AFRICA-GLOBAL
Universities in Africa must be more vocal about the failures of higher education institutions in the Global North to challenge the status quo of innovation- and technology-sharing that is denying millions access to life-saving treatments, Sarai Keestra, a research coordinator of the Universities Allied for Essential Medicines in the United Kingdom has told University World News.
In an e-mail exchange following a commentary she wrote in BMJ Global Health she said: “African universities can hold universities in the Global North to account by actively voicing their concern about the way universities are currently contributing to preventable deaths and suffering when they fail to challenge the status quo of a biomedical innovation system that denies access to life-saving treatments for millions.”
Keestra’s commentary in the open access online journal is titled, ‘Structural violence and the biomedical innovation system: What responsibility do universities have in ensuring access to health technologies?’
She said that, when African universities engage in global collaboration on health research, they could be more vocal about the downstream access implications of these partnerships.
“For example, the University of the Witwatersrand [in South Africa] runs the clinical trials of the Oxford vaccines (ChAdOx1 nCoV-19 vaccine) in South Africa, but has, to my knowledge, not been expressing any opinion towards the fact that, despite running these trials, which included 2,000 volunteers, South Africa reportedly is paying more per vaccine dose than the European Union,” she said.
In response, the University of the Witwatersrand (Wits) highlighted the role of higher education researchers versus that of governments.
Professor Lynn Morris, the deputy vice-chancellor of research and innovation at Wits, said there is a misconception that clinical trial investigators should negotiate access to vaccines as part of the terms of conducting studies.
“There is almost no incentive or need for companies to conduct clinical trials and studies in Africa when they can do these in their comfort zones – this is evident by the failure of even the World Health Organization to ensure that vaccine studies are conducted in other African countries,” said Morris.
Professor Shabir Madhi, the dean of the faculty of health sciences and director of the vaccines and infectious diseases analytics research unit at Wits, echoed Morris’ statement, saying it is the responsibility of government to leverage the fact that vaccine studies are being done in South Africa at all, and to negotiate access to these vaccines to avoid vaccine nationalism.
“It is unknown whether the South African government has leveraged the opportunity to engage with the manufacturers of the two COVID-19 vaccines being evaluated by Wits University. Rather, [the] government has decided not to pursue the use of the AstraZeneca vaccine, and also has indicated it does not plan to use the Novavax vaccine, despite the latter showing 100% protection against severe Covid-19.
“The investigators in the trials cannot be held responsible for decisions made by government which is entrusted to ensure vaccination of the population,” Madhi told University World News in an e-mail response to Keestra’s commentary.
Equitable technology transfer
But Keestra also focused on the role of policy-makers.
Although stating that African universities can be at the forefront of implementing equitable technology transfer themselves to provide an example to their European and North-American counterparts, she adds that policy-makers should ensure that they create the right conditions for universities to be able to apply equitable technology transfer practices.
Also, they [policy-makers] have the ability to support important initiatives such as the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver on COVID-19 health technologies or the C-TAP, which are also challenging the status quo of an unjust biomedical innovation system based on exclusive intellectual property rights, she noted.
“Another way in which policy-makers can make a difference is by attaching access conditions to public funding, which ensures that equitable technology transfer practices are implemented downstream by universities.
“Policy-makers thereby play an important role in ensuring that the public receives an appropriate return on public investment into biomedical research and development,” Keestra said.
Conceptualising ‘structural violence’
Explaining the rationale behind the commentary, she said the idea on how to apply the concept of structural violence to the biomedical innovation system developed in 2018 while she was studying for a masters degree in medical anthropology at Durham University, UK.
Keestra said she continued working on the issue while based at the school of anthropology and museum ethnography at the University of Oxford and now at the London School of Hygiene and Tropical Medicine. She wanted to expand on the argument and see how it could be applied to different case studies of health technologies developed at universities.
“Given the urgency of the COVID-19 pandemic, I ultimately chose to use the Oxford-AstraZeneca vaccine as a case study, partially as this was a health technology developed at the institution [where] I was working at the time.
“I felt personally invested in the decisions my university was making in the commercialisation of research developed from my colleagues’ work,” she added.
Universities should serve the public
Keestra said the COVID-19 pandemic has shown that universities play a central role in health innovation, adding that, “the University of Oxford developed one of the first and leading vaccines, and many other SARS-CoV-2 related health technologies have originated in university laboratories.
“Given that universities are largely funded by public investment, and they usually state that their purpose is to disseminate knowledge that serves the needs of the public, I would argue that universities have a special responsibility during technology transfer to ensure that no pricing monopolies and access barriers are created during technology transfer.”
She said universities occupy a unique position in the innovation ecosystem between upstream research and development, which is often publicly funded, and downstream commercialisation by the private sector.
“Universities’ decisions on the conditions of technology transfer are an opportunity to resist the status quo of a system that is causing a global tragedy of preventable deaths by prioritising profits over health,” she said.
Keestra said that, whenever novel health technologies become available to only a segment of global society, the health gap between the affluent and the poor widens, adding that, “by taking part in inequitable technology transfer practices that perpetuate the existence of an inequitable intellectual property system, universities are complicit in violations of human rights.”
She said the dissemination of university research should be rooted in the concept of global health equity, which envisions a needs-based approach to health and well-being of humanity rather than one based on economic and social privileges.
By attaching access-oriented clauses to contracts during the technology transfer process, Keestra said, universities can do their part in promoting a more just biomedical innovation system.
“Universities can apply equitable technology transfer practices such as non-exclusive, royalty-free licensing of biomedical innovations to promote access to health technologies, ensuring that all members of the global public can enjoy the fruits of scientific progress,” she added.
AstraZeneca
Keestra argued that, based on the University of Oxford’s deal with AstraZeneca as an example, despite its affordable pricing compared to other vaccines, by making an exclusive deal with a pharmaceutical company like AstraZeneca, Oxford transferred to the private sector the power over knowledge dissemination of a technology largely developed using government and charitable funding.
“Oxford could have considered alternative modes of technology transfer that promote affordable access such as non-exclusive licensing to multiple pharmaceutical companies in low- and middle-income countries (LMICs), or putting the intellectual property and associated know-how into the World Health Organization’s LMICs COVID-19 Technology Access Pool,” she said.
Keestra said the technology transfer process around the ChAdOx1 nCoV-19 vaccine should, therefore, have been done more equitably and transparently, with Oxford retaining the power to put its commitments towards inclusive knowledge dissemination into practice to prevent inequalities in vaccine access arising, especially post-pandemic when affordable pricing conditions may no longer apply but the need for an affordable COVID-19 vaccine persists.
University World News approached the University of Oxford to reply to the commentary, but had not received feedback at the time of publication.
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