Episode 68: The People’s Vaccine Alliance — A Conversation with Dr Mohga Kamal-Yanni

In this weeks episode, listen to Dr. Bahijja talk with Dr Mohga Kamal-Yanni, a Global Health and Access to Medicines Consultant who works with the People’s Vaccine Alliance - a coalition of organisations and activists united under a common aim of campaigning for a ‘people’s vaccine’ for COVID-19.

Photo of colourful syringes by Diana Polekhina.

Dr Bahijja: Could you tell us a little bit about yourself to start?

Dr Mohga: Sure — I am from Egypt and am a trained doctor / GP. I joined Oxfam here and have been working on global health policy and programming for many years now. Now Iam a freelance consultant — at themoment I am the senior policy advisor for the People’s Vaccine Alliance.

Dr Bahijja: What is your favourite song at the moment?

Dr Mohga: My favourite song is an Arabic and Egyptian song, the artist is Abdel Halim Hafez (Note: Also known as Abdel Halim Ali Shabana) and although he passed away awhile ago, his music is really lovely. My favourite song by him is called Qari’at Al Fingan in Arabic, meaning the Fortune Teller. It is based on a famous poem about a fortune teller. […]

Dr Bahijja: I heard about the People’s Vaccine Alliance initially online, and saw their discussion on distribution inequalities with vaccines. From my understanding, there are two main components of health inequalities — inequalities of people within the same nation, and those between nations. Could you talk a little bit about what health inequalities are?

Dr Mohga: That’s right — health inequalities can occur between groups (like countries, cities, neighbourhoods) or between individuals. For example, the health inequalities between men and women, or those faced by people who are living with HIV. Within that, a lot of it comes down to income inequality between different countries, areas and people. […]

Dr Bahijja: I also wanted to discuss the history behind health inequalities and access to vaccines. Could you give a quick explanation on the commonalities between inaccess to vaccines and healthcare globally?

Dr Mohga: One thing is that, globally, health is not a priority for many countries. Instead the priorities are security, economy, all sorts of things — and then health at the very end, meaning very little funding is available. The other thing is that there the way health is looked at — some people see healthcare as a human right, that citizens are entitled to that right. For example, we see that with the publically funded and publically delivered NHS in the UK. Alternatively, healthcare can see seen as a good that we purchase as customers — meaning we are not entitled. This means healthcare is privatised and that as consumers we have a supposed choice to access it. Then there is the viewpoint that there is a choice whether or not to seek health for conditions, or receive vaccines, etc. [when oftentimes, with vaccines, it is not a personal issue but a societal one]. This idea of healthcare being a commodity is a huge barrier — the commercialisation of healthcare and how it introduces so many barriers. […]

Dr Bahijja: In the past year we have seen many discussions surrounding the negative impact of having an unhealthy workforce (such as people self-isolating) on the economy — what do you think about this change in mindset?

Dr Mohga: Yes, I mean now we hear the term “health security” and it is viewed more as a security issue. To be honest though, I am not sure we will fully learn this lesson, as we didn’t learn it from Ebola. When Ebola came it was clear that the affected countries didn’t have effective health infrastructure, and in America the few cases saw the country struggling with[ figuring out how to handle potential Ebola cases in the USA], as there was no medicine and no vaccine. I don’t think this will result in a large investment in health systems, as we didn’t see it after Ebola, and we continue to see even rich countries continually cut health budgets. […]

Dr Bahijja: I definitely saw that with Ebola, because it felt like a distant issue that wouldn’t affect people in countries like the USA or UK, many people didn’t view it as a priority. With COVID-19 as well, I often see statements like “I am surprised that it didn’t affect Africa as much” — this has opened by eyes quite a bit to the inequality of healthcare. With COVID-19, it feels as if many people did not expect it would affect their countries.

Dr Mohga: A huge part of it is that it is also affecting the economy, [unlike Ebola which did not really affect the USA’s or UK’s economy, for example]. Early on, the serious lockdown in China was an example of this — at first we saw people saying “well, this just happens in China, in our country we value our liberty”, etc. and then after that we saw similar policies enacted in these countries too. Many people do not take infectious diseases seriously as they assume that it will only affect certain countries. The countries that did take it seriously from the beginning — like Germany, New Zealand, Taiwan, Singapore, Vietnam, etc. They all took it seriously — it is clear from looking at their case counts and death rates. […] Many people seem to forget that viruses don’t need passports and will [travel really where ever they want to]. […]

Photo of pharmacist prepping COVID-19 vaccine by Steven Cornfield.

Dr Bahijja: Something that was highlighted while I have been doing research into Malaria was that in Malaria endemic countries, there is not a enough in-country manufacturing so many medications have to be imported — often due to lack of infrastructure. Could vaccine supply and inequity be solved or improved if these countries were capable of producing their own vaccines?

Dr Mohga: With in-country manufacturing, I mean, we can see in Europe that not every country has a large manufacturing capacity, [so they are still reliant on other countries]. North America, for example, has many companies producing vaccines, but they are still purchasing from other countries — this is due to the emergence of vaccine “hubs”. At first, with the Oxford vaccine, we saw that Oxford wanted to produce a non-exclusive vaccine. They then exclusively licenced Astra-Zeneca, with a few notes in the contract — such as requiring they supply developing countries and also requiring the vaccine being sold at no profit. This deal with Astra-Zeneca was better, as it would mean they wouldn’t receive royalties from the vaccine during the pandemic [and could guarantee a good price]. These other countries, definitely need technology transfer. For example, with the new mRNA technology — it seems easy to produce, it doesn’t require huge infrastructure, but they need access to the technology in order to produce these vaccines. There is a lot of potential manufacturing capacity in other countries […].

Dr Bahijja: Tell us about the People’s Vaccine Alliance and why it was formed?

Dr Mohga: Originally it was from a group of people from the UN Society for HIV or AIDS, and they could see that eventually there might be a vaccine for HIV and that in that case there would likely be an issue of supply, with some countries at the back of the queue. They then got together, with many charities and organisations, like Oxfam, the UN, Amnesty International — many NGOs as well, and formed an alliance. We are really campaigning to have vaccines available to all, and ideally at the point of use for 0 cost. We are also really pushing to share technology and also to share IP for vaccines, as well.

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