Historically pandemics have often catalyzed significant social change. As historian of epidemics Frank Snowden puts it: “epidemics are a category of disease that seem to hold up the mirror to human beings as to who we really are”. At the moment gazing in that mirror remains a regrettably unpleasant experience.
United Nations human rights Treaty Body Mechanisms and Special Procedures, the World Health Organization (WHO), UNAIDS and numerous local, regional and international human rights organizations have produced reams of statements, resolutions and reports bemoaning the human right impacts of COVID-19 and almost every single aspect of the lives of almost all people around the world. The latest being the UN Human Rights Council Resolution adopted today by consensus on “Ensuring equitable, affordable, timely and universal access for all countries to vaccines in response to the coronavirus disease (COVID-19) pandemic”.
Key amongst the human rights law and standards underpinning these analyses is the protection of the right to the highest attainable standard of health, which, certainly for the 171 States Parties to the International Covenant on Economic, Social and Cultural Rights places an obligation on States to take all necessary measures to ensure “the prevention, treatment and control of epidemic, endemic, occupational and other diseases”, and, in the context of access to medicines the right to “enjoy the benefits of scientific progress and its applications”.
Despite these legal obligations, in late February, the UN Secretary General António Guterres felt compelled to highlight the rise of a “pandemic of human rights abuses in the wake of COVID-19”, including, but extending beyond violations of the right to health. The impact of COVID-19 on human rights has, and continues to be, sufficiently ubiquitous that an Indonesian transwoman activist Mama Yuli perhaps captured it best when telling a journalist that she and others in her position were “living like people who die slowly”.
Vaccines for the few, but what about the many?
Disappointingly, however, instead of a symbol of hope of a light at the end of the Coronavirus tunnel, the COVID-19 vaccine has fast become yet another pronounced illustration of the parallel pandemic of human rights abuses described by Guterres. The disastrous state of COVID-19 vaccine production and distribution throughout the world – and even within particular countries where vaccines are available – is now often described by many activists, including significantly the People’s Vaccine campaign, as “vaccine nationalism” and profiteering which has produced a “vaccine apartheid”.
What this means, in human rights language, is that States have often arranged their own affairs in a way that is detrimental to access to vaccines in other countries in spite of their extraterritorial legal obligations to, at very least, avoid their actions that would foreseeably result in the impairment of the human rights of people outside their own territories.
It is worth emphasizing that it has still been only some four months since the first mass vaccination campaigns began in December 2020. At the time of writing, approximately 450 million people had been vaccinated worldwide, while many African nations, for example, had yet to administer a single dose. While in North America 23 COVID-19 vaccine doses have been administered per 100 hundred people, with the number standing at 13/100 in Europe, the ratio decreases dramatically in the Global South with 6.4/100 in South America, 3.8/100 in Asia, 0.7/100 in Oceania and a mere 0.6/100 in Africa.
Vaccines, State Obligations and Corporate Responsibilities
The inadequate and inequitable distribution of vaccines has a variety of causes.
First, is the generally dysfunctional nature of the global health system due to what the UN Committee on Economic, Social and Cultural Rights described in its first statement on COVID-19 as early as April 2020 as “decades of underinvestment in public health services and other social programmes”. The incredible inequities caused by privatization of healthcare services, facilities and goods in the absence of sufficient regulation is well-documented, both in the Global North and the Global South.
Second, are the obstacles to vaccine access created and maintained by States, singly but collectively in the form of intellectual property rights regimes. This is not for a lack of guidance or legal mechanisms to ensure the flexible application of intellectual property protections in favour of the protection of public health and the realization of the right to health. The TRIPS agreement is an international legal agreement concluded by members of the World Trade Organization which sets minimum standards for intellectual property rights protections.
States are specifically permitted to interpret intellectual property rights protections “in the light of the object and purpose of” TRIPS and States therefore retain “the right to grant compulsory licences and the freedom to determine the grounds upon which such licences are granted” in the specific context of public health emergencies. Nor is it the first time that epidemics have necessitated the engagement of flexible arrangements to ensure expeditious, universal, affordable and adequate access to life saving medications and vaccines.
This is why the majority of States and an overwhelming majority of civil society actors have supported South Africa and India’s request that the WTO issue a “waiver” of the application of intellectual property rights for COVID-19 “diagnostics, therapeutics and vaccines”. This request has also been formally supported by a number of independent experts of the UN Human Rights Council of UN Special Procedures, and recently received the emphatic endorsement of the UN Committee on Economic, Social and Cultural Rights. There is already precedent for such TRIPS waivers, with the WTO having already applied a waiver until 2033, for example, for least-developed countries (LDCs), which are exempted from applying intellectual property rules on pharmaceutical products and clinical data.
Disappointingly, however, the ink had barely dried on the issuing of the CESCR’s statement, when, plainly disregarding all of these recommendations, the waiver was blocked by a coalition of wealthier nations, many of whom already have substantial and advanced vaccine access. Importantly, the CESCR’s recommendations were not just made on vague policy grounds, but as the best way to fulfill States’ clear legal obligation in ICESCR that, “production and distribution of vaccines must be organized and supported by international cooperation and assistance”.
The recently adopted Resolution of the UN Human Rights Council, led by Ecuador and States of the Non-Aligned Movement and adopted on 23 March 2021 provides some hope of the alteration of this existing collision course with disaster. The resolution, which calls for “equitable, affordable, timely, and universal access by all countries”, reaffirms vaccine access as a protected human right and openly acknowledges “unequal allocation and distribution among countries”.
The resolution proceeds to call on all States, individually and collectively, to “remove unjustified obstacles restricting exports of COVID-19 vaccines” and to “facilitate the trade, acquisition, access and distribution of COVID-19 vaccines” for all.
However, despite the protestations of civil society organizations involved in deliberations about the resolution, the resolution only restates the right for States to utilize TRIPS flexibilities, as opposed to endorsing such measures as a best practice for realizing State human rights obligations. This tepid approach (which follows principles of international trade while, ironically given the resolution emanates from the Human Rights Council, ignoring human rights standards) to perhaps the pressing issue relating to vaccine access is inconsistent with the Resolution’s otherwise firm grounding of vaccine access in human rights. It therefore remarkably even falls short of insisting that States comply with their own long-established international human rights obligations.
The resolution also inexplicably fails to address corporate responsibilities, including those of pharmaceutical companies, to respect the right to health in terms of the UN Guiding Principles on Business and Human Rights, and States’ corresponding duty to protect the right to health through adopting adequate regulatory measures.
Third, and connected to the above, is the general failure of States to fully and adequately centre their human rights obligations in the broader context of COVID-19 responses worldwide. The subtle but important phrasing of the exercise of TRIPS flexibilities as a “right of States” rather than as one of the optimal ways of fulfilling an obligation, exposes the degree to which the attitudes by State policy makers and legal advisors towards and understanding of human rights are out of sync with the obligations that they have willingly assumed by becoming party to treaties like the ICESCR.
A Critical Moment: it does not have to be this way
As Snowden’s insightful work predicted, the COVID-19 pandemic represents a critical moment in human history. States, collectively and individually, are presented with a unique opportunity to set a precedent and begin to seriously address the root causes of inequality and poverty which are prevalent across the world.
Making the right decision and taking a moral stand on the importance of access to COVID-19 vaccines is both practically and symbolically important if these efforts are to succeed. Vaccines must be accepted and acknowledged as global public health goods and human rights. Private companies too should not stand in the way of equitable and non-discriminatory vaccine access for all people.
For this to happen, bold leadership is required from international human rights institutions such as the UN Human Rights Council, the UN General Assembly and the WTO. Unfortunately, at present, not enough has been done and politicking and private interest continue to trump principle and public good. Until this changes, many people around the world will continue to exist, “living like people who are dying slowly”. It does not have to be this way.AdvocacyNewsOp-eds