13th April 2021 

Dr. Ngozi Okonjo-Iweala Director General World Trade Organization 

cc. Dr. Tedros Adhanom Ghebreyesus Director General World Health Organization cc. Members of the WTO 

Dear Dr. Ngozi, 

We congratulate you on your election as the Director General of the World Trade Organization. Civil society organizations signed on to this letter are encouraged that you would like to contribute to addressing the global challenges of inadequate supply and inequitable access to COVID-19 medical products, especially vaccines. However, we would also like to express our concern over the emphasis on industry-controlled bilateral agreements as the primary approach to addressing global production constraints and supply shortages. We note that some WTO Members have submitted WT/GC/230i . While the objective of this proposal may be well-intended, the proposed approach is also mainly centred on bilateral agreements controlled by corporate rightsholders. The same strategy has already been used by the pharmaceutical industry for the past year, including the oft-cited Oxford/AstraZeneca agreement with the Serum Institute of India. There is considerable experience on the constraints such agreements put on local production and equitable worldwide access to life-saving pharmaceuticals. Bilateral agreements that have been signed to date contain restrictive terms and conditions that reinforce vertical control of technology-holding companies, artificially limit production and supply to constrain global supply options and are mostly un-transparent with governments and the public learning about the limits imposed post-facto, if ever. For instance, Astra Zeneca almost entirely relies on one manufacturer in India, which it has licensed, for the supply of its vaccine to low and middle income countries including the COVAX Facility, and consequently billions of people are now primarily dependent upon the vaccine supplies from one company in India. 

Most of the existing bilateral agreements to produce COVID-19 vaccines are contract manufacturing agreements through which the contracted entity manufactures on behalf of a licensor that maintains full control over the use of its technology, the volume of production and where and at what prices vaccines may be supplied. Although contractors may help ease some production pressure in the short term, the model cannot guarantee sustainability because contractors have no legal rights to independently produce and supply the concerned technologies worldwide. We have also observed from publicly available information that in some agreements the technology holder maintains control over the vaccine component and prevents the licensee from manufacturing the vaccine component, hence creating dependency on the technology holder for the supply of the vaccine component, while others contain territorial restrictions . 

These agreements also depend on the “willingness” of the technology holder to license at all and as such are failing to mobilise global manufacturing capacity and diversifying supply options, on transparent terms that prioritize boosting global supply of the vaccine components and the final product. For instance, Moderna and Pfizer have yet to enter into license agreements with developing country manufacturers allowing for technology transfer and manufacture to supply developing countries. We recall that early on in the pandemic the World Health Organization (WHO) launched the COVID19-Technology Access Pool (C-TAP) initiative calling on pharmaceutical companies to commit to transparent non-exclusive global voluntary licensing. However, this initiative has been rejected by the global biopharmaceutical companies. The voluntary bilateral contracting approach is the preferred choice of pharmaceutical corporations holding the technology for it allows them to control production and supply to markets, which they consider lucrative for their future profits. An example of this expectation of future profits is Pfizer‘s stated intention to shift some production to manufacturing booster doses for rich countries even while some low and middle income countries have not had an initial vaccine and to raise its vaccine price to an estimate $150-175 per dose in what it considers the post-acute-pandemic phase.

 We understand your recent call, alongside other proposals, for a “Third Way” that entails once again appealing to pharmaceutical corporations to take voluntary actions. As elaborated above, we sincerely raise your attention to the inherent limitations of being dependent on corporations' voluntary measures that have been proven to be insufficient in this pandemic. The world is in a state of a global health emergency, where societies, economies, and livelihoods worldwide are in a dire situation. And most pharmaceutical companies have benefitted from large amount of public funds invested in R&D, trials and spent on procurement, with little to no accountability and conditions attached to guarantee access. For instance, Pfizer and Moderna are expecting vaccine revenue of between $15-30 billion in 2021.vii It is time to realize governments' core and collective responsibility to collaborate and address monopolies on technologies concretely. 

We believe that the way forward should be to remove barriers towards the development, production and approval of vaccines, therapeutics and other medical technologies necessary for the prevention, containment and treatment of the COVID-19 pandemic, so that more manufacturers, especially from developing countries, may independently contribute to the global supply. Global supply should not be dependent on the purely commercial prerogatives and exclusive rights of pharmaceutical companies holding the technology. There is simply too much at stake. In the context of WTO, temporarily waiving relevant intellectual property rules that reinforce monopolies, is an important contribution that the WTO as a rule-based multilateral institution can make on this matter in the pandemic, alongside reaffirming and supporting the full use of existing public-health-safeguarding flexibilities of the TRIPs agreement. Voluntary licensing, if pursued, should treat vaccine as a global public good, be open and allow for transparent global non-exclusive licenses with worldwide coverage of supply, and left to the WHO that has established C-TAP for this purpose. 

We look forward to further engagement and discussions on this matter. 

Signatories (updated as at 14 April) Global 1. Amnesty International 2. AVAC 3. Casa Generalizia della Societa del Sacro Cuore 4. Congregation De Notre-Dame 5. Congregation of the Mission 6. Development Alternatives with Women for a New Era (DAWN) 7. EqualHealth Global Campaign Against Racism 8. Fondation Eboko 9. Health Alliance International 10. Health Action International 11. Health GAP 12. IndustriALL Global Union 13. International Network of Religious Leaders living with or personally affected by HIV and AIDS 14. International Presentation Association 15. International Treatment Preparedness Coalition (ITPC) 16. LDC Watch 17. Médecins du Monde 18. Médecins Sans Frontières (MSF) Access Campaign 19. Oxfam International 20. Passionists International 21. People's Vaccine Alliance 22. Reality of Aid Network 23. Regions Refocus 24. Sisters of Notre Dame de Namur 25. Social Justice and Ecology Secretariat, Society of Jesus 26. Social Watch 27. Society for international Development (SID) 28. Vaccine Advocacy Resource Group (VARG) 29. Yolse, Santé Publique et Innovation Regional 30. AIDS and Rights Alliance in Southern Africa (ARASA) 31. African Alliance 32. Arab NGO Network for Development (ANND) 33. Asia Pacific Network of People Living with HIV (APN+) 34. Asian Indigenous Women's Network (AIWN) 35. Corporate Europe Observatory 36. Focus on the Global South 37. Health Action International Asia Pacific 38. International Treatment Preparedness Coalition (ITPCru), (Eastern Europe & Central Asia) 39. International Treatment Preparedness Coalition Latin America and The Caribbean 40. International Treatment Preparedness Coalition ITPC-MENA, (Middle-East & North Africa) 41. Jesuitenmission Germany & Austria 42. Pacific Network on Globalisation 43. Project Organising Development Education and Research (PODER) 44. Red Latino Americana por el Acceso a Medicamentos (RedLAM) 45. South Asia Alliance for Poverty Eradication 46. Southern African Programme on Access to Medicines and Diagnostics 47. Third World Network-Africa (TWN-Africa) 48. Universities Allied for Essential Medicines Europe (UAEM) National 49. Access to Medicines Research Group, China 50. Acción Internacional para la Salud, Peru 51. Action against AIDS, Germany 52. ActionAid Australia 53. Active Citizens Movement, South Africa 54. Africa Europe Faith and Justice Network (AEFJN), Belgium 55. Africa Faith and Justice Network, United States 56. Africaine de Recherche et de Coopération pour l’Appui au Développement Endogène (ARCADE), Senegal 57. Africa Japan Forum, Japan 58. Aid/Watch, Australia 59. Alboan Fundazioa, Spain 60. All India Drug Action Network, India 61. American Friends Services Committee, United States 62. Asian Health Institute, Japan 63. Asociación por un Acceso Justo al Medicamento, Spain 64. Association for International Development and Research in Sustainability, Malaysia 65. Association For Promotion Sustainable Development, India 66. Association Marocain des Droits Humains, Morocco 67. Association of Concerned Africa Scholars (USA), United States 68. Association of legal entities Association of harm reduction "Partner network", Kyrgyzstan 69. ATTAC Hungary Association, Hungary 70. Auckland Peace Action, New Zealand 71. Australian Arts Trust / Music Trust, Australia 72. Australian Council for International Development, Australia 73. Australian Council of Trade Unions, Australia 74. Australian Fair Trade and Investment Network, Australia 75. Balance Promoción para el Desarrollo y Juventud AC, Mexico 76. Balay Alternative Legal Advocates for Development in Mindanaw, Inc., Philippines 77. Belgian Lung and Tuberculosis Association, Belgium 78. Belong Aotearoa (Formerly known as Auckland Regional Migrant Services Charitable Trust - ARMS), New Zealand 79. Both ENDS, The Netherlands 80. Brazilian Federation of Library Association and Institution – FEBAB, Brazil 81. Brazilian Interdisciplinary Aids Association, Brazil 82. Bread for the World, Germany 83. Building Inclusive Society Tanzania Organization (BISTO), Tanzania 84. BUKO Pharma-Kampagne, Germany 85. Campaign for Access to Medicines-India 86. Canadian Centre for Policy Alternatives, Canada 87. Canadian Coalition for Global Health Research, Canada 88. Canadian Jesuits International (CJI), Canada 89. Canadian Society for International Health, Canada 90. Cancer Alliance, South Africa, South Africa 91. Cancer Patients Aid Association, India 92. Center for Accountability and Inclusive Development (CAAID), Nigeria 93. Center for International Policy, United States 94. Center for Peace Education and Community Development, Nigeria 95. Centre Europe- Tiers Monde (CETIM), Switzerland 96. Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa 97. Charitable organization "100 Percent Life", Ukraine 98. Christian Education and Development Organization (CEDO), Tanzania 99. Citizens Trade Campaign, United States 100. Citizens' Health Initiative, Malaysia 101. Coalition for Health Promotion and Social Development (HEPS) Uganda 102. Coalition for Research and Action for Social Justice and Human Dignity, Finland 103. Coalition of Women Living with HIV and AIDS, Malawi 104. Coletivo Mangueiras, Brazil 105. Columban Center for Advocacy and Outreach, United States 106. Consorcio para el Diálogo Parlamentario MX, Mexico 107. Consumer Association the Quality of Life, Greece 108. Consumers' Association of Penang, Malaysia 109. Crisis Home, Malaysia 110. Delhi Network of Positive People, India 111. Diverse Women for Diversity, India 112. Drug Action Forum-Karnataka, India 113. Dua'a Qurie, Palestinian NGO Network, Palestine 114. Ecologistas en Acción, Spain 115. Equal Health and Medical Access on COVID-19 for All! Japan Network, Japan 116. Edmund Rice International, United States 117. Equidad de Género: Ciudadanía, Trabajo y Familia, Mexico 118. Fair World Project, United States 119. Fairwatch Italy, Italy 120. Federation of Democratic Labour Unions, Mauritius 121. Food Sovereignty Alliance, India 122. Fórum Nacional de Prevenção e Erradicação do Trabalho Infantil – FNPETI, Brazil 123. Foundation for Research in Science Technology and Ecology, India 124. Freshwater Action Network Mexico, Mexico 125. Fundación Arcoíris por el respeto a la diversidad sexual, Mexico 126. Fundación Entreculturas-Fe y Alegría España, Spain 127. Fundación Grupo Efecto Positivo, Argentina 128. Fundación IFARMA, Colombia 129. Fundación Mexicana para la Planeación Familiar, A. C. MEXFAM, Mexico 130. Fundación Salud por Derecho, Spain 131. Gandhi Development Trust, South Africa 132. Gestos (soropositividade, comunicação, gênero), Brazil 133. Global Health Advocates / Action Santé Mondiale, France 134. Global Humanitarian Progress Corporation, Colombia 135. Global Justice Now, United Kingdom 136. Grandmothers Advocacy Network, Canada 137. Green Without Borders, Kenya 138. Groupe d'Action, de Paix et de Formation pour la Transformation (GAPAFOT), Central African Republic 139. Grupo de Incentivo à Vida (GIV), Brazil 140. Handelskampanjen, Norway 141. Health Justice Initiative, South Africa 142. Health Equity Initiatives, Malaysia 143. HIV Legal Network, Canada 144. Human Rights Research Documentation Center (HURIC), Uganda 145. Ignation Solidarity Network, United States 146. Indian Social Action Forum (INSAF), India 147. Indonesia AIDS Coalition, Indonesia 148. Indonesia for Global Justice, Indonesia 149. Initiative for Health & Equity in Society, India 150. Instituto Cidades Sustentaveis, Brazil 151. International Treatment Preparedness Coalition-South Asia, India 152. International Women's Rights Action Watch Asia Pacific (IWRAW Asia Pacific), Malaysia 153. IT for Change, India 154. It's Our Future, New Zealand 155. Jan Swasthya Abhiyan (JSA) Rajasthan/Prayas, India 156. Jesuit Conference of Africa and Madagascar, Kenya 157. Jesuit Justice and Ecology Network Africa, Kenya 158. Jesuit Missions, United Kingdom 159. Just Treatment, United Kingdom 160. Justice is Global, United States 161. Kenya Legal & Ethical Issues Network on HIV & AIDS, Kenya 162. Knowledge Commune, Republic of Korea 163. Korean Pharmacists for Democratic Society, Republic of Korea 164. Lawyers Collective, India 165. Life Concern, Malawi 166. Little Sisters of the Assumption, United States 167. Madhyam, India 168. Malaysian AIDS Council (MAC), Malaysia 169. Maritime Union of Australia Victoria Branch, Australia 170. Mauritius Trade Union Congress, Mauritius 171. Médecins sans Frontière, Japan 172. Medical Action Group, Philippines 173. Medical Mission Institute Würzburg, Germany 174. Medico International, Germany 175. Médicos sin marca Colombia, Colombia 176. Migration and Sustainable Development Alliance, Mauritius 177. Milwaukee Fair Trade Coalition, United States 178. MISEREOR Germany, Germany 179. Missionary Society of St Columban, Australia 180. MY World Mexico, Mexico 181. National Campaign for Sustainable Development Nepal, Nepal 182. Nelson Mandela TB HIV Community Information and Resource Center CBO Kisumu Kenya 183. NETWORK Lobby for Catholic Social Justice, United States 184. New South Wales Retired Teachers' Association, Australia 185. New Zealand Alternative, New Zealand 186. NGO Federation of Nepal, Nepal 187. Nigerian Women Agro Allied Farmers Association, Nigeria 188. Observatoire de la transparence dans les politiques du médicament, France 189. ONG Positive Initiative, Republic of Moldova 190. Oxfam New Zealand, New Zealand 191. Pacific Asia Resource Center (PARC), Japan 192. Pakistan Fisherfolk Forum, Pakistan 193. Passionist Center-Justice, Peace and Integrity of Creation, Inc., Philippines 194. People PLUS, Belarus 195. People's Health Forum, Malaysia 196. People's Health Movement Canada, Canada 197. People's Health Movement (PHM) - Japan Circle, Japan 198. People's Health Movement Nepal, Nepal 199. People's Health Movement Uganda (PHMUGA), Uganda 200. People's Health Movement South Africa, South Africa 201. Pertubuhan Kebajikan Intan Zon Kehidupan, Malaysia 202. Philippine Alliance of Human Rights Advocates (PAHRA), Philippines 203. Philippine Human Rights Information Center (PhilRights), Philippines 204. Phoenix Settlement Trust, South Africa 205. Positive Malaysian Treatment Access & Advocacy Group (MTAAG+), Malaysia 206. Public Citizen, United States 207. Public Eye, Switzerland 208. Public Health Association of Australia, Australia 209. Public Health Research Society Nepal, Nepal 210. Red Argentina de Personas Positivas (Redar Positiva), Argentina 211. Red de Acceso a Medicamentos, Guatemala 212. Réseau québécois sur l'intégration continentale (RQIC), Canada, Quebec 213. Rural infrastructure and human resources development organisations, Kpk, Pakistan 214. Salesian Missions, Inc. United States 215. Salud y Farmacos, United States 216. Sankalp Rehabilitation Trust, India 217. Save the Children South Africa 218. SEATINI-Uganda 219. SECTION27, South Africa 220. Sentro ng mga Nagkakaisa at Progresibong Manggagawa (SENTRO), Philippines 221. SHARE, Japan 222. Sisters of Charity Federation, United States 223. Social Development Through Community Action (SODECA), Kenya 224. Social Watch Philippines-Alternative Budget Initiative Health Cluster, Philippines 225. Southern and East African Trade and Negotiations Institute - South Africa 226. Southern African Programme on Access to Medicines and Diagnostics (SAPAM), South Africa 227. Students for Global Health, United Kingdom 228. SWP-ABI Health Cluster, Philippines 229. Tebtebba (Indigenous Peoples' International Centre for Policy Research and Education), Philippines 230. Terra Nuova, Italy 231. Third World Network, Malaysia 232. Trade Collective, South Africa 233. Trade Justice Network- Canada 234. Trade Justice PEI, Canada 235. Trade Justice Pilipinas, Philippines 236. Trade Justice Prince Edward Island, Canada 237. Transnational Institute, The Netherlands 238. Treatment Action Group, United States 239. UDK Consultancy, Malawi 240. UNANIMA International, United States 241. UnionsWA, Australia 242. Universities Allied for Essential Medicines UK, United Kingdom 243. War on Want, United Kingdom 244. Washington Biotechnology Action Council, United States 245. Watch Democracy Grow, United States 246. Women's Coalition Against Cancer – WOCACA, Malawi 247. WomanHealth Philippines 248. Women’s Probono Initiative, Uganda 249. Youth and Small Holder Farmers, Nigeria 250. Zimbabwe National Network of PLHIV (ZNNP+), Zimbabwe