On July 10, Dr. Abraham Sokhaya Nkomo died of COVID-19 in Pretoria, South Africa. Abe Nkomo, as he was popularly known, was a giant of South African public life: a doctor, an activist in the fight against apartheid, deputy, diplomat and defender of public health throughout his life.
He had received the first dose of the Pfizer vaccine on June 9. On June 24, his family noticed he had developed flu-like symptoms and took him to a hospital after testing positive for coronavirus. At first, he seemed to be getting over the infection. However, his oxygen levels fell shortly after, and he needed a respirator. He was later transferred to the ICU, where his condition rapidly deteriorated.
During the weeks leading up to his death, thousands of miles away, his youngest son, Marumo Nkomo, a counselor to the South African Mission in Geneva, was engaged in frenzied negotiations at the World Trade Organization (WTO). As her country’s trade representative, Nkomo and her boss – mission director Xolelwa Mlumbi-Peter – lobbied the WTO to support a worldwide exemption of pharmaceutical monopolies so that the poorest countries around the world could produce the vaccines they need. (To date, less than 3% of the African continent because the richest countries have bought and monopolized almost all the global supply). When his father’s condition worsened, Nkomo made the decision to return home. Ten minutes after his plane landed in Johannesburg, his brother called to tell him that his father had died.
The history of the Nkomo reveals the cruelty of this moment. While the richest countries on the planet (and the companies based in them) argue with some of the poorest, the result is a stalemate that wreaks havoc on a personal level.
“Dr. Abe Nkomo was a small man but a giant in the hearts of people living with HIV,” says legendary South African activist Zackie Achmat. Achmat, founder of the Treatment Action Campaign (TAC), launched a global movement against pharmaceutical monopolies on AIDS drugs in the early 2000s, says Dr. Nkomo offered him a crucial support when he headed the Health Committee of the South African Parliament. “He fought for access to medicines and defended changes in the legislation in the late 90’s that gave us the right to live. He fought against speculation from the pharmaceutical industry. He understood the emergency we were in.”
Dr. Nkomo was in good health and remained active until the end of his life. He went through the pandemic cautiously, avoiding big events except once, when he traveled to Johannesburg to attend the funeral of his brother, who also died of COVID-19. Had he lived in the UK, the US or Germany, Nkomo, who was 80 years old, would have been fully vaccinated in January. Had he lived in India, he could have been vaccinated in March, in time for the onslaught of the delta variant. Instead, living in South Africa, she received her first dose in June and missed the second. “Every time I open Facebook, I find out that at least three or four people I know have died from COVID-19,” says Achmat. “It pains me that Dr. Abe Nkomo, who did so much for the public health of this country, was not vaccinated on time.”
Rich countries, against
When South Africa and India proposed the IP exemption for vaccines to the WTO in October 2020, it was precisely to avoid the situation we are in now. Vaccines are in short supply due to corporate monopolies that restrict who can make them, while existing supplies have mostly been sourced from wealthy countries. The resulting global shortage leads to deaths in the poorest countries that were completely preventable. All rich countries opposed the exemption when it was first proposed, including the United States government, then chaired by Donald Trump.
It did not matter that the majority of the world population was in favor of the suspension of patents, while the rich countries were against it, the WTO – which works with a consensus model in which all member countries must agree to a proposal for this to flourish – he couldn’t even begin to discuss it. Nor did it matter that vaccinating more people everywhere is also beneficial to the population of rich countries. The less the virus circulates, the less chance it has of mutating or evolving.
In May of this year, the United States government changed course and announced its support for the exemption, thus giving the proposal a chance. It was a welcome move, but the euphoria was short-lived. The UK continued to oppose it, as did Switzerland and the European Union, where German opposition has been especially intense.
“The opposition to our proposal is primarily ideological,” Mlumbi-Peter tells us. When her office submitted the proposal in October last year, she was working alongside Mustaqeem de Gama, the former business representative whom Marumo Nkomo replaced this year. “But what we had in mind was saving lives. If we had been ideological, we would not be negotiating. We are willing to give in, but not to the point of ending up getting something meaningless. Our goal is to unlock global production. ”
Unlocking global production has taken on a new urgency. Until recently, one of the theories held that Western pharmaceutical companies would finish supplying rich countries soon and could then focus on poor countries starting next year. The theory imploded when in recent weeks rich countries booster doses authorized for some of its citizens, thus delaying the first dose in much of the world to administer a third to a minority that is already vaccinated.
In September, the WTO resumes its activities after its usual summer holidays. Discussions on exemption from intellectual property for pharmaceutical monopolies will begin immediately. Mlumbi-Peter is clear about what needs to happen. He wants the WTO to urgently formulate an appropriate response to the emergency in which we find ourselves. “There has been no real commitment,” he says. “We need a real negotiation from texts. We need a clear political message from the United States that says it wants to see a result. We do not believe that the European Union moves independently of the United States. That would help us create a credible WTO response to COVID-19. ”
As it stands, the burden of ending the global monopoly on COVID-19 vaccines falls largely on the shoulders of Mlumbi-Peter and Marumo Nkomo. They have worked, despite devastating personal losses and hostility, with unflappable persistence. When they win, if they do, it will be too late to save loved ones who have already lost in the pandemic. But they will still be in time for the rest of the world without vaccinating.
Achal Prabhala is the coordinator of the AccessIBSA project, which works for access to medicines in India, Brazil and South Africa. Chelsea Clinton is an adjunct professor at Columbia University’s Mailman School of Public Health and deputy director of the Clinton Foundation in New York City.
Translation of Julián Cnochaert