Dr Hakan Seckinelgin discusses the lessons we could learn from the Global AIDS pandemic for thinking about how the COVID-19 pandemic could be tackled.

This is the second blog in the Blogmas 2021 series 

Last year I was asked a number of times if there were lessons we could learn from the Global AIDS pandemic for thinking about how the COVID-19 pandemic could be tackled. This question approaches theCOVID-19 situation from a global health angle and looks for a global response.  Implicit in it is an assumption that by looking at the achievements from the global HIV interventions over the decades might be of help for dealing with some aspects of the present pandemic.

To answer the question my first step is to recognise that these are different pandemics. They are created by significantly different diseases, which differ not least in how and the speed with which they are transmitted. So, it is not helpful to think about a comparison at the level of ‘what worked for HIV’ simply because both are contagious diseases with a global reach. My next thought was a comparison through the Global Health lens, considering the structural constraints informing the global intervention policies in both pandemics. Here, the development and implementation of various vaccines for COVID-19 from December 2020 facilitated the comparison.

The vaccine developments made the issue of vaccine access a pressing and central Global Health policy concern. The urgent question was how to create a policy to deal with a global disease, one that is potentially making most of the world population vulnerable, by using vaccines developed/produced by the private sector located within specific political contexts. The challenge here was not simply about the vaccines being developed by private companies, the pharmaceuticals are broadly located in the UK, Germany and the US, and the disease is also a health emergency in these countries too. The issue was and is how to get those countries that host the vaccine development to allocate resources to address global needs elsewhere in this emergency. A solution to this problem was proposed through a resource pooling system: COVAX, which was initiated by the WHO and supported by a number of other international policy actors.

The comparison with HIV is useful for thinking about the decision to create a policy process, COVAX, as the most relevant pathway for pool resources together for a subsequent redistribution to different parts of the world for dealing with the emergency. A first general observation is that the solution relies on a central mechanism that combines international aid donations, pharmaceuticals and other actors to make the vaccine available in resource-poor settings, which is just like the way HIV treatment provision was facilitated by the Global Fund, which  was created for this purpose. The Global Fund was created to structure the provision of the treatment in contexts where the purchasing power (of nations and people) did not allow people to have access to the treatment.

For HIV, the approach was arguably grounded in lobbying, based on compassion and solidarity, to motivate the private sector to become part of the global AIDS community and to participate to deal with an emergency in order to address peoples’ needs (the Medicines Patent Pool is also one such initiative). However, it is hard to ignore the structural inequality within which this solidarity is operationalised in both cases ignoring the structural inequality it maintains.

What I am observing in relation to COVID-19 vaccine production and distribution is that decisions on production and distribution are based on self-interest and charity, which immediately prioritises donor countries’ own needs over people’s needs elsewhere

The second general observation is that in both of these pandemics, first with HIV and now with COVID-19, needs are considered and attempts are made to address these needs within the existing institutional arrangements of the pharmaceutical industrial complex which has interests in maintaining the international intellectual property rights regime. Not only is the provision of medicine to deal with health needs located within the structures of inequality, but these structures are clearly treated as a given, the common ground for policy actors to think about policies. In both pandemics there has been little interest formally to move towards the development of the relevant medicines as international public goods.

This policy approach is based on a structural relationship, identified by Didier Fassin, between inequality (domination) in owning resources and solidarity (assistance) in showing interest in the needs of others as a function of charity. Another important perspective is captured in Achille Mbembe’s concept of necropolitics. What I am observing in relation to COVID-19 vaccine production and distribution is that decisions on production and distribution are based on self-interest and charity, which immediately prioritises donor countries’ own needs over people’s needs elsewhere. This positionality controls the distribution of resources and vaccines impacting who lives and who dies. In this way the global health policy in relation to the COVID-19 pandemic is inherently located within what is arguably a colonial relationship: the needs of others and how they can be addressed are considered according to the interests of outsiders who maintain control of resources.

The lesson learned in this comparison is a deeply depressing one: in the middle of COVID-19 pandemic that continues to effect billions of people, an approach that is based on private interest orientated charity is preferred rather than treating a vital medicine, the vaccines, as international public goods.

The views expressed in this post are those of the author(s) and in no way reflect those of the Global Health at LSE Blog or the London School of Economics and Political Science.

Photo: On 7 March 2021, Ethiopia received 2.2 million doses of the Astra Zeneca COVID-19 vaccine via the COVAX Facility. Credit: UNICEF Ethiopia. Licensed under creative commons (CC BY-NC-ND 2.0).