By Javier Suazo on April, 2021

“The pharmaceutical industry has the responsibility to share intellectual property, while developed countries should be more supportive.”

UNESCO’s International Bioethics Committee and the World Commission on the Ethics of Scientific Knowledge and Technology.“Rumors are circulating about bringing salary-deductible vaccines to private company workers.”

Carlos Umaña, IHSS physician, Honduras

With vaccines that provide temporary protection against COVID-19 and several of them having undesirable effects on human health, a growing problem is the control of production and availability by the countries with greater economic and financial power.  Not only is production being monopolized, but also a line of action is being taken that seeks to control patents, so that less developed countries or those on the periphery cannot produce them at lower cost.

An example of this control is that out of 70 million vaccines applied, 87% correspond to the population of high or upper-middle income countries, with 1 out of every 4 people being vaccinated, compared to 1 out of every 500 people in low income countries (WHO: 2021).  This gap is manifested in a growing loss of human lives, jobs and the collapse of health systems, which is not compensated by higher foreign debt.

In Latin America, countries such as Bolivia have started a campaign to allow the release of patents, eliminating the prohibition of intellectual property and making it possible for other countries to manufacture the vaccines.  The United Nations is required to coordinate a World Plan of Mass Vaccination against COVID-19, where the production of vaccines is generalized and is not an obstacle for lower income and elderly people to have access to vaccination quickly.

In this sense, “it is necessary to put back at the center of the Latin American and Caribbean agenda the reconstruction of a regional integration in health based on autonomy, healthcare sovereignty and South-South principles of international health.  This does not only concern and depend exclusively on the intergovernmental relations of “States and Governments,” but regional health sovereignty is a strategic process that is nested in the interweaving of territories and actors in the construction of Health from the South.” (CLACSO: February 2021).

Added to this is the use of vaccines for political and ideological purposes, where the countries that have monopolized part of the production, authorize the delivery — through donations — of small doses to those governments aligned with their policies and interests.  An example is the donation by the government of Israel to the government of Juan Orlando Hernandez (JOH) in Honduras — and the same in the case of Guatemala — of 5000 doses of the Moderna vaccine.  It is known that this government endorses the policy of cutting off Palestinian territory and moving its embassy to Isreali-occupied East Jerusalem.

It should be added that several governments and transnational pharmaceutical companies consider that vaccinations are not a pure public good, since it can be provided directly by private companies which rake in the profits.

That is to say, it’s important to eliminate the prohibition on the sale of vaccines by pharmaceutical companies to governments, not directly to intermediary companies, private interest groups or trade unions. For this to happen, governments must authorize or regulate the importation or direct purchase of vaccines by private companies, which could distort current legislation and generate a systematic violation of a public right.  Health is a universal right, so mass vaccination is a public function whose exclusive competence lies with the State and government; it cannot be delegated.

In Peru, a law was passed authorizing the private sector to acquire, import, store, commercialize and distribute vaccines against COVID-19, thus allowing the vaccination of employees and family members of companies with a minimum number of 200 workers on the payroll.  But small companies can join forces to reach the required number.  The price must be solidarity-based and set by the health authorities, but private companies can sell 10% of the imported lot to governments to vaccinate their vulnerable population.

In the case of Honduras, the Honduran Council of Private Enterprise (COHEP), the Honduran Institute of Social Security (IHSS) and the Health Secretariat-ARSA, signed an agreement so that companies can negotiate directly with pharmaceutical companies for the acquisition of vaccines against COVID-19.  In this regard, COHEP would draw up a list of the companies interested in importing, as well as the vaccine needs required according to the number of employees and dependents.

The argument is that the Honduran government has been unable to efficiently manage the pandemic, since the evidence shows about 5,000 deaths due to COVID-19 and the waste of resources, caused mainly by the prevalence of corrupt practices at all levels of government.  For the workers of the companies, the vaccines would be at no cost, since they assume it as a necessary expense to continue operating at 100%, without sick workers and loss of productivity.

The collaboration of the private sector ends when a purchase-sale contract has already been established with the pharmaceutical companies, making the Honduran government responsible for the storage and application of the vaccines, preferably through the Expanded Program of Immunizations (PAI) of the Health Secretariat.  There is talk of vaccinating all workers and their families, especially those affiliated to the IHSS, but there is a demand from professional associations that are also betting on vaccinations with private management.

Some 5,500 companies have registered and shown interest in this mechanism, but the evidence shows that not all of them (it is necessary to see the list of companies managed by COHEP), have the capacity and resources to manage the importation.  The interest of the registered companies is to vaccinate workers and their families quickly, that is, before the vaccines contracted by the government arrive.

Businesses talk about vaccinating 1.8 million Hondurans, which represents 42.6% of the EAP, but very little is said about the unemployed and their families, or the self-employed and informal workers who expect the government, through the COVAX mechanism and the Russian vaccine Sputnik V, to comply with the constitutional duty to provide a public good at no cost.  COVAX is intended to vaccinate 20% of the population, but has only delivered 48,000 doses, a marginal allocation.  In the case of Sputnik V, a purchase of 4.2 million doses was authorized, but only 6,000 doses have arrived, which has necessitated a trip of government officials to Russia with public funds.  The arrival of 1.4 million doses of AstraZeneca vaccine, contracted by the IHSS through direct purchase, is still pending.

These vaccine purchases, given the weak public finances and the economic crisis facing the country, are made with foreign debt funds, which also affects the future sustainability of a policy of access to health and social protection.  In the case of Honduras, the World Bank recently approved a loan of $20 million U$D for the purchase of vaccines and related items, as it did with El Salvador for $50 million.

COHEP has also signed an Integrity and Transparency agreement with the National Anticorruption Council (CNA), to act as a social overseer of operations, and even provide advise on good administrative, financial and technical management practices.  The problem is the discrimination and segmentation of the market that will be caused by the purchase of vaccines and their application.  On the one hand, the delivery of vaccines to the government advances at a snail’s pace and, on the other hand, COHEP and its foreign partners demonstrate that they are more efficient than the government in importing vaccines and applying them to those who need them, not only workers and family members.  Complaints from consumer protection organizations fear the creation of an illegal market for the purchase and sale of vaccines, in addition to price speculation and unreliable administrative management processes.

There are at least five (5) lines of work at the level of governments of Latin American countries on the issue of vaccines: a) The United Nations and member organizations should lead the Global Plan for Long-Term Mass Vaccination without exception; b) A worldwide recognition that vaccines are a universal public good that should be provided by the State (there is already a letter from 140 world leaders declaring vaccines to belong to everyone); c) Greater pressure on pharmaceutical companies and governments for the liberalization of patents; d) Greater protection in constitutions of Latin American countries that access to health is an acquired human right, with vaccinations against COVID-19 a mechanism to vindicate this right; e) Revitalization of the instances and mechanisms of regional integration to form a block and to be able to negotiate joint purchases of vaccines, and to demand liberalization of patents.

In the latter, the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) has already gained experience, so it should take it on as a regional agenda item, in order not to continue fighting for quotas of vaccine doses on an individual basis.  The same happens with UNASUR, which has made joint purchases of vaccines to face the influenza AH1NI, beyond the hidden agendas of the governments in the political and geostrategic issue.

In the particular case of Honduras, faced with the interest of the private sector to demonstrate that they are more efficient than the government, a solution suggested by members of the Libertad y Refundación (LIBRE) party is that the government appoint the director of COHEP as Minister of Health, since business people have participated in the actions executed by the JOH government and have benefited from business with the State.  Greater private efficiency can help improve public inoperability in the area of vaccines and management of financial and budgetary resources as well as alleviate corruption.

Source: Alainet, translation Resumen Latinoamericano – English

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