Norway plays a leadership role in the global pandemic response as co-lead of the Access to Covid-19 Tools Accelerator (ACT-A) and chair of the World Trade Organization TRIPS Council. The country is also a key negotiator in discussions on new financing instruments for pandemic preparedness and response. In addition, Norway is one of the five countries who paid their “fair share” to ACT-A and has been instrumental to the launch and funding of CEPI (2017) and Gavi (2000).
So far, ACT-A has not delivered on equitable access to Covid-19 vaccines, diagnostics or therapeutics. However, Norway’s (outgoing) Minister of Health, Bent Høie, claims the global situation would look “very different” if all countries did as much as Norway to get vaccines to other countries. But how exceptional is Norway’s contribution really?
Giving with one hand and taking with the other
Norway has provided significant aid money to ACT-A’s vaccine pillar COVAX and even bought options to purchase vaccines through its self-financing window. But Norway has also been among the countries that have undermined COVAX by competing with it for limited supply, securing prioritized access for its citizens through the EU joint purchasing agreement. While COVAX has so far only been able to distribute 280 million doses to low-income countries, the EU has secured three times as many. This has enabled Norway to fully vaccine nearly nine in ten adults.
A friend of pharma
Like other wealthy countries, Norway has heavily subsidized the pharmaceutical industry to develop Covid-19 vaccines. Through pre-purchase agreements and public funding to CEPI (Norway has promised USD 434 million by 2030), it has helped enable the record-speed development of Covid-19 vaccines. But like elsewhere, there have been few strings attached. Norway has issued a series of “principles” for pharma action for vaccine equity but has refrained from setting contractual demands on fair pricing, access, and transparency. Even CEPI’s CEO Richard Hatchett conceded that the great missed opportunity of 2020 was that “the funders of vaccine development did not include access provisions in their funding agreements.”
Norway’s government has also come under intense criticism from civil society organizations and opposition politicians for rejecting the proposed patent waiver on Covid-19 tools, widely seen as necessary to break manufacturers’ monopoly power and expand production capacity.
Hoarding and “sharing”
In response to wealthy countries’ hoarding of vaccines, COVAX has called on them to share their excess doses. The WHO’s ACT-A tracker shows that Norway is among the many countries that have not yet delivered on their donation pledges. As of Sept 3rd, 400,000 doses had been delivered (of 5 million pledged), with 1 million more in process. The government has rejected WHO’s call for a moratorium on third doses and announced that it would share mRNA vaccines only once they no longer are needed in Norway. It started “sharing” the AstraZeneca vaccine two months after excluding it from its vaccination programme, and decided to stockpile the Johnson & Johnson vaccine even though the use of this vaccine is severely restricted in Norway.
If all countries were like Norway…
It is misleading to claim that the current vaccine apartheid could have been averted if other countries behaved more like Norway. While Norway’s financial contribution is exceptional, many other wealthy countries have taken a similar approach: they have provided public subsidies to pharma; offered high-level political support for COVAX and aid money to purchase vaccines for low-income countries, while also monopolizing vaccine supply, protecting pharma interests, and failing to deliver on dose pledges. They have shown the folly of our Health Minister’s oft-repeated claim that it is possible to do two things at the same time: prioritize your own population and contribute to global vaccine equity.
After Norway’s General Election last week (September 13), the Labour Party’s Jonas Gahr-Støre, a former Minister of Foreign Affairs and Health with WHO experience, seems set to lead a coalition that will likely include the Socialist Left Party. The latter has rejected the (outgoing) government’s position on Covid-19 patents as “embarrassing.” Given Norway’s influence in ACT-A, Gavi, CEPI and the TRIPS council, the new government (if it materializes), may turn out to be good news for global vaccine equity.
This opinion piece is adapted from a Norwegian-language piece published in Aftenposten on September 14, 2020, and is based on research conducted as part of the PANPREP-project funded by the Research Council of Norway.