporating reductions in social sector spending, labour market and pension reforms, regressive taxation policies and the privatization of many public services, including health services, it added.

“Their cumulative effect on people in danger of falling into poverty or already living in poverty was to increase deprivation and reinforce existing social and economic inequalities, including gender-based inequality.”

Today, the COVID-19 pandemic poses an extraordinary threat to societies worldwide. Although it began as a public health emergency, the crisis has had far-reaching socioeconomic consequences, said the report.

The equivalent of 255 million jobs were lost during 2020, nearly four times more than had been lost in the global economic crisis in 2008, with women more severely affected than men in all regions and income groups.

As of October 2020, the COVID-19 pandemic was estimated to have pushed between 88 million and 115 million people into extreme poverty – the number could reach 150 million by 2021.

South Asia and sub-Saharan Africa are projected to add 32 million and 26 million people, respectively, to those living below the international poverty line.

Constituting just over 60 per cent of the global workforce, informal sector workers, most of whom are women, are expected to have lost 60 per cent of their income in the first month of the crisis, and up to 81 per cent in some regions.

Worldwide, hunger too is on the rise, with 132 million more people having become vulnerable to undernourishment in 2020.

“Overall, progress on achieving many of the Sustainable Development Goals, including Goal 3 (to ensure healthy lives and promote well-being for all at all ages) has been disrupted or reversed,” said the report.

If radical steps are not taken to protect economic, social and cultural rights and support low-income countries, the outlook remains bleak, it cautioned.

More than 40 Governments, including countries with pressing development needs, are expected to reduce their budgets by an average of 12 per cent during 2021/22 compared with 2018/19, the report noted.

Despite its impact on economic, social and cultural rights, austerity is likely to affect around 85 per cent of the global population by 2022, and over three quarters of all people may still be living under such conditions in 2025.

Already in debt distress or at high risk of developing it, low-income countries have seen their ability to respond effectively to the pandemic and its impacts hamstrung by severe fiscal limitations, said the report.

Consequently, for the developing world, there is a two-fold challenge: “a balance of payments and debt crisis that may up-end development progress, and a development crisis that could erupt into a debt crisis as the state of the economy deteriorates”.

Although most States are making genuine efforts to minimize the socioeconomic impact of the crisis, critical gaps remain, said the report.

“Perhaps most egregious is the exclusion of women from COVID-19-related policymaking and decision-making, which has led to policies that fail, generally, to adequately address the gendered social and economic consequences of the pandemic.”

The impact on older persons, persons with disabilities, persons in detention, lesbian, gay, bisexual, transgender and inter-sex persons and other populations and groups has been severe.

The report said that there are also other areas, including climate change and the environment, business and human rights, and international and unilateral sanctions, that must be addressed in any effort to build back better.

According to the report, the crisis caused by the COVID-19 pandemic has shown that the lack of investment in economic, social and cultural rights and in the implementation of the 2030 Agenda for Sustainable Development left societies insufficiently prepared for the pandemic and led to great human suffering and economic losses.

“As the socioeconomic impact of the response to the COVID-19 pandemic reverberates around the world, some States have sought to mitigate it by, for example, adopting moratoriums on evictions, broadening access to health care and essential services and, crucially, introducing economic stimulus packages.”

Running into the tens of trillions of dollars collectively, these packages were generally designed to stimulate short- term demand and foster long-term growth. They included social protection benefits, support for businesses and tax cuts.

However, the report said, the poorest countries have spent only 2 per cent of their gross domestic product (GDP) on stimulus packages, while industrialized countries have spent up to 20 per cent of their GDP on them.

Faced with collapsing trade, falling remittances, capital flight, currency depreciation and insufficient international development assistance, many poor countries have been forced to choose between providing basic services for their people or servicing their debts, said the report.

“States’ responses under the pressure of the crisis have confirmed that economic, social and cultural rights can be prioritized and must be upheld both as a matter of principle and to provide protection in the event of pandemics and other health emergencies,” it added.

The COVID-19 crisis and its socioeconomic consequences call for political leadership, including at the highest levels, to reverse the marginalization of economic, social and cultural rights, which are binding obligations, and prioritize their realization, the report emphasized.

“States and other stakeholders should use the maximum of their available resources, including resources available through international cooperation, for the progressive realization of economic, social and cultural rights.”

In this context, the report highlighted several key actions including extending new allocations of special drawing rights to middle-income countries in need of liquidity; cancelling or restructuring debt or reaching agreements on debt standstills, including from private creditors; and recommitting to the target of allocating 0.7 per cent of gross national income to official development assistance to ensure that low- and middle-income countries have the fiscal space necessary to navigate the crisis.

The report called for implementing a holistic approach to debt management and restructuring, with the participation of all actors.

In the short term, the Debt Service Suspension Initiative and the Common Framework for Debt Treatments should review their criteria to ensure inclusion of those low- and middle-income countries that are currently excluded, it said.

The report also said that the pace at which the COVID-19 pandemic gained ground has left many Governments unable to respond adequately.

It said the high demand for health services quickly outstripped supply, leading, for example, to severe pressure on intensive care facilities and to shortages of vital equipment and supplies such as ventilators and oxygen.

Although vaccines might offer an important route to controlling the pandemic, new variants of the virus responsible for COVID-19 have already begun to complicate efforts to reduce transmission at the community and global levels.

It is likely, however, that the stronger determinant of whether and how soon control is achieved is the universal and equitable distribution of vaccines, said the report.

The dominant approach taken by some wealthy countries has been to favour the protection of their own populations as opposed to privileging a more coordinated response that would ideally target vulnerable groups in all countries first and follow evidence-based guidance for a subsequent roll-out, it added.

Access to vaccines is not only an important component of the right to health, it is a requirement that engages the immediate responsibility of States, the report underlined.

It noted that the availability and accessibility of good quality health facilities, goods and services on the basis of non-discrimination remains a challenge, especially in developing countries.

The report said that structural and societal discrimination, the marginalization of entire communities, groups and populations, prohibitive health-care costs and the failure to address other underlying determinants of health have driven much of this deficit and pose a serious challenge to achieving universal health coverage by 2030.

The COVID-19 pandemic has also highlighted the resource constraints under which many health systems have been operating, particularly in developing countries, which have tended to bear the highest burden of disease.

In 2020, more than half of the global population still lacked access to adequate essential health care. There are wide disparities between regions and among populations: 56 per cent of the global rural population, compared to 22 per cent of the global urban population, lacks health coverage.

As many as 18 million health workers are needed to address the global shortage of personnel, said the report.

The report called on States to ensure availability and accessibility of essential medicines and vaccines.

To that end, the report said that States should protect the primacy of public health over private profit, in line with their commitments to support research and development of vaccines and medicines, as well as preventive measures and treatments for communicable diseases, especially those that have a disproportionate impact on developing countries.

The report also said that the positive vision that the 2030 Agenda paints lies in sharp contrast to the current reality, where the COVID-19 pandemic and the accompanying socioeconomic crisis have aggravated existing inequalities between and among countries, added tens of millions to the count of those already left behind and undermined progress towards achieving the 2030 Agenda as a whole and its Sustainable Development Goals specifically.

“The socioeconomic crisis has devastated businesses, industries and livelihoods. It has exposed the flaws of the existing political, economic and social system and, once more, the burden of hardship has not been evenly borne.”

Following the pandemic, in 2020, hundreds of millions of workers lost around 3.7 trillion dollars in earnings, while some of the world’s richest individuals increased their wealth by an estimated 1.9 trillion dollars, said the report.

“Populations and groups already subjected to poverty and marginalization and to multiple and intersecting forms of discrimination on grounds such as income, gender, location, race, religion and age continue to sink deeper into deprivation.”

Although social protection systems help prevent and reduce poverty, nearly three quarters of the global population is either not covered or only partially covered by social security systems.

Only 22 per cent of unemployed persons receive unemployment benefits and only 35 per cent of children worldwide enjoy effective access to social protection, said the report.

“Vaccines have become the newest frontier in the struggle for equality, demonstrating that the divide between rich and poor countries remains as stark as ever,” the report emphasized.

It noted that with several vaccines cleared for use by regulators in several countries, a handful of wealthy countries have received more than 87 per cent of all vaccine doses while developing countries have received 0.2 per cent.

“This situation not only undermines the solidarity and cooperation that must underpin an effective and responsive multilateral system primed for the optimal protection of human rights, it is also inefficient in the context of a global pandemic,” said the report.

The report further said that the COVID-19 pandemic has shown that the failure to integrate human rights-based approaches into health emergency preparedness, response and recovery efforts has serious consequences for human rights and development.

Among the recommendations highlighted by the High Commissioner for Human Rights for “building back better” are that the global approach to pandemics and other health emergencies should be coordinated and be in line with the International Health Regulations (2005), the International Covenant on Economic, Social and Cultural Rights and the 2030 Agenda.

“Efforts should be directed, among others, to increasing manufacturing capacity and ensuring equitable global access to COVID-19 medicines, vaccines, therapies and health technologies; pooling and sharing knowledge, intellectual property and data; participating in global initiatives aimed at supporting equitable, non-discriminatory access to health facilities, goods and services such as the COVID-19 Technology Access Pool; and strengthening health systems.”

Ms Bachelet also called on States to adopt as best practice, irrespective of crisis situations but especially during pandemics and other health emergencies, the interpretation and implementation of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) in line with the right of World Trade Organization members to protect public health and, in particular, to promote access to medicines for all.

The High Commissioner also recommended that debt relief should be extended to all countries in need, even middle- income countries, for example, by cancelling or restructuring debt or reaching agreements on debt standstills from all stakeholders, including from private creditors, in order to provide developing countries with the necessary fiscal space.