[Ip-health] Devex: Battle over CEPI's access to vaccines policy deepens

Thiru Balasubramaniam thiru at keionline.org
Tue Mar 12 02:58:12 PDT 2019


Inside Development
Global health

Battle over CEPI's access to vaccines policy deepens

By Jenny Lei Ravelo // 11 March 2019

The board of the Coalition for Epidemic Preparedness Innovations has stood
by its revised equal access policy after questions were raised about
maintaining access to vaccines.

But Médecins Sans Frontières, which led the criticisms, said its concerns
about the policy had deepened since its initial objections last year, and
that the board’s response had failed to address those issues.

“If you look at this two-pager that they've published, there's basically
nothing in it … There's zero detail.”

— Katy Athersuch, senior policy adviser, MSF Access Campaign

Ahead of CEPI’s board meeting last week, MSF published an open letter
calling on it not to renege on its commitments to ensure affordable and
equitable access to its funded vaccines. It came after the board decided to
make changes to CEPI’s equal access policy. While the original version
contained details on what CEPI expects from recipients of its grants — from
price setting to intellectual property — many of those details were taken
out of the newly adopted policy.

At the conclusion of CEPI’s meeting Friday, Jane Halton, chair of the
board, told Devex the board had considered the issues raised by MSF in
“great detail” and maintained they “share a common purpose” with partners
like MSF in tackling the “devastating impacts of epidemics, particularly in
already vulnerable communities.”

“The board is united in delivering those shared objectives and is confident
that the implementation of CEPI’s access policy will safeguard equitable
access to the products developed through CEPI. This includes issues of
affordability and data, and extends through development to licensure,” she
said, adding that CEPI will “honor” its commitment to publish details of
how signed agreements will achieve equitable access on a regular basis.

But global health advocates remain unconvinced. “Stated commitments to
access that are not backed up by solid and transparent policies and
processes are meaningless,” said Ellen ’t Hoen, a lawyer and public health
advocate who has published widely on medical law and policy.

“When you work in the public interest, you need to be publicly accountable
and that comes with disclosure of the terms and conditions that govern the
collaboration with others,” she said.

A ‘weaker’ policy

Katy Athersuch, senior policy adviser with MSF’s Access Campaign, explained
that the policy in question was “an even weaker” version of the one MSF had
opposed in October 2018, at the time of the last meeting MSF International
President Joanne Liu attended before her term on the CEPI board ended.

“We were very surprised because we assumed that Joanne's criticisms [had]
been listened to in October,” Athersuch told Devex. “If you look at this
two-pager that they've published, there's basically nothing in it … There's
zero detail pretty much in the whole policy.”

One of MSF’s key concerns was around transparency. The original policy
stated that “a summary of the provisions in agreements which CEPI enters
into with awardees will be made publicly available unless there is an
exceptional reason not to, which would require board approval. It is
anticipated that the summary will focus on equitable access obligations,
shared risks/shared benefits arrangements and management of IP
[intellectual property].”

The revised draft presented to the board in October removed the requirement
for board approval, which MSF opposed. But the policy subsequently adopted
in December includes even fewer assurances — mentioning only that the CEPI
secretariat will summarize the partnerships agreements “to facilitate the
board’s oversight.”

“This isn’t an oversight process, since it will come after the signing of
the agreements. Further, the board itself is only to see ‘summaries’ rather
than the full agreements themselves,” Athersuch said.

In addition, Athersuch said that when the board voted on the revised equal
access policy in December, there were only seven voting members present.
Members including Peter Piot, director of the London School of Hygiene &
Tropical Medicine, and Gagandeep Kang, head of the Wellcome Trust Research
Laboratory at the Christian Medical College in Vellore, India, were absent
from the meeting.

“These voices that you would expect to be speaking up in the interest of
developing countries were not present at the board meeting where the policy
was adopted,” she said.

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Governance issues

MSF also questioned CEPI’s current governance, pointing out there are no
civil society representatives on the board. Athersuch said MSF suggested
several people who could take over Liu’s place but, to date, no civil
society representative has been appointed.

Els Torreele, executive director of MSF's Access Campaign, currently serves
as member of the CEPI Joint Coordination Group, an advisory team that CEPI
convenes to discuss how the vaccines it finances will be rolled out. But it
is not the board, and the position does not entail decision-making powers,
an MSF spokesperson said.

Athersuch is also worried that the task of finding Liu’s replacement has
been given to a pharmaceutical executive.

A public summary of the CEPI board meeting in December states that Rajeev
Venkayya, president of the Global Vaccine Business Unit at Takeda
Pharmaceutical Company Limited and chair of the Nominations & Compensation
Committee at CEPI, “will work with the CEO and Board Chair on the process
for appointing shortlisted candidates before the March Board.”

“Would you ask MSF to appoint the industry representative? Probably not.
Should you ask industry to appoint the civil society representative or to
be in charge of the selection? I find that in itself a quite worrying
development,” she said.

However, a CEPI spokesperson said that while Venkayya is chair of the
committee, he works with four other committee members in selecting
shortlisted candidates for the board, including Trevor Mundel from the Bill
& Melinda Gates Foundation and Joachim Klein from Germany's Federal
Ministry of Education and Research.

The board has appointed two voting members since Liu stepped down alongside
two others — Awa Coll-Seck, minister of state and former minister of health
and social welfare of Senegal; and Tore Godal, special adviser on global
health at the Norwegian Ministry of Foreign Affairs.

The two new members are Nadine Gbossa, representative of the International
Fund for Agricultural Development in Nigeria; and Charlotte Watts, chief
scientific adviser of the United Kingdom Department for International
Development. Their arrival leaves just one more seat on the board, which
requires a total of 12 voting members.

“I think the state of their board in terms of the lack of civil society
representation is something that you can clearly see reflected in the
policy decisions they are taking,” said Athersuch.

Rachel Grant, spokesperson for CEPI, acknowledged that three board members
were unable to attend the meeting in December when the new equal access
policy was adopted. But she explained the policy was shared with all board
members in writing in November, including a request for feedback.

She did not specify if and when the board plans to appoint a member of
civil society, only saying: “We continually strive to ensure that our board
is fully representative of all our stakeholders.”

CEPI was created in 2017 to speed up vaccine development for often
neglected, epidemic diseases after the Ebola crisis in West Africa in 2014.
Its arrival was seen by many as a game changer in the area of vaccine
development, where lack of market incentives has led to an absence of
life-saving vaccines, particularly for the world’s poorest.

It has so far raised $750 million of its $1 billion target, with multiyear
funding from Norway, Germany, Japan, Canada, Australia, the Bill & Melinda
Gates Foundation, and the Wellcome Trust, some of whom have voting
representatives on the board.

Chair of the board Halton was formerly head of Australia’s departments of
health and finance.

Update, March 11: This story was updated to include additional comment from
CEPI on the process of making appointments to the board.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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