The experience of the COVID-19 pandemic has shown that countries in the Global South cannot rely on the international system or the wealthy countries of the Global North to help them in health crises.
When Bolivia entered into an agreement with Canadian manufacturer Biolyse Pharma to provide it with COVID-19 vaccines for its people, the Canadian government did not take the necessary steps needed to give the export green light.
When Uganda tried to buy doses of the AstraZeneca vaccine, it was charged triple per dose what wealthier European countries paid.
When India and South Africa led an alliance of most countries on Earth at the World Trade Organization to change their rules and allow COVID-19 vaccines to be produced wherever they can, a small group of rich nations led by the United States, the European union and UK blocked them.
When the COVAX initiative was created by rich countries and international organizations, it promised to procure and distribute COVID-19 vaccines equitably around the world, but it did not. Some wealthy countries, such as the United Kingdom, received significant supplies of COVAX vaccines, while poorer countries were left waiting or had to rely on vaccine donations, which too often came with expired doses.
Today, the coronavirus pandemic may have subsided, but the real enemy of health survives: a patent system that keeps drug prescriptions secret, a trading system that allows corporations to set unaffordable drug prices, and a global governance system that keeps the power to change all this from poor countries.
If we want a better international health system, we will have to build it ourselves. With the victory of Luiz Inacio Lula da Silva in Brazil and the rise of new progressive governments in the region, Latin America is well poised to begin this urgent work.
In my previous roles as Minister of Health of Ecuador and Director of the Health Institute of the Union of South American Nations (UNASUR), I saw how opportunities are created when countries work together according to the principles of equity and social justice, bound by a common vision, and with the power to bring this vision to life.
To break the power of the current system and create a new one, we must challenge it on four levels: transparency, knowledge, industry and governance.
First, we need collective pricing and purchasing. The main reason companies get away with arbitrary drug pricing is trade secrecy.
We can turn things around by creating a Drug Price Bank and start buying drugs collectively. We launched such a bank in 2016 when I was UNASUR’s Director of Health. It was a simple drug price database compiled from an initial list of 34 drugs. The 12 participating countries shared the prices they were being offered by pharmaceutical companies – to see in turn the prices being offered to others.
Armed with comparative statistics, governments have successfully reduced prices at the negotiating table, improving access to medicines for all in the region, while challenging the secrecy built into big pharmaceutical contracts. At the time, UNASUR estimated that if all 12 countries bought the required amounts of the 34 drugs listed at the lowest price in the region, the total savings would amount to about $1 billion a year.
We can relaunch this price bank and move on. Once we have the price information, we could negotiate a collective purchase, further reducing the prices with our bulk order. By buying collectively, we can reduce the inflated profit margins of big pharma and instead turn this into healthier lives for our people.
Second, we need shared capacity. Regulating new drugs and vaccines is not easy. Building a regulatory infrastructure takes years, from training skilled technicians to building laboratories and establishing information exchanges with regulatory agencies around the world. When a country has more capacity to regulate vaccines and treatments, it can provide that capacity to countries that don’t—a simple system of solidarity that accelerates access.
This is already happening in the region. During the pandemic, Mexico’s drug regulatory authority (COFEPRIS) supported Paraguay’s health agency in evaluating India’s Covaxin for emergency use approval, even though Mexico had no plans to use it. We can build on this and create a mechanism for the whole region.
Third, we must establish and expand national production. Within months of scientists developing vaccines against COVID-19, rich countries bought up nearly all available and future doses, leaving little for the rest of us.
Cuba was isolated from this failed system. It benefited from decades of investment in public health and local pharmaceutical manufacturing, which meant it was able to develop two of its own vaccines—over 90 percent effective—and quickly begin immunizing its population. It has shipped its vaccines to other embargoed nations such as Iran, Venezuela and Nicaragua, and has signed vaccine cooperation agreements with countries such as Vietnam and Argentina.
Domestic pharmaceutical production in Latin America is expanding. Argentina has significant manufacturing capacity with 190 factories and 40 public laboratories. Mexico plans to produce its own Patria COVID-19 vaccine candidate at its national pharmaceutical company Birmex. Brazil has remarkable production capacity, and Colombia is also looking to expand.
By nationalizing production and developing our own industries, countries in the Global South can coordinate production and distribution, ensuring that urgent health problems are addressed in the interests of our people, not the corporations of the Global North.
Finally, we also need coordinated action on the international stage. From pushing for international trade reform to co-sponsoring resolutions and filing complaints together, we can be more effective by coordinating our actions.
When I led the Health Institute at UNASUR, we created a space for new forms of collective action in the region by renegotiating the terms of existing health policies at the WHO World Health Assembly. Between 2010 and 2016, 35 joint interventions were carried out at the WHA on behalf of UNASUR countries on issues such as access to medicines, health as a basic human right, WHO reform, sustainable development goals and others.
Likewise, when the tobacco company Philip Morris tried to sue Uruguay for initiating anti-smoking legislation, the Southern Common Market (MERCOSUR) was able to act as a bloc before the International Center for Settlement of Investment Disputes (ICSID) to show its regional support . ICSID ultimately ruled in favor of Uruguay.
Acting as a bloc could support other efforts to secure compulsory licenses for the production of COVID-19 vaccines and medicines in Chile, Colombia, Bolivia and the Dominican Republic. Such licenses, permitted under WTO rules, allow governments to start alternative production or import of a generic version of a patented medical product without the license holder’s prior consent. This is what Bolivia needs from the Canadian government to be able to import 15 million doses of vaccine produced by Biolyse.
A progressive health bloc with collective purchasing, regulatory capacity, drug manufacturing and distribution capacity can exert pressure to jointly achieve the right to produce life-saving drugs.
These ideas for building a new global health system from below can be implemented quickly and begin to improve the lives of our people. Now is the time to bring together progressive governments in Latin America and beyond to end big pharmaceutical monopolies, democratize pharmaceutical production, lower drug prices, build robust health systems that expand public provision of health services, strengthen regulatory capacity and uphold the right to health for all. We know what needs to be done, now we must join the collective power to make it happen.
The views expressed in this article are those of the author and do not necessarily reflect the editorial position of Al Jazeera.