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UK COVID-19 Inquiry Must Examine the Paternalism and Power Dynamics Underpinning its International Pandemic Response

By guest contributor Harry Bignell, Health Policy Advisor at Oxfam

Since being officially declared a pandemic in March 2020, COVID-19 caused the death close to 15 million people by the close of 2021, according to WHO (others put this figure higher).

In July 2021 the UK Government lifted all remaining pandemic restrictions, largely to widespread vaccination coverage.

Meanwhile, just 20% of people in low-income countries have received at least one dose of a COVID-19 vaccine. Extreme inequality in access to vaccines, tests and treatments has resulted in mass loss of life and continued public health risks across lower income countries. It has also prolonged the pandemic globally by creating the perfect breeding ground for new variants, with devastating health, social and economic impacts everywhere, including the UK.

Despite the clear interdependence of national and international pandemic responses, the Terms of Reference for a recently launched inquiry into the UK Government’s handling of COVID-19 entirely neglect its role in international COVID-19 response.

A new report out today helps to explain why this significant blind spot is counterproductive and inexcusable in terms of accountability and learning for future pandemic responses. It will also mean the inquiry will fail against its own stated commitment to examine the ‘impact of the pandemic on inequalities at every stage.’

Assessing the UK’s role in international efforts to tackle COVID-19 is crucial to ascertaining the successes, failures and lessons to be taken from the UK’s COVID-19 response.

Paternalism and Power in UK Pandemic Preparedness and Response

The new report, Paternalism and Power in UK Pandemic Preparedness and Response, highlights where paternalism and racism have driven the UK’s international position on COVID-19 and manifested in policies which are detrimental to low- and middle-income country recoveries.

The UK bought up early supplies of COVID-19 vaccines, monopolising over a third of the world’s vaccine supply along with other G7 countries, despite collectively making up just 13% of its population. Similarly, high-income countries purchased all of the first 30 million available courses of Pfizer’s oral antiviral Paxlovid, with the UK claiming 2.5 million of these.

Rasha Mezher-Sikafi, an NHS GP based in London, lost her only surviving and highly vulnerable grandmother who was based in Iraq to COVID-19. She had been unable to get a vaccine. Rasha reflects on the mental health impacts access disparities have on those in the UK with family overseas, “As a family we still have not come to terms with our losses. Especially as Bibi had not received a vaccine, when so many of her age here in the UK had received two at that time. Her death could have been prevented. If vaccines were made available to her, she would have been alive today and my children would have been able to hug her.”

Early in the pandemic the governments of South Africa and India anticipated the disparity in access to pandemic medicines, with historical examples like HIV/AIDS providing a grim foreshadowing. They called on WTO members to temporarily waive intellectual property rights and share knowledge and technology for the manufacture of COVID-19 tools with would be manufacturers around the world to maximise supply.

Image by Van3ssa Zheki Dany from Pixabay

But a handful of rich countries, including the UK remained opposed to this proposal, advocating instead for a charity model based on donations, which were slow and unpredictable.

Eighteen months on from when this proposal, South Africa’s President said, “we don’t want to be receiving crumbs from anybody’s table. We don’t just want to fill and finish, where we get the drug substance from somewhere, fill it and put it on the market. We want to be able to manufacture the drug substance ourselves.”

Nosicelo Dyani, a 39-year-old woman living in Khayelitsha, an informal settlement outside of Cape Town, talks in the report about hospital conditions in South Africa and lack of access to medicines. Her father was forced into early retirement after being unable to access vaccines and contracted COVID-19, “The hospitals were always overcrowded, and clinics were full. There were no beds, my father had to sit on the floor when he was struggling to breathe. You would wait from 6AM to 6PM not being seen by the hospital staff, and you would have to come back the next day hoping to be looked after.”

Instead of supporting South African and India to enhance the capacities of global manufacturers during the pandemic, the UK Government aligned itself with unsubstantiated claims of pharmaceutical companies that a waiver would threaten innovation and cause harm.

UK Government Minister for the Foreign, Commonwealth and Development Office, Lord Ahmad, claimed, “The reality is that the proposal for a TRIPS waiver would dismantle the very framework that helped to produce COVID-19 vaccines at an unprecedented pace. More worryingly, the waiver proposal could lead to a dangerous reduction in the quality of products being manufactured and in the already limited supply of key raw materials. This risks compromising vaccine efficacy and patient safety.”

The suggestion that patient safety would be compromised if vaccines were produced by southern based manufacturers is baseless and discriminatory. All new vaccines would face the same quality tests and be held to the same standards as those they were derived from. Additionally, there are extensive examples of vaccines being developed and manufactured in low- and middle-income countries and research by Human Rights Watch identified more than 100 capable companies in the Global South.

Despite numerous questions – both in and outside of parliament – to the UK Government, no evidence has been given to substantiate its official opposition to the waiver or to assertions that intellectual property protection, rather than billions of pounds of public funding, incentivised successful vaccine research and development.

The UK’s COVID-19 inquiry is an opportunity for an honest reckoning about these and other elements of the UK Government’s international COVID-19 response; its willingness to listen to and support pharmaceutical interests in comparison to other governments in crisis, and its attitudes and prejudices in respect to medicine and vaccine manufacturers in the global south.

The inquiry must reflect where global health can be better driven by the needs and priorities of countries worst impacted by existing inequitable access to medicines. This is especially vital given history seems poised to repeat itself with Mpox.

As host of last year’s G7 in Carbis Bay, the UK Prime Minister welcomed the opportunity to learn from errors saying, “What’s gone wrong with this pandemic, what risks being a lasting scar, is the inequalities that have been entrenched. We need to make sure that as we recover, we level up across our societies – we need to build back better”.

Over a year on, those lessons are not being learned, and inequalities remain. This inquiry presents a real and tangible opportunity to take an honest look in the mirror about what ‘Global Britain’ has truly done to-date, and how we can turn the tide.

Read the full report and recommendations here.

About the author:

Harry Bignell is Health Policy Advisor at Oxfam GB and a freelance writer on nutrition, health, equity and more. Find more of Harry’s writing here or follow her on Twitter at @HarryBignell.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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