Equity and solidarity – where are we at?

The WHO call for solidarity has hardly been heeded when it comes to serious matters

Solidarity was more seen within countries than between them. The first call was the WHO telling us that this is a dangerous virus (or rather, we don’t know – something which carries more moral responsibility) but advised to allow airports open and foster solidarity. Of course, common sense of the people – seeing China build a hospital within one week – told otherwise.

While the EU followed this advice, we all remember how countries surrounding Italy, which was the first to have large numbers in the North, basically closed down their borders. Eventually everyone closed borders and China was buying the stocks which were falling in price and making profits by selling medical products which were seriously needed. Was it not scandalous that France was going to buy an airplane-full of supplies for $1 million from China and then Trump bid $3 million? This hoarding certainly was characteristic between countries.

And now it is the hoarding of vaccines which is at issue. What has this to do with my field of Bioethics? It is simply the concept of Equity, if not of solidarity as well. Last week President Macron asked the G7 Group to donate 5% of their vaccines to developing and poor countries. The BBC world service denounced the hoarding by the USA and the EU. Notwithstanding talk about equity in health care we seem to have been blind to developing countries. Even the council of Europe bioethics committee (DH-BIO) has made Equity as one of the main columns of its five-year strategic plan. Do we need to wait five years before we acknowledge the issue? Well done Mr Macron for championing this cause. But it is at a deeper level than simply solidarity and equity.

Hoarding vaccines and not giving opportunity to developing countries to buy the vaccines at a lower price seems to me to be a big issue. Pharma industry has been known in the past to use what then were called third world countries to develop treatment for diseases like Aids. It then did not give them the treatment for free as the Declaration of Helsinki states – at least not until a lot of pressure was put on them. Many people died during the trials and John le Carre’s book The Constant Gardener described the story in what seemed to me to be relating a lot of truth.

If we look at the new cancer drugs, big countries get up to 75% discount on drugs which can cost up to €30,000 per capsule – a seven-day course costing €210,000. But since Malta does not have the quantities, we pay the higher price. When appeal to Italian companies was made to buy the product from the company over there, and at the cheaper cost, they referred us back to our own representative here, who of course probably cannot do anything about it. Where is the solidarity and equity, even within Europe? When companies are allowed to make discounts based on the size of the country, of course they will have more patients with cancer and can give a better price, but does that justify the morality of allowing people from smaller countries to die or not to give them the deal, which was effected with France that we pay for the drugs, which actually give a result on the patient?

Conversely, vaccinating people in developing countries makes a lot of sense morally, socially and politically as well. Morally we have the equity and solidarity aspect. Socially it makes a lot of sense to give vaccines to poorer countries which perhaps cannot afford to buy them. We are seeing how the virus evolves into new variants. The more we control the virus globally the less chance there is of variants developing. Control the numbers and you have a grasp on the virus. Covid knows no boundaries – we have to see that we are all safe; otherwise no one is safe. At the time of writing 600,000 vaccines arrived in Ghana following the agreement between the G7 countries. But just a week ago, the BBC World Service revealed that only 30,000 Africans (yes, in the whole of Africa) had been vaccinated.

Politically it is a human rights’ issue but it is also a West vs. East issue. If the West, which cherishes democracy, wants to do the right thing it has to put its money where its mouth is and do its part. But instead we saw the UK and the EU quibble about the Astra Zeneca vaccine. What is the point of having all of Europe and the United States vaccinated when the virus continues to go around in other areas? The USA has pledged $3bn for this cause. But at the end of the day, the $3bn have to be converted into vaccines, which, incidentally, are not yet available. Conversely the US pledged it will not take away vaccines from American people. One of course blesses this money, but it will take time for it to be converted to the urgent vaccines. It is in our interest as well that our neighbours are vaccinated. Therefore, if we do not do it for the right moral reason, we can at least look at the socio-political and indeed the preventive medical reasons. It is a health-of-the-public issue, which requires a principle-based approach.

The morale of all this is that: 1. It is a humanitarian issue, and 2. By protecting everyone we protect ourselves. If this is not enough one can even (perversely perhaps) think about the second cold war going on – it is about creating tangible relations with countries in time of need. Perhaps the US, to move away from the “America First” slogan, can modify this blunt statement and show that “America First” does not mean we compromise on humanitarian causes. Macron’s appeal within the G7 has made effect. Covid19 is not a seasonal virus like influenza; it comes all the year round.

Moreover, it spreads globally all the year round. We must have a coordinated way to spread the vaccine equitably in good time. Hoarding may have been an initial attempt. Let’s hope we learnt from the mistake.

Pierre Mallia is Professor of Family Medicine and Patients’ Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee. This article is his personal opinion and does not represent the opinion of any committee or Board he serves on.

After the early work on understanding the virus and tracking the pandemic, new treatments and diagnostics, the universal acclaim for the discovery of effective vaccines in record time is fully justified. And it is not just medical science - artificial intelligence helped to recreate the virus’ genome sequence and 3D printing provided swift solutions for personal protection and extra ventilators in our hospitals. Leading scientists have become media personalities, sharing the stage with politicians and supporting society through the unprecedented challenges of recent months. Never before have we been more aware of the vital contribution of science, research and innovation preserving and promoting human existence.

So what lessons should we draw for the green and digital post-COVID recovery? How can we harness the transforming power of research and innovation to accelerate the transitions our planet and societies desperately need – a sustainable new economy for health, wellbeing and equality in its broadest sense? Are we seizing the oncein-a-generation opportunity of massive public spending to build back better and boost economic resilience by investing in research and innovation? The honest answer is a mixed. There is no shortage of political determination: Europe is united behind an ambitious green growth agenda to deliver full decarbonisation by 2050 and an industrial strategy with digital opportunities at its core. And we have the financial means to succeed, with €1,8 trillion in the EU financial settlement for the next 7 years including €95,5 bn for the largest ever research and innovation framework programme Horizon Europe. Yet according to recent figures from the European Investment Bank – the EU’s future green bank - the pandemic has led to alarming reductions in private R&I investments and risks similar cuts in public R&I spending as governments and companies struggle with short-term liquidity challenges potentially harming the future achievement of our European efforts towards climate neutrality.

Public authorities can and should lead the way in reversing this trend, consistent with our R&I investment target of 3% of GDP in the EU. The European Commission has just concluded a €1bn call for research and innovation proposals directly linked to delivering the European Green Deal. With more than 1500 responses, the call was twentytimes oversubscribed and we have similarly encouraging results for the new Innovation Fund focused on climate action and greenhouse gas reductions. The European Innovation Council will create new opportunities under Horizon Europe to support innovative start-up and scale-up companies and promote Europe’s venture capital market. Pilot actions in this area show public funding creating multiplier effect of three times in terms of private investment.

The recently-agreed Recovery and Resilience Facility (RRF) will provide early support to EU countries’ post-COVID investment and reform strategies. With nearly €672.5 bn to support Member States’ national recovery and resilience plans, the RRF will create synergies with other EU financial programmes like the structural funds in support of the green and digital transition. We are working with Member States on national Recovery and Resilience Plans to maximise the impact of these investments and their support for reform plans. EU Research Ministers are calling for RRPs to include significant R&I investments and reforms to address persistent challenges and to bridge the innovation divide between EU Member States. For example, the RRF may be used to help innovative SMEs and startups to cover the costs of developing their innovations and bringing them to the market, as well as for scaling up. To increase the effectiveness of the RRF support, Member States may join forces in transnational projects, for instance in the field of hydrogen and renewable energy. And to be truly impactful in the long-term, RRPs should couple investments with reforms.

These are only examples, and there is ample scope to embed R&I in national recovery strategies. And the moment to act is now as we work with Member States to finalise their Recovery and Resilience plans in the coming months. Fully compatible with the European Green Deal, the RRF gives directionality in expenditure consistent with the ‘Do-no-significant-harm’ principle and Europe’s sustainability pledges. Investors are crowding into environmental, social and good governance projects, reinforcing the need for the emerging EU taxonomy for sustainable finance and our forthcoming framework proposals for green bond standards. Investments in research and innovation are fully compatible with this new architecture.

Europe’s world-leading scientists, researchers and innovators have every reason to be proud of their leading role during the pandemic. Research and innovation is equally vital in supporting our economies, our societies and our way of life coming out of the crisis. The pace and scale of the global challenges of climate change and the digital revolution require us to listen to them in framing our post COVID responses to ensure a sustainable, healthy, resilient and fair inheritance for future generations. Including a strong dimension of research and innovation in our post-COVID recovery strategies is an opportunity we should seize.