Daily Editorial Analysis for 4th June 2021

Tapping trips flexibilities for public health

About TRIPS

• The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs) came into effect in January, 1995.
• It protects four intellectual property rights – patents, copyrights, industrial designs, and trade secrets.
• At the same time TRIPs contains provisions to relax or suspend these IP rights during health emergencies.
• Covid-19 pandemic has shaken the world. No country has been spared from its devastation.
• Vaccines are considered to be a lasting solution to controlling it but availability of these vaccines in the developing countries has become a huge issue- multinational companies have the monopoly over these.

Vaccine Diplomacy

• For the first time in the history of WTO, as many as 62 countries led by India and South Africa have approached this august body for a temporary waiver of IP rights in vaccines and other essential medicines and therapeutics.
• This proposal has emanated from the belief that developed countries are stocking up the vaccines and developing countries are being denied access to these.
• Developments of the last few months are pointers to this: developed countries have cornered 70 per cent of the vaccine production while over 100 low-income countries have had not a single dose of vaccine. Some countries have termed it as ‘vaccine apartheid’.
• Many of the countries in Africa dread a repeat of the 1990s when HIV/AIDs ravaged the continent, and there was no access to the newly launched triple cocktail of drugs to treat this illness as it cost over US$12,000 per person per year.
• Ultimately under huge pressure from governments, civil society and other groups, generic production was allowed to companies like Cipla. The result was a drastic drop in prices to US$1 per person per day (in 2001).
• The Doha Declaration on the TRIPs Agreement and Public Health in 2001 (by WTO Ministerial Conference) reiterated the flexibilities in TRIPs for public health.
• It recognized the rights of member states to make use of these at times of health emergencies. Despite all this the developed countries and Big Pharma have always resisted use of TRIPs flexibilities.
• As in the past, most developed countries have opposed the proposal to suspend the IP rights in vaccines and other medicines, even if temporarily. They give the oft-repeated argument that it will harm innovation and discourage private investment into research and development.
• Further, since the current crisis is witnessing a mutating virus, it needs constant tracking and innovation, hence more investments.
• It is also being said that most developing countries do not have the capacity and competence to handle the production of complex vaccines.
• Instead, these countries have offered to supply vaccines in charity to the low-income countries through the COVAX facility created by WHO and three other international agencies. This charity-based model has not been found sustainable during the past epidemics.
• The developing countries are highly skeptical of the motives of the developed countries and want to tap the flexibilities offered by the TRIPs agreement – collectively this time rather than individually.
• Last month efforts of the developing countries got a shot in the arm when the USA reversed its earlier stand and announced support to their proposal in WTO. Still, the road to the final destination is paved with uncertainties and would need all the acumen and perseverance at the level of the proposers.
• Two other significant developments took place:
• First, to break the deadlock, the 62 co-sponsor countries have on 21 May amended the proposal to limit the waiver period to three years with a provision to review the position at the end of it. It is hoped that the revised submission will help reconcile the two opposing positions.
• Second, the date for the long-pending meeting (12th) of the Ministerial Conference, the highest decision-making body in WTO, has been announced. It is scheduled to be held from November 30 to December 3, 2021. The delay is due to the Covid-19 pandemic but this may also delay a final decision on the proposal of the developing countries. This decision will be taken based on the consensus of all WTO members. If consensus is not reached, the decision will be taken by voting with a majority of three-fourth members voting in favour.
• Covid-19 vaccines have been developed in a short period, primarily with the help of public funds from the USA, EU and other sources.
• Therefore, the argument in favour of retaining monopoly rights with multinationals is not wholly convincing.

Production of COVID-19 Vaccine

• There is so much logic and urgency for suspending IP rights and sharing technology with a larger number of companies and this demand is getting louder.
• Among other positive moves is the EU initiative worth $1.2 billion on manufacturing and access to vaccines, medicines and health technologies to Africa.
• Big Pharma comprising of BioNTech, Pfizer, Johnson & Johnson and Moderna, have together pledged 1.3 billion doses for low-income countries at no profit and to middle-income countries at lower prices by the end of the year — mainly through the COVAX facility.
• Italy has pledged Euros 300 million (1.8 billion doses).
• Gavi, the Vaccine Alliance, which oversees COVAX, has been able to pool over $7 billion of the targeted $8.3 billion for 2020-21 for COVAX for the lower-income countries.
• Furthering these efforts, the European Commission, in its Rome Declaration of May 21, announced sharing of intellectual property rights for global public health. It talked of “promoting the use of tools such as voluntary licensing agreements of intellectual property, voluntary technology and know-how transfers, and patent pooling on mutually agreed terms”.

Way Forward

• Despite all the above developments the developed countries remain divided on the issue of waiver of IP rights.
• Further discussions in TRIPs Council are held up. Since access to vaccines in all countries is the key to control the pandemic, it is essential that an early decision is arrived at the pending proposal.
• There is need to multiply and diversify the production capacities and the production centres without further loss of time.
• It is heartening to see India and South Africa emerge as the voice of over 100 low-income and lower middle-income countries of the world who are the most vulnerable needing greater access to vaccines.
• Hopefully, with pressure building up on the developed countries, there should be a breakthrough in WTO and collective efforts of all countries will bear fruit.
• We have to win the fight against Covid-19, so that everyone feels safe and protected.

GS PAPER III

Rural health care needs fixing, and now

Why in News

• The two consecutive waves of COVID­19 and Mucormycosis have left us shattered. Multiple bruises have been caused to us.

Data show shortfalls

• The second wave of the novel corona virus pandemic has exposed the inadequate and poor health infrastructure in the rural areas.
• In the fast-changing health scenario, India should have one expand Public Health Centres for every 10 villages along with the provision of some beds and other minimum necessary facilities.
• India has 5,624 community health centres (CHCs) against the requirement of 7,322. Data on CHCs, which act as a referral centre covering a population of 80,000 people to 1.20 lakh people, show that, overall, there is a shortfall of 81.8% specialists at CHCs as compared to the requirement for existing CHCs.
• As in the Human Development Report 2020, India has eight hospital beds for a population of 10,000 people, while in China; it has 40 beds for the same number of people.

The picture in Haryana

• The health infrastructure in Haryana, which remained a backward area of Punjab till 1966, it had only one medical college in the public sector up to 2005.
• In 2014, Haryana Government emphasize on health services; besides many private sector medical colleges, one State health university, four medical colleges (at Karnal, Faridabad and Nuh in Mewat), and one medical college for women (in the rural area of Sonipat district) were established.
• Yet, Haryana requires 5,070 sub­health centres (SHCs) as against the existing 2,666; 845 PHCs as against 531 at present, and 253 CHCs as against 118 working at present.
• When infrastructure in the health services is so poor in a progressive and prosperous State such as Haryana, one can easily estimate the inadequacy of the physical healthcare infrastructure in the rural areas in other States.
• It is of utmost importance that governments everywhere engage with all kinds of rural community organizations such as panchayats, gram sabha, notified area committees, municipal bodies and nongovernmental organisations in minimizing the adverse impact of the pandemic on rural life.
• According to worldometers.info, out of 139 crore population of India, at least 91 crore people are living in 649,481 villages.
• There are at least 10% of people in the urban areas who are partly settled in villages as well since they keep moving to their rural habitations quite frequently. Villages need adequate health services.
• Given the alarming proportion of no communicable diseases (NCDs) in India, we cannot sit idle any longer and need to focus on the existing health infrastructure in the rural areas.
• This is one of the most important takeaways for us after the two waves of COVID­19 and the spread of Mucormycosis in the country.

The Health Network

• As per an estimate of WHO, NCDs including cases of cardiovascular disease, chronic respiratory problems and cancer cause nearly 41 million (71%) of all deaths globally and about 5.87 million (60%) of all deaths in India.
• It will not be humanly possible to treat them all, thereby causing premature deaths on such a large scale. Persons with such morbidities are the most vulnerable in the case of a pandemic.
• India needs to treat the disease/s at the primary level in its first stage to create a healthy India. It will also help us save a lot of money and the resources being spent at tertiary level health care.
• If SHCs work effectively, there will be less pressure on PHCs. If the PHCs function well, then there will be minimal pressure on CHCs and so on.
• Unfortunately, we have not been able to maintain the vibrancy and vitality of the network of health care. As a result, the vast rural populace remains deprived of critical health interventions.
• The chain of SHCs, PHCs and CHCs can very well take care of the multiple health needs of our people. They should have the health data of people in their respective areas.
• It will enable them to identify those likely to slip into the secondary or tertiary care zone. Regular health camps will help us identify those on the verge of developing tuberculosis, hypertension, diabetes or any diseases likely to be caused because of their socio and economic conditions.
• A CHC or referral centre equipped with specialists will do wonders if made to work efficiently. Every CHC is supposed to have ‘at least 30 beds for indoor patients, operation theatre, labour room, X­ray machine, pathological laboratory, standby generator’ and other wherewithal.

Collective responsibility

• As more than 65% of the population resides in the rural areas, we cannot ignore their health needs. WHO has its norms and yardsticks?
• Health is a state subject, but all those living in the rural areas are not only the responsibility of the States or the Centre but also a collective responsibility.

Conclusion

• Only spending is not the solution, nations have to ensure that the money being spent improves facilities and contributes to people’s ease of life.
• It is hugely challenging as a task but we have to firm up our strategies, their execution and by rigorous auditing so that we are ever well prepared not only to meet this pandemic effectively but also to make our rural folk healthier.
• We must remember that no one will survive unless all of us survive. As Bertrand Russell has put it, “It’s co­existence or no existence.”