 Okay, welcome everyone. Good afternoon or good morning or good evening. Wherever this finds you or wherever you're joining us from. We are about to have our last seminar in the Health Law Institute seminar series for this semester and we're very lucky to have Dr. Marley's Rich Richter joining us from South Africa. Just before I introduce her and turn it over to her, that was her lovely suggestion to have folks enter the space with a music riffing off of Fiona Sock's famous comments around patents and important health interventions. A couple of little logistical items to share with you. First of all, we had a little bit of technical difficulties. That's why we're a couple of minutes late starting and getting the closed caption going. I think it is now underway, although I'm seeing a little bit of conversation to try and that suggests otherwise. So I hope by the time I'm done this little introduction, the captioning will be in place. For those who are not familiar with it, you should be able to sort of turn captioning on through the menu of options in Zoom towards the bottom right, I believe, depending on the kind of browser you're using. So hopefully that will be in place momentarily if it's not already in place right now. The second thing to note is that questions, we welcome them. It will be lovely to have a conversation after the presentation in light of it. The way that that works logistically is to put your questions in the Q&A and then I as the moderator will go through those and put them through towards our speaker so she can engage them and folks can hear both the question and the response. So feel free to put those questions in the Q&A during the chat as they occur during the presentation as they occur to you. And then we'll have some questions to work with by the time Dr. Lifter is concluded her presentation. So I should have said off the stop. My name is Matthew Hurter by the way. I'm the Director of the Health Law Institute here at Dalhousie. We're pleased to have lots of folks joining us for this seminar today. Now about our speaker. Marlies has worked in the health and human rights field for over 20 years. She's served in several key South African civil society organizations and coalitions. She was for instance a researcher at the Project Literacy, the AIDS Law Project, the Treatment Action Campaign, the Reproductive Health and HIV Research Unit, and more recently served as the Head of Policy Development and Advocacy at Sanke Gender Justice. She holds a Bachelor of Arts Honours Degree and Master of Laws Degree from Witts University in South Africa and completed a Masters in International Peace Studies from the University of Notre Dame in the United States as a full-bite scholar. In 2013 she graduated with a PhD in Public Health from the International Centre for Reproductive Health at the University of Ghent in Belgium and her focus in terms of that PhD was on sex worker access to healthcare services in sub-Saharan Africa. She's published in academic and popular forums in areas of law, bioethics, gender, migration and public health. She holds a visiting researcher position at the African Centre for Migration and Society at Witts University and currently focuses on research, advocacy and policy change in gender human rights and of course the COVID-19 pandemic with an emphasis on the impact of the criminal law on health access for sex workers as well. Her talk is incredibly timely, that would be true any day for the last several weeks with its focus on just using the title of her talk ARV's COVID-19 Vaccine Equity and Intellectual Property Protection. It's perhaps particularly timely today in Canada where Health Canada are regulated just to prove the Pfizer COVID vaccine, not that I should call it the Pfizer vaccine for children aged 5 to 11. So when other parts of the world are struggling to get their first dose of the vaccine, we have it already being made available for children. So there's a stark perhaps inequity there and I'm sure our speaker will help us to think about that and work through those kinds of questions. So with all of that said, over to you Dr. Richter, we'll have a presentation and then usually by around one o'clock or so start to move into a discussion which I'm really looking forward to. Thanks again for joining us. Thank you very much Matthew. I just would like to check if you can see my screen. We just practice it but I might have clicked the wrong screen. Can people see a full presentation or is it still in presentation mode? It's still in presentation mode more or less. Let's see if I can do it now. Sorry, just give me a sec. I'm going to try and project for my second screen. Perfect. Is that better now? Yeah, I'm glad. Perfect. Thank you very much. Good afternoon everyone. I'm speaking to you from Cape Town in South Africa and it's such a pleasure for me to speak to you about the topic of intellectual poverty. As Matthew pointed out, my background is much more general and especially in the last 15 years I've been focusing much more on sex work, health and human rights and since starting my work at the Health Justice Initiative in January this year, I returned to some of the treatment access work that I started doing when I was very young and perhaps naive when I started working at the Treatment Action Campaign in the AIDS Law Project and some of the work that we did there during the AIDS epidemic. I'm hoping to speak to you a little bit in today's session. Sorry, let me just see if I can move this on. The topic of today's presentation is mainly quite broad strokes around some of the lessons learned during the activism and the advocacy domestically in South Africa but importantly the international partnerships that brought about a radical rethink of intellectual property and how intellectual property would be able to bolster health and human rights specifically and I believe that some of the lessons that we learned during the HIV epidemic are particularly important in the way that we are grappling with the COVID pandemic. A little bit about the Health Justice Initiative so that you have a sense of the context and the disciplines in which we work. The Health Justice Initiative is a very small NGO. We were established in July 2020, I joined this year and we look specifically at the intersection between racial and gender inequality and we focus mainly on COVID TB and HIV and the work that we do always include the lens of health equity. Sorry, I just realized I need to stop here to just check if the live captions, if all of that is sorted and if there's anything that I need to do around that. Okay, I'm going to continue and I assume that everything is in order. What I thought that I would do to start off this discussion and to provide some of the context of more than 20 years ago is to provide a short video around the initial work of the treatment action campaign and the documentary is longer, it's about 20 minutes, but I'm going to only show six minutes of it to talk a little bit about the treatment action campaign's work and then to juxtapose that to some of the issues that the global south especially is experiencing in terms of the COVID pandemic. What I'm going to do is to try play it off my computer as opposed to the PowerPoint and I just want to check if everyone can hear this. Okay, thank you so much for joining us today and I'm going to start off with the first presentation program. We held our first demonstration on the steps of St. George's Cathedral in Cape Town. At first relations with the minister of health at the time, Dr. Tangoza and Azuma were friendly. In 1999, one man's treatment with antiretrovirals would cost between four and 6,000 rents. When most people on the end, less than people. We started organizing branches. Most papers was to educate ourselves about HIV and AIDS. This was the origin of our focus on treatment literacy. It was through education about the scientific, social and political aspects of HIV and AIDS that we could take control of the virus within us and off the pandemic as a whole. In 1999, Tabombegi succeeded. Nelson Mandela is a president of South Africa. Then the unthinkable happened. Tabombegi announced the appointment of a presidential AIDS panel to investigate whether HIV was the cause of AIDS. Some of the people in this room to ask what is the cause. In 2000, South Africa hosted the World AIDS Conference. Welcome to the 30th International World AIDS Conference. The number of people living with HIV in South Africa had increased to nearly 4.5 million in 2000. South Saharan Africa had become the epicenter of the epidemic. Yet antiretroviral treatment was unaccorded for most in our region. The TAC organized a mass march for treatment access. The march mobilized global opinion in support of the call that patients and profits should not be allowed to prevent access to life-saving medicines. In a crucial opening address to the conference, Judge Edwin Cameron placed the issue of access to treatment on the agenda. I'm here. I'm able to be talking to you. I'm able to engage with you. I'm able to speak with you about this important topic because I'm on antiretroviral therapy. There are people throughout Africa, 25 million people in Africa and 34 million people in our whole world who are this moment dying and they're dying because they don't have the privilege that I have of purchasing my health. Where are the drugs? That's where they are. The drugs are where the disease is not. The disease, the disease is where the drugs are not. During her term as Minister of Health, Dr. Zuma tried to introduce the Medicines Act, which allowed for wider access to cheaper generic medicines once the patent had expired. The Pharmaceutical Manufacturers Association opposed the Medicines Act. The TAC organized a campaign against the Pharmaceutical Manufacturers Association in support of the Government and the Medicines Act. We mobilized trade unions, religious leaders and other NGOs to support the campaign. Faced with this opposition, the PMA withdrew. The victory encouraged the growth of the TAC. Ask us to announce a price of 180 rand for a course of AZT to treat a pregnant mum and a rape survivor, in other words, the possible post-exposure proper access. You also ask us to reveal our manufacturing costs. Now I have to be upfront with you today and say right now, right here, we can't do that. TAC went to Thailand and brought back a generic version of Pfizer's Flocanozo, a highly effective medicine in the treatment of oral crash. The generic version costs only 58 U.S. cents per tablet, when Pfizer charged the Government $7 per tablet. In 2001, the TAC held I'm just going to play a second short video. This pandemic has brought everybody to the same level, rich, poor, educated, uneducated, all of them crying out for the one little thing that we take from granted, oxygen, air. Breathing seems like a basic human right, but when you have COVID, it's not. First, it was my mum who got infected. I had to go and buy a drip to put it myself because she was in such a bad shape. And when I was there, still missing my mum, I got a phone call that my daughter is sick. I started coughing and I was struggling to breathe. I was isolating myself and my son wanted to come touch me and see me. My husband was also very sick. They are both just saying, we can't breathe, we can't breathe. I mean, in Zimbabwe, we needed an ICU bed, we needed oxygen and there was nothing. Good afternoon, Zimbabwe. I'm one of the specialist physicians on the coast. Today has been a very difficult day. The food is like a bloodbath. Nutriness since morning has been death upon death. Patients who are not vaccinated and their condition progresses unabated until they can't breathe and they come to us very desperate. When my family was almost dying, there was not one single vaccine. It makes me really sad because this has been before and we lost millions of people to HIV. When in the West, people are already living normal lives. For how long are we going to sit and just look at people dying again? Since the pandemic started, we've lost a quarter of these patients and this is the only hospital providing critical care support in Northern Uganda. We have the poorest vaccination status of the whole world. The country is talking about going back to business is normal and WHO has challenged them to stop this vaccine apathy and to stop the boosters until everyone is vaccinated. We want them to share the vaccines, share the recipe so that countries like South Africa can produce vaccines for Africa. India is in the same situation. They can't do it. Breaks my heart. Those stories of people dying in the streets, it's so important that we vaccinate the whole world. I will continue to fight for access to vaccines until my own last press. I just want to check that people could see my screen with the presentation. Just blue background. Thank you. Thanks for all the help. Let me just see if I can do a quick swap around. Is that better? Okay. I'm sorry. I can't seem to get the presentation back onto the second screen. Let me just try once more. Yay. Okay. Thank you very much. So that was a little bit of a roundabout way of giving some context to some of the discussions that we hope to have this afternoon. What I want to start off with specifically is the devastation of the HIV pandemic. In 2000, when I started working for the AIDS Law Project, there were more than 4.2 million people who had HIV. The anti-retrovirals that were available in the global north were completely unaffordable in Africa. You heard the insert on the video from Judge Edwin Caverin who spoke about how he can purchase health because he had a good salary, but that it was completely out of reach for most South Africans. The treatment action campaign used innovative legal advocacy, research, social mobilizations, and social mobilization in public education to really challenge the global conversation on broke pricing and ultimately to increase the access to people with treatment. South Africa, we are proud today to have one of the largest HIV treatment programs in the world. The focus of the treatment action campaign and the AIDS Law Project was specifically the pharmaceutical industry and the abuse of intellectual property protections. There was a reference in the video to the pharmaceutical manufacturing association case, the PMA case, and in South Africa there was an amendment to our medicines act in 1997 where we wanted to increase the ability to have greater access to medicines and the pharmaceutical industry supported by the US government to challenge the amendments to our domestic legislation, arguing that it was violating trips and will return to trips quite soon. The major concern of the pharmaceutical association is that this new legal framework would allow for parallel importation. The treatment action campaign joined the case and they made the argument around how the domestic amendments would dramatically increase the ability of people with HIV and AIDS to access medicines. The organizations were joined with demonstrations around the world. There was great global solidarity. During the hearing of the case, there were more than 5,000 people who marched to the court and there was engagement of activists in South Africa and globally around the issue of this case. The PMA eventually withdrew their case and some of the analysis of the campaign and the strategies around it point towards the synergies around litigation, mobilization and education and especially how activists, networks were able to share resources, knowledge and strategies to hold the pharmaceutical industry to account. And those are many of the networks that are still existing today and that are working on the issues of the COVID pandemic. Some of the visuals that you saw in the video was around the AIDS conference in Durban in 2000 and it was at this point that President Tobin Becky's AIDS denialism and especially his skepticism around antiretrovirals came to the fore. So the treatment action campaign and treatment activists had to negotiate the great difficulties of an anti-science policy approach in South Africa. In 1999 it was the start of the prevention of Mother to Child Transmission case where civil society organizations challenged the South African government's AIDS denialist policy and rejection of antiretrovirals and this case eventually landed up in our highest court, the constitutional court, that came out resoundingly in support of the case that was brought by the treatment action campaign and provided for the provision of navirapino, other antiretrovirals to prevent HIV to unborn children. This also led to momentum in our national ARV rollout in April 2004. In 2002 we used the competition law and especially our competition commission to fail a complaint against GlaxoSmithKlan and Buyinga Engelheim, arguing that they violated competition law by abusing their dominance in the market and charging excessive prices for ARVs. The pharmaceutical companies reached the settlement in 2003 and that dramatically cut ARV prices. Against the background of these events, it's important to be in mind the broader global framework around trade and intellectual property. So you might know that the WTA adopted trips in 1995, 1994 and it makes provision for the safeguarding of intellectual property for a wide range of products for up to 20 years. As I've noted before, it had a big impact on addressing the AIDS epidemic. Countries from the global south fought for the DOA declaration that focused on the public health consequences of trips and provided specific safeguards. So the DOA declaration in 2001 were unequivocal that the trips agreement should not and does not prevent members from taking measures to protect public health and they confirmed that the agreement should be interpreted in a supportive manner to give substance to the right to protect public health and in particular to promote access to medicines for all. Yet it's regrettable that many of the DOA declaration flexibilities have not been used. There's immense political pressure not to use the flexibilities. For example, although the US agreed to the DOA declaration, the US trade policy never changed and the US often imposed significant pressures on countries not to use the trip's flexibilities and to increase or extend the highest levels of intellectual property protection. Governments who seek to use trips are singled out. They often even placed on a watch list and pushing new trade agreements, the US also seeks to extend IP protections beyond the level mandated by trips. South Africa to our shame has not really used the DOA declaration. We haven't even once issued a compulsory license which points to the importance of road by domestic legislation in intellectual property and health, public health issues. I want to move from HIV to COVID and I'm aware that there's only 18 minutes left. And I want to situate these these figures are perhaps something that you are very familiar with. This is from the WHO dashboard. The figures from yesterday or two days ago showed that they were over 250 million cases confirmed of COVID leading to more than five million deaths and that they have been a number of significant, thank you I just saw the note, a significant number of vaccine doses that have been administered. So where are all these vaccines going? As of two days ago, at least just over half of the world population had to receive at least one dose of the COVID vaccine. As we've noticed, there's been five billion doses that have been administered globally and that there's almost 30 million that are administered each day. But yet only less than 5% of people in low-income countries have received at least one dose. So this is a map that gets updated daily from our world and data and you can see from from the legend there that Africa is definitely not the dark continent. It is very pale in comparison to other countries and the coverage of vaccines. We ran a webinar recently entitled the 5% continent to highlight the fact that so few people in Africa have been vaccinated and I'll speak a little bit about that in a minute. So this is another graph that shows the vaccines administered by continent and perhaps because you haven't seen it, it's a little sliver at the top that depicts Africa's proportion. So this brings us to the issue of vaccine equity of course, the fact that there is massive disparities between the global north and the global south. The WHO director general speaks about the world being on the brink of a catastrophic moral failure and that this may failure will be paid with the lives and livelihoods of the world's poorest countries. If we want to repeat COVID-19 as a planet, vaccine equity is absolutely key and vaccine equity is essentially about the equitable distribution of vaccines worldwide. I want you to just briefly speak about global public goods and I draw here on Neva Deter Shaksina's work on global public goods. A good in this sense is a product or an issue that can be either good or bad. Some people argue that national defence, peace, security and even global warming can be seen as a public good. In the health context it refers to programmes, policies and services that have a truly global impact on health. Usually it refers to something that's beneficial. Often a global public good is seen as non-rival risk and non-excludable and Shaksina says in multi-lateral negotiations these efforts have been accompanied by calls to designate the vaccine of global public good. Lacking formal legal definition of the phrase signals a commitment to ensure equitable access for all countries. Many of leading candidates of the vaccines when she was writing this was developed in research centres and universities in the global north but despite that even before it can be proved that these vaccines have already been patented by pharmaceutical companies which means that they have a monopoly over the vaccine and they can decide where the vaccine goes and at what price. This basically means that through patent rights pharmaceutical companies control and know how of manufacturing these vaccines and this gives rise to artificial scarcity. So it's very important to note that the research centres in the human universities are funded by public money. So much of the vaccines development the research and development that brought about successful and even unsuccessful vaccines have come from the public purse. In the beginning of the pandemic there was an innovative suggestion by Costa Rica to create CTAB the COVID-19 technology access pool through this mechanism pharmaceutical companies would be invited to voluntarily share COVID-19 related knowledge IP and data. It's not one major pharmaceutical company with a WHO approved vaccine has contributed to CTAB. This is despite the fact that we know that there's been more than five million deaths and two hundred and fifty million cases. So this brings us to to the trips waiver and as I've noted before it's about how the agreement how most countries in the world deal with patents and intellectual intellectual property rights and the DOA declaration softening some of some of the the provisions of trips and trips provided an opportunity to to flex some of the the muscle of the DOA declaration. In October 2020 South Africa and India presented a trips waiver proposal. The proposal specifically speaks to temporarily suspending IP rights so that COVID-19 vaccines and other new technologies are accessible for countries and it helps countries to override monopolies at that point until herd immunity is is reached. There's some discussion about whether herd immunity not herd immunity whether herd immunity is still a useful concept and more than a hundred countries have supported the waiver except if you look at this graph you can see that the countries designated in in red are countries that are opposing the waiver. The countries in green are supporting it or co-sponsoring it and you can see that your country in Canada it's not clear what what the position is at at the moment or at least by the 16th of November when Mids and Sons Frontiers did this infographic. So there's a very neat plot plot and a neat plot of countries that have a lot of vaccines and those who who have pharmaceutical companies manufacturing vaccines and resistance to to the trips waiver. This is a graph from from earlier this year this is in in January 2021 and it shows how different countries had already purchased doses of the vaccine and how many times over people in those countries would be able to to vaccinate their populations. The EU had had already bought 3.5 doses per person the US 3.7 Canada was 9.6 so I think that's been downgraded now to to six times as much vaccines as as the population and that all in comparison to the African Union which at that point was at 0.2%. It also goes to the issue of stockpiling. Many countries in the global north are stockpiling vaccines. A proportion of them are expiring and in this BBC insert in September they're asking whether many of these doses might be might go to waste which means no one benefits from it. It has of course given rise to a very strong resistance from activists world over and some of the the clips that I've played to you are from the the free the vaccine campaign as well as the the people's vaccine campaign who are are doing important work in shining a light on these inequalities and leveraging and putting a lot of pressure on the World Trade Organization discussions to to be able to to push the trips waiver through. I want to spend a little bit of time to to speak to some of the the gist of of the lessons learned from from two decades ago and some of the the lessons that I'm going to to include in a video by my colleague Fatima Hassan have to do with some of the the harder some of the harder things we we learned during the AIDS pandemic and the importance of analytical framework of exposing issues of power and control especially the the type partnerships between governments and and pharmaceutical companies. The cynicism or the the critical engagement around donations and volunteerism where where many people are rejecting the trips waiver because they say there's there's a lot of donations that are coming in terms of of vaccines to to the global south and I think the slogan we want justice not charity is an important one during HIV we've seen we've seen a lot of promises about donations that that didn't materialize the issue about domestic laws to issue compulsory licenses and the importance of mobilizing internationally. One of the one of the the suggested readings that that are included for today's seminar is a piece in the the British Medical Journal where Fatima and colleagues speak about the importance of a sustainable way forward is to globalize manufacturing so that this advantage countries no longer rely on on charity and how this was achieved in HIV and how poorer countries require the relaxation of intellectual property rights technological transfer and being able to rapidly establish regional vaccine manufacturing hubs. So what I would like to do is to to play a clip from from this webinar in which Fatima speaks to some of these these issues and I'm also playing the clip because I'm I'm aware that FIFA was earlier a lecturer in this course and to share some of their thoughts around the the lessons learned so I'm going to try and do my take again by seeing if I can play the the video and have you watched it at the same time. So much of this is very you because some of both what Peter have said and Kamran has just talked about reminded me and you know they said it very clearly that we've been through this before you know so much of this is very reminiscent of the the struggle for HIV meds and you mentioned you know this notion that we couldn't take our medication on time what was the point there was the you know the fact that Nelson Mandela's administration was sued by 38 or 40 pharmaceutical companies with the support of the US government and Europeans so I wanted to give you an opportunity to talk about that you know in the moments where we feel very depressed and we think that we're not going to win this battle you know what are the lessons that you can bring us from that time because I know that you despite the fact that you look very useful we're in in that battle as well back then and anything else that you'd like to add or respond to to what Eddie of the other panelists have said. Thanks so I mean I think you know just to echo what Kamran and Peter and Tifa have said in many ways the the way in which this pandemic has been managed has been worse right from the age of age right it's because we thought we wouldn't have a repeat of that I mean thought we wouldn't have a repeat of the creed and the hoarding and the refusal to share knowledge in the middle of a pandemic where you have a life-saving intervention so you know Kamran and Peter have talked about how remarkably we've got these vaccines multiples of vaccines that are considered safe and effective they have been made to use authorization and what happened all of the supplies was allocated to the global north very little targets for the global south where black and brown people have to live which is why you know I'm going to go back to the point about racism because for me this just feels like the racism wasn't even disguised you know in HIV AIDS it was initially whereas in this case we thought it would be so different it would be that solidarity the clearing of knowledge and that did happen so you know the lesson from HIV AIDS I think that just became clearer last night when we had a panel discussion with David Casca who was in charge of the Biden White House team on the COVID-19 response and you know incredulously in October 2021 we're having the same discussions we should have had you know what I've imagined a year ago where we're a government like the U.S. which is considered to be so powerful that has put a lot of funding into particularly Pfizer, Johnson, Johnson and Moderna's vaccine is saying to us that they are still negotiating with the CEOs and the boards of these pharmaceutical companies they are still having a conversation about manufacturing and sharing of knowledge and so you know I don't know if any of you heard the conversation last night because it was really disheartening because I think it goes to what Kamran and Peter talked about and that is financial grief there is so much interest in extracting profit and extracting wealth and extracting you know there's this number of overnight billionaires are believed in people who have been vaccinated and reported on this that they that they even in low income countries which is really really I think a political embarrassment and economic embarrassment social embarrassment that even with those low figures and codex cutting its own focus and saying we simply don't have supplies right that that companies are still sitting around the table and having these conversations with elected leaders who are saying to them share the tax and they're like no this month maybe next week no maybe nature only with that company not on these certain conditions no you can't export yes you can't export so so the question goes to can we have so much self-interest in money and extracting profit that you are willing to withhold a life-saving technology to millions and millions of people around the world and so I think I agree with Peter what are the boards of these pharmaceutical companies doing they have a fiduciary duty how can the chairperson of the board of Moderna refuse to share the technology um with the rest of the world be celebrated and get an award for leadership how can this be the leadership the CEO of Pfizer who said that the reason why Africans are not getting all vaccines because they vaccine has existed and that you know it will take some time for people in Africa to be convinced and really says but you know countless other things which we share and I'm trying to address he also said that Africa is not the hardest continent which is not exactly true so how can you have a situation that CEOs of pharmaceutical companies have more power than the DG of the WHO than elected leaders and I think it goes to the fact that these elected leaders particularly Boris Johnson you know formerly Angela Merkel a lot of these governments have actually propped up these pharmaceutical companies and we saw that for the HIV AIDS it's that you cannot exercise so much power and control unless you have the political support of those closest to you and we've seen that with the trips waiver the countries that are blocking the trips waiver are countries that are fundamentally led by people who are political parties that are heavily funded by the pharmaceutical lobby all those companies I hate to say the fact that the German government cannot force bio intact to share its technology with the rest of the world the fact that the Biden administration is still having nice conversations with you know three leading companies that could actually take office has been very much faster tells you I think the levels of greed that we have been working with and also the levels of power which is obviously very reminiscent and similar to the HIV AIDS presence in some respects these are the same companies but none of us ever thought last year when we gave the warning bells around never trust volunteerism never trust benevolence never trust donations because we've learned from the HIV AIDS fact none of us thought that it would still take so long for world leaders in this pandemic because it's to be so interconnected to this pandemic the variant circulating with you know potential additional ways and Peter said what comes after Delta I think Cameron said what comes after Delta none of us thought that political leaders would be so scared and and I mean you know let's also just lay a little bit of blame in African leaders right so you know the South African government told you would face maybe laws to be ready to issue compulsory licenses why are we so scared of taking on pharmaceutical companies I mean we know why we know the trade pressure but if you're not going to use those powers I think it's what you know the DG of the WHO said last week why have provisions in the tropes agreement on a tropes waiver if you're not going to use it if you're not going to use it in this pandemic we never we never did it so unfortunately Peter is right what turned the tide on HIV AIDS was that all of us basically mobilized to force the drug companies to issue multiple licenses to increase the number of manufacturers until then we didn't have a turning point and so when people see our response to Madonna by the Johnson Johnson it's not because we are anti private companies or anti the pharmaceutical industry it's because we know that time is in essence people are getting sick and dying we don't force these companies through public pressure and public activism because governments and companies we have to increase the public pressure on these pharmaceutical companies and they would actually do the right thing and right now to stand up manufacturing participate in the mRNA house and stop diverting supplies to richer countries that already have thank you on that on that note and the special emphasis that fighting my place a lot of people wonder when's the right time to get tested did you get an STD test right away or is it better to on the note of the importance of mobilization and especially to force pharmaceutical companies to to share their recipes and I think I'm going to to conclude that thank you very much thank you my least powerful bringing together of a lot of experiences through HIV AIDS to the current pandemic a lot of parallels obviously so I just want to remind folks that we'd love to get a bit of a discussion going we have some time we typically go until about 20 after the hour so please do feel free to put some questions into the Q&A and then I'll repeat those for the people as a whole just to start the discussion off I guess I enjoyed seeing how you brought together a lot of different people in the field that have been you know working both historically and at present to improve the supply essentially and access globally to COVID vaccines that I was curious if you wanted to sort of situate your own experience having worked as we talked about early on in the introduction in a range of different advocacy organizations because in some ways you know what we're hearing or what you shared with us was that there's a lot of similarities between what happened with HIV AIDS and the current pandemic and and yet here we are again right so in some ways it's kind of a very depressing note around corporate power and the ineffectiveness of advocacy to alter that or push back against it so I wondered if you're coming from perhaps adjacent spaces in public health different organizations if you had any reflections about what's new here or what aren't we doing what should we be doing just either at a personal level in terms of you're moving into this space coming from outside of it. Thanks Matthew that's a great question and it makes me think about about being in spaces that always had public health and access to medicines issues but probably a bit more tangentially so I noted that most of my work in the last while has been around law reform on sex work specifically and the decriminalization of sex work and the work that I've been involved in around there has been access to health care services and the importance of having enabling health contexts to to speak to spot particularly more modernized people and the work that I've been doing in gender-based violence more broadly it's also been around policy and law reform to acknowledge the impact of gender-based violence on levels of safety and well-being and health in South Africa but of course broader much broader than that and I think that the issue of the difficulties within the health sector and especially because of the emphasis placed on profits and often on money and the way that profit margins as well as the stigma that often attaches to particularly marginalized groups how those reinforce each other to force the people who often need health care services the most how they get forced even more to the margins and I think Paul Farmer spoke very eloquently about the fault lines of epidemics and how they track the marginalized populations and reinforce some of that structural violence. I think something that that struck me in the comparison of the work that we did early on in HIV and now in COVID in a match spanner form is the social solidarity that the global solidarity and I think that that's something that's very important to point out how the networks of activists who came together with HIV and how it was truly a global response how many of those people are still working very strongly in issues of intellectual property and access to medicines and have been able to reactivate in working in tandem with people all over the world especially the advocacy around the trips waiver the trust and the relationships that have been forged over many years how activists could pick that up and just run with those and I think those are those are important lessons in in terms of how I would say capitalism has has become even more robust in in the last the last few decades the consolidation of pharmaceutical power and political power specifically but that there's been such a coordinated and important pushback by human rights activists academics and and advocates. Yeah no that's that's very thoughtful I mean I think in some ways it's it's amazing to see this pushback coalesce quickly and in full force and bring out those lessons and try and mobilize I guess the the sort of challenge that occurs to me at the same time is how to sustain that between pandemics when you know there is this you know obvious stark inequality that you can point to to to build public support and support across organizations when that's less easy to do that's how these sort of structures seem to be reproduced again but I really appreciate that response we have we have a question from the audience thank you for your inspiring presentation marlies countries companies and countries adopt different approaches about the exclusivities on different types of co vid medical countermeasures I think using that broadly to capture drugs vaccines and other things like you know testing devices for example the US supported the trips waiver in relation to co vid 19 vaccines but not necessarily in relation to other countermeasures and Pfizer although I think this might need to be merc didn't contribute to any technology pool on vaccines recently announced that will issue voluntary license licensing of its oral antiviral therapy to the medicines patent pool I think that's mark my father but I forgot the details what do you think underpins the shifts in approaches and strategies thanks Matthew I think thank you for that question and I'm going to start off with a important point that Matthew made in an article earlier this year around how vaccine manufacturers have strong incentives to to keep the pandemic going right I think Matthew talked about it as being a durable franchise and I think that pharmaceutical companies have have held on to that power that they that they are still holding on to that power at all costs and that what what I think where where there's been some some minor concessions and those have been probably precipitated by the the the moral arguments and the the global push by activists where citizens within within countries in the global north have said no more that countries that are blocking the the trips waiver need to to stop doing so and that there's been a lot of push on on pharmaceutical companies hopefully through their shareholders hopefully through their boards but also through the general public to make those to make some of those concessions I don't think there's been a major shift at all I do think that that the this approach while it is is heartening that you that you refer to is by no means the no means the extent of what we would want and what we need in terms of of the changes that would be brought about by the the trips waiver and that would essentially be around the transfer of know-how for people to make their own vaccines and for for some of the some of the materials that are needed to to make some of the vaccines that are are held still in countries that that manufacture manufacture the vaccine so you need to be able to do the transfer of of of know-how in a in a much more robust way to to radically increase the supply of vaccines and other medicines so I do think there is some chipping away and that this is a good example of it but it's by no means it's by no means what we what we really need in some ways it might distract from the bigger questions around it and the fact if we don't use the trips waiver and the the COVID-19 pandemic when when will be when will we ever use it well said another question from the audience are there or any organizations in particular that you think are doing good advocacy work on the on the patent issue during COVID-19 in particular? Thanks Uzi that's a that's a great question I'm mostly in touch with with some of the the organizations that that we work with and they are generally grouped together under the People's Vaccine Campaign and some of the links at the the end of my presentation some of the really creative videos I don't think there will be time to to show the the athletes video at the end of my presentation that I think is really innovative the People's Vaccine Campaign bring together a large number of international NGOs and and as well as academic organizations that have a very clear advocacy ask around the the trips waiver and putting pressure on the World Trade Organization so my entry point would be the People's Vaccine Initiative and they have sparked a lot of regional and country specific country specific splinter cells these are people with teen campaign in South Africa these are African wide People's Vaccine Movement and that looks specifically at issues and within Africa and they all tie together globally through the through the the global network so that would be my my key entry point and then second would be Doctors Without Borders the MSF Access Campaign is really robust and it is situated in a lot of expertise on intellectual property and academic research and it's it's worthwhile mentioning public citizen in the US and also knowledge ecology international that are doing a lot of a lot of academic work as well as as research to bring out some of the some of the particularly disturbing aspects around non-disclosure agreements around the the profits that pharmaceutical companies make and how that play out on a on a global scale then the last one that I particularly like is called the Free the Vaccine Campaign that's uh yeah that's been forged by a number of of activists world over and and led by the Center for Autistic Activism in New York that uses creative advocacy techniques um to uh and the arts and especially uh especially theater um to to challenge people's um challenge people's views and to do so in a in a creative way um so those would be my my key my key organizations thank you there is hope I guess in some ways around the the mobilization and the sort of growth of civil society I just hope we can sustain their actions long beyond the pandemic as crucial as they are right now yeah um uh we're just about out of time so unless there are other questions in the Q&A I just wanted to close by thanking Dr. Richter but before I do that I'll just one housekeeping point to share with folks um so as uh long-time followers know of the series as much as we're privileged to have guests come from afar sometimes in person outside of the present context um we've been operating online for some time uh through COVID the tentative plan which we are very fortunate to be able to work towards is that we will be back in person next semester so this is our last seminar of the current semester speaking in very university oriented terms there but in January we're hopeful that we will be able to get together in person and uh in the future be able to host uh speakers speakers like Dr. Richter to come and attend and bring our audience back together so just wanted to make a note for our attendees that um we'll tentatively be planning to be back in person in January so stay tuned for more details in the year uh with that housekeeping notes said um I hope everyone join me in giving a big virtual round of applause for uh Marlies for joining us it's especially late in South Africa today uh or at least well into the evening on a Friday night so we appreciate it for that reason as well but obviously these issues are front and center we applaud the work uh that you and others in civil society are doing so I cannot thank you enough for sharing the experience and perspective and bringing uh to the fore that history around antiretrovirals as well um so on that note I think we unless you wanted to any offer any parting words Dr. Richter I just wanted to say thank you again thank you everyone for joining us and we'll see you hopefully soon okay