Ideas - How Canadians Can Help Lead the Global Fight for Health Equity

Episode Date: November 13, 2024

In an era of rampant commodification of life-saving medicines, healthcare must be secured as a global public good, argues health justice advocate Fatima Hassan. In her Boehm Lecture on Public Health she explores ideas of solidarity and leadership in pandemic, epidemic and war responses.  

Hey there, I'm Kathleen Goltar and I have a confession to make. I am a true crime fanatic. I devour books and films and most of all true crime podcasts. But sometimes I just want to know more. I want to go deeper. And that's where my podcast Crime Story comes in. Every week I go behind the scenes with the creators of the best in true crime. I chat with the host of Scamanda, Teacher's Pet, Bone Valley, the list goes on. For the insider scoop, find Crime Story in your podcast app. This is a CBC Podcast. We turn overseas now to the spiraling COVID crisis in Indonesia as the Delta variant spreads. Welcome to Ideas. I'm Nala Ayyad.

The country faces oxygen shortages and cases and hospitalizations escalate. When the pandemic was in full swing in 2020, wealthy countries stood at the front of the line for COVID-19 vaccines. We begin tonight with that new hope in the battle against the coronavirus. One week after that news from Pfizer, tonight news on a second vaccine. Moderna announcing its vaccine is nearly 95% effective. But in the global south, vaccines seemed like the stuff of fantasy. India's outbreak is setting global records.

Every day, another 400,000 people test positive and more than 3,000 die. For South African lawyer Fatima Hassan, that disparity was all too familiar. Growing up in apartheid South Africa, one of the first things we understood quite intimately was just that we were second or third class citizens. According to Fatima Hassan, the dismantling of apartheid in South Africa hasn't meant a great deal for achieving equality. South Africa, firstly, is regarded as one of the most unequal countries in the world. In many respects, we are regarded as being at the epicenter of several epidemics, including TB and HIV. We have a growing cancer crisis.

So the inequality is pervasive and features in every aspect of your life. Fatima has a term for the lack of access that poorer people in poorer nations experienced during the pandemic, vaccine apartheid. What happened in the COVID pandemic with vaccine apartheid. What happened in the COVID pandemic with vaccine apartheid in 2020 and onwards? By the end of 2021, not so long ago, according to the World Health Organization, not even 10% of people in Africa had received a COVID vaccine, not even a single dose. Three or four health workers in Africa were still waiting for a first dose of a vaccine. The same workers being poached by richer nations such as Canada. This is why even

the DG of the World Health Organization, the Director General, called the situation morally grotesque and a recipe for seeding viral variants capable of escaping vaccines, which is exactly what happened. For Fatima, knowing what was happening was unsatisfying. She wanted to know why. So she and a group of her fellow lawyers sued their own government. They wanted to look inside the secret deals South Africa signed with vaccine manufacturers and producers.

They won their case. And what their victory revealed was that the contracts were one-sided, that the pharmaceutical companies employed bullying tactics in negotiations, and that South Africa wound up paying more for vaccines than EU countries. paying more for vaccines than EU countries. I want to dedicate this lecture to the 14 million plus people who died in the COVID pandemic in the space of just two years when life-saving technologies existed that could have mitigated that unimaginable loss but were denied to us in the global south so that human greed, nationalism, vaccine hoarding caused untold suffering and death.

Fatima Hassan founded the Health Justice Initiative, a non-profit organization that addresses inequity and injustice in health in South Africa and the Global South. She delivered the 2024 BOEM Public Lecture in health at the University of Toronto. You'll hear excerpts from her lecture along with a conversation we had after she returned to South Africa. You started the Health Justice Initiative in South Africa just as the COVID pandemic was getting started. What were you seeing in terms of the pandemic that pushed you to start the organization? So if we go a bit back, I mean, the point about growing up in apartheid South Africa was you witness firsthand how a legal system can turn people into second or third class citizens. And it turns people into beggars for services or for houses or for land.

I mean, my grandfather's land was possessed by the state. We had bulldozers on our property. We were only compensated for that expropriation some 20, 25 years later and not even at a market value. And that's the experience of most non-white people growing up in South Africa. We lost a lot from dispossession to denial of services to, you know, arbitrary arrest. I mean, the political repression of an apartheid regime was obviously quite dire and quite severe. And I mean, this is well documented and I don't need to go into all of those details.

But when you see that type of injustice and when you see that type of oppression, there's one of two ways in which you can proceed with your life. You can try and lift that injustice up and try and fight it, or you can turn a blind eye to it. And what we decided as a generation growing up in the 1980s in apartheid South Africa, where the repression and the political violence was so intense, was that we would try and see whether we could use the law to undermine the law. whether we could use the law to undermine the law. None of us thought that we would be studying law and then be able to practice law in a post-apartheid South Africa.

We thought that apartheid would last for much longer and we would try and use the legal subsystem to subvert the very features of the apartheid regime. So it was fortuitous that, you know, my generation graduated at the time when South Africa had its first elections. And within the first few years of practicing law in South Africa, we had a new constitution. And that for us, working in the health justice movement at that time, was a game game changer because we were able to advocate for the right to healthcare services for all people in South Africa, not just an elite minority as it

was under apartheid. And to argue that that wasn't just ethically required or a nice thing to have, but it was actually required as part of our constitution and as part of, you know, what we call the progressive realization of rights, which are included in our Bill of Rights. And we've never enjoyed that protection before. The legal protection afforded to us gave us an opportunity as young lawyers at that time in the late 90s and early 2000s to really advocate for the protection of people who are marginalized. And at that time, my job was to promote and protect the rights of

people living with HIV. And at that time, we basically saw once again firsthand what inequality does at a global level when hundreds of thousands of people in my country, including many of my clients, including many colleagues and friends, were unable to access what we call antiretrovirals, the medicines to treat HIV, at a time when global north countries had sufficient supplies, when the technology existed, where the medicines were there. And we were denied the same opportunities as people in the global north. And it was eerily similar to the way we experience apartheid, right? Being denied something because of your geography or because of your race or because of your class or your income.

And so that is how we basically spent the 90s and the early 2000s fighting, litigating, advocating, researching for access to antiretrovirals for people living with HIV in South Africa and elsewhere in Africa. And having witnessed that, you know, I spent about 10 to 12 years doing HIV AIDS work, having witnessed the consequences of intellectual property monopolies, of greed, of nationalism, of the double standards of many global North countries, including the US. What prompted the establishment of the Health Justice Initiative was to ensure that we didn't have a repeat of what happened in the HIV AIDS crisis with COVID.

Because quite early on, we saw reports about progress on vaccine research and we were worried that we would be last in line again. And unfortunately, you know, that's exactly what happened. In my country, poverty is alarmingly high. We see it everywhere, and this has been the reality for 30 years since our democratic transition in 1994 celebrated just days ago. But inequality is not natural. It shouldn't be regarded as natural. It has a huge impact on our ability to access affordable health care.

But domestically, not just in South Africa, elsewhere in Canada too, it thrives because of a global backdrop of staggering economic inequality and global trade, regulatory and economic policies or rules that don't prioritize the economic upliftment of poor people everywhere, forcing us in the global south often to rely on charity and what I call voluntary benevolence from donors and richer governments. Oxfam's 2024's inequality report shows that just a handful of billionaires and financiers in the global north control a system of global economic apartheid. The big corporations and the market monopolies have historically

created unprecedented inequality and wealth on the backs of the poorest people and of the poorest nations. To put the global wealth disparity in perspective, Oxfam's report reveals that since 2020, when the COVID pandemic started, almost 5 billion people have become poorer. Poverty at current rates will not be ended for about 230 years. We will all be dead by then. But we could have our first trillionaire in just over a decade in our lifetime.

Seven out of the 10 world's biggest corporates have either, wait for it, a billionaire CEO or a billionaire as their principal shareholder. Something's not quite right. So as campaigners for access to equitable health care, we know all too well what this means. It means that huge pharmaceutical corporations make more profit every day, while ordinary people across the world are often denied timely access to medicines

that could save their lives. In the global south, we have not only experienced colonial exploitation and racism but we've also experienced what hoarding of knowledge means. Ultimately we also want access to the best science has to offer and to the fruits of scientific research and knowledge that we have also contributed to but we want it at the same time as all of you in the global north. I don't think that that is an unfair proposition. So I want you tonight to imagine your loved one or yourself finding out that they or you have tuberculosis or cancer or HIV or cystic fibrosis, and you find out

that there is a drug that can cure them or you or prevent suffering or even death, and now imagine that you can't access it, either because somebody has decided they will not sell it in your country or because you can't afford it. You don't have enough money, even with private health insurance. How would you feel about this? Right now, people are dying from exactly that, from diseases that are treatable and curable, like they did during COVID, while pharmaceutical corporations protect their bottom line. Nations, including Canada, that contribute to scientific research through research and development, participation in clinical trials, they too are often prevented, like us, from manufacturing health products. No one wants to give us the recipe,

including for products such as medicines that could help free us from dependence, neocolonialism, and arbitrary trade rules. But these rules are globally enforced and are commonly called intellectual property rules, and I'm going to talk a lot about that as we go through this lecture. These intellectual property rules require that for medicines, pharmaceutical companies or corporations anywhere can seek protection for a medical innovation, even if often publicly funded, for at least 20 years.

This is usually in the form of what's called a patent, but there are other intellectual property rights that companies in the medicine market regularly seek, including copyright claims, trade secrets, and confidentiality. So in that 20-year period, and sometimes more, it's what's called evergreening, they have the exclusive right to manufacture the relevant medicine or vaccine and the exclusive right to set the price. They can choose when to share the recipe, with and with whom. We call this a voluntary license. If a state, if a government like Canada or the US or South Africa compels that company to share the recipe before the expiry of the 20-year period, it's called a compulsory license.

And these rules are contained in an international agreement in a document called TRIPS. And I won't bore you with the full details about that, but it's governed by an organization that is based in Geneva called the World Trade Organization. I'm sure you've heard about it, the WTO. And member states of the WTO, including Canada, South Africa, are member states, are in turn required to domesticate these rules in our own laws, in our own countries, in our own patent laws, with a few exceptions. So essentially, what we have is a situation where this document called TRIPS, governed by the WTO in Geneva, codifies monopoly power. It gives too much power, in my view, to CEOs of pharmaceutical companies, because they get to decide the price, the countries they'll sell to, and the pace and volume of manufacturing, which then has an impact on the global supply chain system for all medicines and all medical products, including diagnostic tests, including treatments, including medicines, including vaccines, including even the equipment

to give you oxygen. But understanding these rules and understanding Pfizer and other companies' roles in developing the TRIPS agreement, I think, is key to understanding the reasons why the world failed to deliver medicines with urgency to treat my friends, my colleagues, our volunteers, and the people in my country who were living with HIV AIDS in South Africa and elsewhere in the continent in the 90s, and why in COVID again, particularly as Africans, people living in Africa, we were last in line for vaccine access. And the same is also now true for cancer, for TB, for cystic fibrosis, other diseases. The list is endless.

Can we just back up a little bit and just take us to the summer of 2020, when COVID vaccines were unavailable. Could you speak to how your previous experience informed what you were thinking about how access to vaccines would unfold in this new crisis? The way we thought access would unfold was that the world would have learned the lessons of the HIV AIDS crisis,

that there would be equitable sharing of available vaccine supplies, that the calls of the WHO and its DG would be heeded to share vaccines on a need basis that is based on public health needs, so that you'd vaccinate healthcare workers first, and then elderly populations around the world. And more importantly, we expected that there would have been, you know, an unambiguous prompt sharing of vaccine technology, because a lot of these vaccines, the early vaccines, were actually developed with public funding from governments around the world, because there was a desire to make sure that the entire world was able to get out of this global pandemic much sooner and with greater speed, because it was

not just costing people money, but it was costing lives. You'll remember the early reports of the number of deaths around the world when people were still waiting for a vaccine. I mean, around the world when people were still waiting for a vaccine. I mean, the footage of what was coming out of Italy, the US, India, parts of Africa, it was devastating. And that was basically, for many of us who had worked in the AIDS movement, deja vu of what inequity would look like if there wasn't going to be greater sharing of technology. Unfortunately, the total opposite happened. Nobody learned any of the lessons of the HIV AIDS crisis or of any of the other outbreaks of the last 20 years, including Ebola. And what we saw and what I spoke about in my lecture was a pernicious form of vaccine nationalism and greed. And it resulted in hoarding, overordering of vaccine supplies,

and a refusal to share technology when it mattered the most. Now, critics will say, well, technology was shared, supplies were shared. And what we would say to that is that when was it shared? When was it felt that Africa deserved some donated vaccine supplies or some sharing of the technology? It happened months later and months after. So when you say, do you recall that time? I recall it with great sadness because my colleagues in the Global North were getting vaccinated months ahead of my own grandaunts and my godmother and my own family members who were elderly. People with comorbidities were waiting and waiting for vaccines in South Africa while people in the global north were getting their first shot, in some cases their second shot. And then we found out in the middle of 2021 that vaccines that were being made in South Africa after we were told that we didn't have the technology to do that were actually being shipped to Europe because they were the priority customers. So what we saw cumulatively was a selfishness and a greed and a refusal to tackle the systemic

reasons why we couldn't make vaccines in Africa or why we didn't have sufficient supplies. So South Africa, as you point out, has been fighting pharmaceutical power for a very long time, starting with Nelson Mandela and the fight for HIV drugs. In a nutshell, can you just tell us what happened there, that fight then? So if you remember the late 90s in South Africa, we had a growing HIV problem. Our incidence rate, our infection rate, the number of people living with HIV and dying prematurely and needlessly was on the increase. We had a new government coming to power because we had just won our democracy and we had just had our first democratic election.

and we just had our first democratic election. And one of the first things that President Mandela had undertaken or had promised to do was to try and fix this unequal health system in South Africa and to address the high cost of life-saving medicines, including for HIV AIDS. And as part of a suite of laws that the African National Congress at that time had promised to amend or basically rewrite, because these were apartheid laws, was a set of laws designed to improve access to healthcare services and to ensure that South Africa could get more affordable versions of key medicines, including for HIV. And when those laws were drafted and

then tabled in parliament and passed by the Mandela administration, the global pharmaceutical industry took it upon themselves to sue Nelson Mandela. And that became this Herculean legal fight, which eventually resulted in the industry withdrawing their challenge because of public disapproval, because of the public relations consequences for these companies. But I also believe because of negotiations between the Mandela administration and the industry, because one of the things that's not spoken about is that while the challenge was dropped, mainly also because the treatment action campaign at that time, which had just been formed, a social movement of people living with and affected by HIV, had intervened in that case as a friend of the court, the consequences of the industry withdrawing the case, we thought would mean access to affordable generic versions,

parallel importation of key medicines, but that is not what happened legally. Our government didn't pass the necessary regulations after the withdrawal of that case by the pharmaceutical industry to make that into a reality. So while our government tried, was sued unsuccessfully, it then, in my opinion, didn't follow through. And that is why in the early 2000s, it was left to civil society organizations. I was fortunate to be part of that campaign to ensure that there were generics ARVs in the system and to ensure that there were more affordable versions of ARVs for both the public and private sector. Now, the side note to the saga is that after the first administration completed its work,

the Mandela administration, when he stepped down, President Mbeki came into power. And so the battle then for ARVs in South Africa became even more complicated. We weren't just taking on the pharmaceutical industry to drop the prices of ARVs that were generally available in the global north at more affordable levels. But we also had to take on what was called state denialism, which was being promoted by President Mbeki. Clearly, our government, the South African government's denialism of the science of HIV AIDS and the big pharmaceutical companies' actions at the time, backed by governments in richer nations, contributed to the suffering and deaths of thousands of my people. They talked solidarity,

but they acted to prevent poor countries from accessing affordable medicines that could have prevented their death. And moreover, when poor people were getting sick and dying in Africa from AIDS, we were told by the representatives of richer nations, it's on record, and pharmaceutical company CEOs that we did not need those life-saving

drugs because Africans cannot tell time. So the argument, their argument, was that we wouldn't take our medicines on time because we can't tell time. Worse, if we use legal measures to secure cheaper versions of the medicines, we would then face trade or legal repercussions. The Clinton administration put South Africa on the trade watch list. As a result, millions of people in Africa died. And when we did get widespread access in generic medicines, it was because we fought for it.

It was social movements that mobilized to demand access at affordable prices with the support of academics and research. And that death toll, that experience of HIV AIDS and the global activism of the AIDS movement, you've all heard of ACT UP. You've heard of the Treatment Action Group, multiple groups in Canada and the U.S. and North America that helped us mobilize a global movement to fight for access. These groups have catalyzed researchers and activists to tackle undue medicine commodification and excessive profiteering ever since, even for COVID. And we've advocated for the recognition of medicines and vaccines and diagnostics as public goods, public health goods, because they save lives. They're not a luxury car.

They're not a luxury handbag. They're not a perfume. They are life-saving medicines. And also because publicly funded universities and state-supported institutions have often generated the research to develop them. the research to develop them. And worse, often Africans, people in my country, are asked to be trial or study subjects to help generate knowledge for researchers working on these diseases. But post-trial access and benefit sharing is not guaranteed and is a mere afterthought. That certainly can't be right. So when it mattered the most, we were not allowed

to manufacture the medicines also known as Lazarus drugs for HIV because it brought people literally back to life, even though we had the ability and the capacity to manufacture. Instead, during HIV AIDS, we were made to rely on charity, donations, and empty promises, and we had to wait. Even with COVID vaccines that had been created thanks to publicly funded research and the work of public scientists, they were protected by these intellectual property rules and patent rules designed to make huge profits, not to deliver access. So I just want to say tonight that in my view, any policy decision, even if informal, even if you can't find a government memo to this effect,

that says that we're only going to vaccinate everyone in the global north first. By the way, they're currently doing this with monkeypox. Without prioritizing timely access for the global south is actually frankly rooted in racism. Because for those people making those decisions, it suggests to us in the global South that black and brown lives in the global South

matter less than white lives in the global North. You're listening to Ideas. Thank you. on ABC Radio National and around the world at cbc.ca slash ideas. Find us on the CBC News app and wherever you get your podcasts. I'm Nala Ayyad. Hey there, I'm David Common. If you're like me, there are things you love about living in the GTA and things that drive you absolutely crazy. Every day on This Is Toronto, we connect you to what matters most about life in the GTA, the news you gotta know,

and the conversations your friends will be talking about. Whether you listen on a run through your neighbourhood, or while sitting in the parking lot that is the 401, check out This Is Toronto wherever you get your podcasts. In October 2020, the governments of South Africa and India submitted a proposal to the World Trade Organization. They wanted a waiver for TRIPS, the Agreement on Trade-Related Aspects of Intellectual Property Rights. That proposal and its fallout came to be known by activists as the TRIPS Waiver Saga. This year's speaker at the BOEM Public Lecture in Health

was South African lawyer Fatima Hassan. She spoke about the barriers to global health equity. She also details how the TRIPS waiver saga came to be a cautionary tale in the quest for fairness. So basically the waiver was to ask for permission to waive the rules for a limited period of these intellectual property rules for the duration of the COVID pandemic. But the waiver was met with so much of lobbying, so much of resistance, so much of obstacles that it's now 2024 and we still have no waiver. And my view is that the reason for that is it became a symbolic and a real existential threat

to the private pharmaceutical industry and the continuing practice of treating medicines like a luxury handbag. And so the proposal was blocked by many richer nations, including, of course, the US, the EU, the UK, Australia, Switzerland, Canada, and Japan. And so basically, high-income countries prevented textual negotiations on that proposal, and they decided what was best for us in low-income countries, even though we told them what we needed to respond to the pandemic. Canada started out opposing the

proposal, and then because of an unknown reason, it said it would remain neutral. So it had an about turn, but it never really remained neutral. And I think that's the point of somebody can issue a press statement, but their actions can be very different. But the proposal was supported by 100 countries, 65 co-sponsors, Nobel laureates, the DG of the WHO, many trade unions, health groups, the African Union, researchers. But all of these proponents of the waiver proposal were blocked, and the U.S. basically ensured that there was only a limited deal on vaccines. There was no deal on diagnostics, no deal on treatments. And basically, the deal that was finally agreed to at the end didn't really do much for vaccine access in the global south.

And the irony of the mixed messaging and the opposition and the vested interest is that Canada for some time has insisted, like the US, despite its own use of compulsory measures in the past, like during anthrax in the US for COVID, that countries shouldn't push for the relaxation of IP rules and, you know, make use only of voluntary measures. So basically, what they've been asking us to do and still asking is for us to go and ask the pharmaceutical company for their cooperation. And usually the company rejects it. But the irony is that Germany and Canada also pass laws about overriding patents to ring in for COVID for

Canada and for Germany. But we were told that we have to rely on voluntary measures and to ask these corporations nicely to help us. And the EU said, on the other hand, in contrast to Canada, that we should use compulsory measures. But nobody is able to use compulsory measures in the global south, because when you do try and do that, you're faced with trade sanctions and pressure. But right now, the EU is passing a law to make it easier for them to make use of these compulsory measures in the next health emergency, and there will be one, or in the next pandemic. This is the exact law that Mandela tried to pass in South Africa and for which he was sued.

So this is why many of us in the global health community have argued that the WTO, the World Trade Organization, is not fit for purpose. It's a colonial relic. Even the Nobel laureate Joseph Stichlitz has called the TRIPS agreement ethically indefensible. And in my view, the WTO represents everything that is wrong with monopoly capitalism and its commodification of life-saving technologies, because it does treat medicines like luxury jewelry or a designer handbag. So at the time, here in Canada, the TRIPS waiver story was typically framed as a defense of intellectual property rights, which is necessary for innovation.

But I wonder, as a South African, you've had a long relationship with Canada. How were you thinking about the position Canada took at those discussions at the WTO? So to be honest, we didn't expect that Canada would side with countries that would oppose the TRIPS waiver and has continued regrettably to side with countries to oppose the lifting of intellectual property restrictions, not just for COVID, but for other diseases as well. What we had expected was that two things. Canada would share more of its vaccine supplies with the global south in a more timely manner, because you'll remember that Canada overordered vaccines and had stockpiles of vaccines.

So it was able, by some media reports, to vaccinate its own population five times over, while many countries in the global south were waiting for vaccines. So one, we expected that Canada would have donated more supplies to what was then called COVAX, a global mechanism to try and ensure equitable vaccine delivery and supplies for the global south, which didn't really materialize or work out because of the greed and the nationalism. But two, and more importantly, we expected Canada not to block efforts, not to actively block efforts in Geneva to block the passing of the CHIPS waiver. Now, you'll recall that the CHIPS waiver had the support of the majority of countries in the global south.

So here you had about 65 member states, about 100 countries telling the global south what we needed in the form of the TRIPS waiver, and the global north telling us, no, that's not what you need. That's not what we're going to support. And in fact, we're going to spend three years actively blocking any efforts to try and lift the IP barriers. So to say we were disappointed with the Canadian response, I think, would be an understatement. you know, the way Canada conducted itself in the vaccine negotiations and clearing supplies for itself by not prioritizing countries in the global south. So that type of greed is not acceptable. ordering enough supplies to vaccinate your population, sure, but over-ordering, hedging your bets, clearing the shelves, and then not undertaking to make prompt or sufficient donations and at the same time actively blocking any efforts by the global south to share that technology, to share the technology of life-saving vaccines in the global pandemic. I think that was, you know, the disappointing aspect of Canada's response to a global pandemic.

Disappointing, but I also wonder what lesson you drew from that. What did it tell you that Canada behaved in this way? So I think it was just a confirmation of the trends that we have been seeing in the last 20 years, in particular, where global North countries have been politically persuaded by the US government, by the US administration, whether they're Republican or Democrat, to favor an IP maximalist position, including for life-saving medicine. So the geopolitics of the WTO, the provisions of TRIPS, the inclusion of medicines as patentable subjects, you know, is all part of a particular industry approach to try and ensure that they, in my view, can get an extended period of a price monopoly and of a supply monopoly through patents.

I mean, medicines were not always patented. It's a recent development of the last few decades prompted and pushed by the pharmaceutical industry. So what all of this showed us is that even in a global pandemic, we are, Australia, Switzerland, Germany, several others who will ensure that IP protection trumps patient access. we thought would happen, the total opposite happened, irrespective of the documented evidence of the number of infections and the number of deaths and the number of people waiting for vaccines in Africa. So I've spoken a lot, and I'm sure I'm so over time. This is what happens when you ask a South African to speak. But I've spoken a lot about what happened in the COVID pandemic and the lack of global solidarity. And the irony, as I mentioned earlier, is right now they're negotiating

and they've been given a deadline of Friday, that's in less than 48 hours, to come up with what's called a pandemic treaty to prepare for the next pandemic. Now, the scientists that we have spoken to said that in my lifetime, and I'm older than most of you sitting here, is that I may experience another four pandemics, right? So this is a serious issue of how do you manage

and how do you share resources and how do you share surveillance data and how do you do the genomic surveillance for the next few pandemics in our lifetime? Because we certainly don't want a repeat of what happened in COVID, also what happened with HIV AIDS. And so in the same modus operandi of the blocking of the IP proposal or the TRIPS waiver that I've discussed already, the same richer nations, including Canada, unfortunately, are once again trying to undermine the attempts to ensure that there are enforceable guarantees and commitments on equity in this next

pandemic treaty. There was a time when Canada had a proud history of promoting and advancing global health equity. Take Canada's important role in sharing manufacturing technology for the production of penicillin in the post-World War II era. It's a remarkable story that's been shared by colleagues at MSF Canada. But in contrast, now the Globe and Mail has also reported that Canada, like the US and others, is pushing for weak language and vague aspirations in the text of the pandemic treaty and threatening to walk away if there's anything that's more enforceable. Can you just give us a small sense of what happened to the pandemic treaty? treaty? Okay. So the pandemic treaty has been beset with a number of problems. The current, and I think the main issue for global health equity is that, again, the very same countries

that blocked and opposed the TRIPS waiver and did everything in their power to ensure that there was no sharing of technology with the global south, are actually refusing to agree to language on equity and on transparency and on technology sharing. So it's become a political fight. It's become a Geneva negotiated process, which is totally removed, I think, from the reality of patients in the global south. And unfortunately, you know, the time period for which they can now negotiate this document has been extended. So, yeah, you're trying to get the global North and global South to agree to a text of an accord when there isn't a lot of goodwill, I think, between the two because of what happened

in HIV, because of what happened in COVID, and because of right now what's happening with Ampox vaccine access. So to be honest, there was once the intention that this was going to be a blueprint to make sure that future pandemics would be responded to with greater speed, with greater equity, with greater empathy even. But that has just fallen by the wayside. You say in your lecture that inequality is not natural. It shouldn't be regarded as natural. Why do you think that it is regarded as natural? So I think it's influenced by what the market wants and what the market needs. And so we're going to have to use the C word, and that's capitalism. And so what you do is you create the norms and

the rules and the standards, and you justify an industry that prioritizes profit over patience. And you make that seem natural and normal that intellectual property rights can trump, that intellectual property rights can trump speed and intervention and a proper public health response to a pandemic. And so you create the tools and the PR strategies to justify your conduct and your behavior. And so you, over time, make it seem like a very logical thing, a very natural thing that people in Africa will just rely on donations, that they can wait their turn. I mean, we were told in COVID, you need to wait your turn. And we said, by how many more months, by how many more years?

We're facing the same pandemic. Why is it okay for somebody in Africa to wait eight or nine months for their first shot when people in the global north were getting it already in early 2021? inequality seem normal, right? When you live in a capitalist system, you make housing inequality seem normal. You make land inequality seem normal. You make food inequality seem normal. And it's the same thing with healthcare services and access to medicines. And I think that's the point, right? That's what happened in Geneva, that for three years, you had Global North delegations basically justifying the opposition to the TRIPS waiver as if that was the most natural thing in the world to do, as if that was not unethical, as if that was not, you know, contrary to public mores or public policy. Yeah. And if we look at the bigger picture, Fatima, I wonder, given the behavior of Western countries during the pandemic, what you're hearing and seeing in discussions among and between countries of the global south about the international, the current international order, just, you know, is there any

trust that remains there in the way things are supposed to work? I mean, I think that COVID was a wake-up call that all the promises and the pledges of solidarity was just an empty phrase and slogan. You remember the beginning of the COVID pandemic, all the world leaders stood up and promised solidarity and they said whoever found the vaccine first would share it. And that didn't happen. So I think there's more of a, less of a naivete, to put it bluntly, or political naivete, that countries in the global north will always do the right thing and will stand on the right side of history. And, you know, we're seeing this in

the way in which the Gaza war is playing out and the way in which countries respond to that. We're seeing that in the way in which countries are responding to the Ampox vaccine. We're seeing that in the way in which countries responded even to the possibility of getting treatment for COVID into certain countries. We're seeing that with cancer, with TB, with obesity drugs. So I think it's the pattern of behavior that people are finally alive to. And I think the one thing we were able to do in the COVID pandemic, drawing on the lessons of the HIV AIDS crisis, was to show to many more actors that this is not just a health activist issue. There is a serious problem with the way in which medicines are commodified, the way in which they are priced,

the way in which they are deliberately turned into, in inverted commas, a scarce product. And that shouldn't be the case. There's something fundamentally wrong when you're responding to a health crisis, when the technology exists, but when you can't get supplies to the people who need it the most. So I think that's what people have woken up to. And fortunately, it's not just health activists who are highlighting this and who are bringing attention to this issue. I'm now going to conclude, and the question I want to ask is how do we provide solidarity in

a time of war? And so in this final section, I want to talk about another Canadian, a former Lieutenant General by the name of Romeo Dele, who, as you all know, led a UN peacekeeping force in Rwanda in 1994. And I think as Canadians, you know his contribution better than me. But critically, he is on record as having warned the UN that a genocide was imminent in Rwanda in 1994. A warning that was unfortunately not heeded, leading to the slaughter of at least 800,000 people in Rwanda.

He had the courage, moral clarity, and bravery to speak up then and since. And in one haunting interview, he said, we could have actually saved hundreds of thousands, but nobody was interested. So we need more Canadian voices such as Mulroney and Lewis and Dele, and the powerful activism of people who advocate for social justice here every day. People such as the renowned Cindy Blackstock, who has worked tirelessly for the rights of

First Nations children. And I want to quote from one of her powerful interviews. When you see unfairness, it's your job to learn how and why things become unfair and do your best to fix it. I'll repeat that. When you see unfairness, it's your job to learn how and why things became unfair and then do your best to fix it. Deleuze also spoke about picking up dead bodies and carrying them in a genocide. His accounts of what happened in Rwanda remind me of the reports right now in 2024 from doctors in Gaza and from surgeons, the WHO, UN, and other humanitarian teams who have also worked there in the last few months on medical, humanitarian, and other critical missions.

on medical, humanitarian, and other critical missions. So as a South African child of apartheid and a social justice and health justice activist, I would be remiss in not concluding tonight's lecture with a few words on the unfolding genocide in Gaza. In December 2023, the South African government filed a case at the International Court of Justice, setting out a charge of four specific genocidal acts. South Africa stated that the fourth act committed included the assault on

Gaza's health system, making life, including reproductive life, unsustainable. On 26 January, the International Court of Justice, majority of the judges, found that the South African charge of genocide is plausible and as such issued provisional measures, including also a duty on all signatories to the Genocide Convention to take measures within their power to prevent genocide, failing which they will be regarded as complicit in war crimes. Rwanda, East Timor, Namibia, Germany, Bosnia, all were meant to offer us lessons. But now the world is in proximity, in my view, to a genocide unfolding right now on our screens that, in my view, again, several world leaders are complicit in.

So I really want to ask all of you here today, and I don't think we'll get the answer tonight, how do we offer solidarity in a time of war, in a time of genocide, as a health justice community? You started your lecture by dedicating it to the 14 million people who died from COVID. I wonder what you think it would take, if not that kind of loss, that scope of loss, what do you think it would take to promote solidarity and more equal access to the healthcare that people need? So I think what COVID has shown us is that solidarity is hard won. It's not going to come voluntarily or naturally. And so what it would take is a way in which you can force governments to act in a manner that is consistent with some kind of solidarity for the global self. How will that happen in the current geopolitical landscape where there's such unequal power, unequal trade relations, unequal diplomatic and scientists around the world to change the

paradigm that we are using to, you know, that often for many diseases prevents timely access to a medicine or a treatment or a vaccine that can actually save someone's life. So unfortunately, I don't think that it's going to come naturally, and it's going to have to be something that is compelled. So whether we use the law, whether we use public protest, whether we use other forms to compel governments to do the right thing, I think that's going to be the challenge for activism for at least the next few decades. Thank you to Professor Leslie Bone, Professor Robert Steiner, Dr. Adelstain Brown, Afshan Kohari, and Vanessa Smith, all with the Dalla Lana School of Public Health. Our technical producer is Danielle Duval. The senior producer is Nikola Lukšić.

The executive producer of Ideas is Greg Kelly. And I'm Nala Ayyad.