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Roojin Habibi is a research fellow and PhD student at York University’s Global Strategy Lab and Osgoode Hall Law School. Uchechukwu Ngwaba is an assistant professor at Ryerson University’s Lincoln Alexander School of Law. Obiora Chinedu Okafor is the Edward B. Burling Chair in International Law and Institutions at Johns Hopkins University. Sanjay Ruparelia is the Jarislowsky Democracy Chair at Ryerson University.

On Jan. 10, Ngozi Okonjo-Iweala, the director-general of the World Trade Organization (WTO), urged member states “to fully contribute to the global efforts in the fight against COVID-19″ by reaching a multilateral outcome on intellectual property issues. This comes as a year-old proposal to temporarily waive intellectual property barriers to scaling up the manufacturing of tests, vaccines and treatments continues to languish, despite the endorsement of more than 100 countries (but not Canada).

Ms. Okonjo-Iweala’s call followed a historic special session of the World Health Assembly just the month prior, on the heels of World AIDS Day, where countries launched negotiations toward a new international global health accord. They declared that such a treaty should prioritize equity and be based on the “principle of solidarity with all people and countries” – core values that are neither novel nor untested in past public health emergencies.

The commemoration of humanity’s decades-long struggle to end the HIV pandemic reinforces crucial lessons for our fight against COVID-19. It was in 2001 that developing countries won the right to produce and import generic antiretroviral drugs, after a protracted legal battle between Nelson Mandela’s South African government and big pharmaceutical companies at the WTO, thanks to the mass mobilization of activists and communities across continents. Yet our “wealth-based” vaccine-distribution paradigm has once again paved the way for gross inequality in access to medical countermeasures to contain a lethal virus. Countries in the Global North continue to hoard far more COVID-19 vaccine doses than they can use, while the vast majority of people in low-income countries wait for their first shot. The very slow progress in getting doses to countries that need them the most meant that new and potentially more dangerous mutations of the virus were almost certainly in the cards.

The aggressive push to universalize booster shots in rich nations, given Omicron’s greater transmissibility, now seems inevitable. But doing so could lead to a shortfall of three billion vaccine shots in low-income countries, in which less than 10 per cent of the population has received even a single dose. The failure to establish a globally co-ordinated, needs-based vaccine production and distribution regime will continue to unnecessarily prolong the pandemic and cause far too many preventable deaths.

Part of the problem lies in the architecture of the global health regime itself. Diplomats have historically failed to reform the international rules, institutions and power dynamics that undercut global equity. From the lending policies of international financial institutions that have long subverted the health systems of developing countries, to the WTO’s rules on intellectual property, which constrain access to lifesaving medicines even during the worst pandemic in a century, root-and-branch reform is required. In failing to address these upstream determinants, the current regime institutionalizes deep inequity in health outcomes around the world.

How can we trust governments to craft and implement an effective pandemic treaty capable of defending the world against future global health threats when their actions have consistently failed to achieve the same for the past two years? To spur hope, countries must show international solidarity to solve the crisis immediately before us through effective multilateral co-operation.

The steps required to end our continuing plight are relatively clear. First, rich Western democracies must finally support the proposal to temporarily waive intellectual property rights for tests, vaccines and treatments. Second, we should ensure adequate public financing to incentivize leading producers of COVID-19 vaccines to share their production methods with counterparts in the Global South in order to scale up vaccine manufacturing across the world, and ensure reliable supply chains of necessary inputs. The IMF estimates it would cost US$50-billion to ensure sufficient manufacturing capacity exists in many countries – a fraction of the trillions spent by rich democracies to shore up their economies since the pandemic began. Finally, we must ensure that our pledged vaccine donations are shared immediately, and not when they are about to expire.

Progressive transnational mobilization by rights advocates, public-health experts and civic organizations, together with solidarity from powerful states, turned the tide in the AIDS epidemic two decades ago. We must not wait any longer to act on its fatal lessons.

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