Access to essential health products: challenges but also new opportunities for regional cooperation
The world has seen tremendous development and production of vaccines, therapeutics and diagnostics in the two years since the declaration of the COVID-19 pandemic. However, gross inequalities in access to essential health products persist across countries and regions. As global demand continues to outpace production and supply chain limitations limit distribution, how do you weather the storm? Can regional collaboration in trade, investment, and research and development promote fair and affordable access to these products? The upcoming Regional Conversation on Promoting Regional Cooperation to Improve Access to Essential Health Commodities on March 23 will address these questions and more.
Several challenges hamper the availability of essential health commodities in Asia and the Pacific. Research and production capacity is limited, especially for vaccines as they require highly advanced research capabilities, complex manufacturing processes and meticulous quality control. The necessary capital and technology is often beyond the reach of many countries and companies in the region, particularly due to barriers to licensing by pharmaceutical companies in developed countries. More investment and technology transfer are urgently needed. Much has been said about a proposal to temporarily waive the intellectual property protections of the WTO’s TRIPS Agreement governing health products related to COVID-19 – a move that could significantly increase technology transfer and access to products. However, negotiations remain stalled as opposing voices raise concerns that such a waiver could have a negative impact on pharmaceutical innovation.
In the absence of (sufficient) domestic production, trade becomes an instrument for countries to purchase essential health products, but regulatory challenges and trade barriers have impeded this. Regulating health products is complex and resource intensive. Few national regulatory bodies – responsible for functions ranging from pre-market approval to post-market surveillance – in the region are mature and able to operate effectively and at high capacity. Additionally, during the pandemic, many countries imposed trade barriers on essential health products, especially after the delta variant emerged. These tariff and non-tariff measures, such as export restrictions, impede trade in finished products, as well as the inputs needed to manufacture, administer, transport and store them. In some cases, the old non-tariff barriers imposed before the pandemic have remained, even as the same countries implement trade facilitation measures. In response to trade barriers, some countries have sought domestic alternatives, including local input sourcing, further complicating regulatory approval and planning.
Countries also faced logistical obstacles, such as complex customs processes, warehousing constraints and inadequate transport capacities. Distribution has been particularly difficult for Pacific island countries, whose populations are spread across many often remote islands. When it comes to COVID-19 vaccines, many Asia-Pacific countries do not have sufficient cold chain capacities (e.g. refrigerated trucks, freezer containers) for their transportation and storage. Inbound vaccine deliveries to Nepal, for example, had to be delayed in late 2021 due to a lack of refrigeration facilities. Cold chain requirements are particularly stringent for mRNA vaccines, which must be stored at very low temperatures, putting them out of reach for many countries.
But alongside these challenges, there are new opportunities.
The region has performed relatively well as a source of development and production, as countries continue to participate in various stages of essential health commodity value chains. Notably, China, the world’s largest exporter of COVID-19 vaccines (by dose), has played a crucial role in supplying developing countries within and outside the region. More than 1.6 billion doses of Chinese Sinovac and Sinopharm vaccines have been delivered to more than 100 countries around the world, with the bulk exported to Asia and the Pacific. As for India, local versions of AstraZeneca and Novavax made by the Serum Institute of India – the world’s largest vaccine manufacturer – have been exported to the region, including to Indonesia, Nepal and Tajikistan, and outside the region, such as in Brazil and Mozambique. Bharat Biotech’s Covaxin, India’s first indigenous COVID-19 vaccine, is also being exported globally, and talks are ongoing regarding its supply to the COVAX Global Vaccine Facility. Going forward, manufacturers in the region may be able to count on support from the World Health Organization’s Global mRNA Technology Transfer Center, which was established last year to facilitate the production of vaccines in developing countries.
At the sub-regional level, the efforts of the Association of Southeast Asian Nations (ASEAN) point to the potential for regional collaboration in the face of the crisis. As early as January 2020, member countries launched a collective response and two months later pledged to boost supply chain connectivity amid the ongoing coronavirus outbreak. ASEAN then established, among other mechanisms, a COVID-19 response fund, a strategic framework on public health emergencies and a regional reserve of medical supplies for such emergencies. These initiatives are supported by and complement existing working groups on public health emergencies and pharmaceuticals, as well as the ASEAN Joint Assessment Coordination Group. The latter two have, over the years, facilitated cooperation among member countries in regulatory coherence and regulatory approval of medical products, thus contributing to the removal of technical barriers to trade in essential health products in the sub-region. region.
As we enter the third year of the pandemic, how countries collaborate and leverage these positive developments to address the myriad challenges – in cooperation with the private sector and other stakeholders – will be crucial in shaping the the region’s ongoing struggle against the virus and to build resilience to future crises.