We did not expect innovative proposals, but we did expect a little more breath of change. Well.... there was no breath. Worse still, in its place there were strong ugly winds.

1.First, the Declaration never, not even once, refers to the 'universal right to health'. It does not mention it, confirming what the dominant groups have been doing for years: erasing it from the world political agenda and with it the principle that guaranteeing health universally, i.e. for all, is an institutional obligation for the public authorities, the states, and not a political option of magnanimity or compassion towards 'the poor' on the part of world leaders. Conversely, the Declaration speaks several times of "equitable and affordable access" to the tools for combating Covid-19 pandemic (vaccines, medical treatments, diagnostics and individual protection tools). In other words, a typically mercantile principle and objective, of monetised exchange (sale and purchase) according to market rules that have nothing to do with the right to health in equality and justice. In the market there are no rights, except for private property, no social justice. Forgetting the universal right to health is an act of political indecency. 

2. Not surprisingly - another key aspect - the Declaration insists that the necessary steps that will be taken in the coming months to promote access to vaccines for all, must be defined and taken in the framework of the WTO Treaties (World Trade Organization, an independent body from the UN) and, in particular, of the WTO-TRIPs (Trade-Related Intellectual Property Rights) treaties. And not within the general framework of the UN and specifically the World Health Organisation (WHO, a UN agency). The Declaration of Rome remains entrenched in the primacy given, also in the field of health, to the "world" regulation fixed in the logic of inter-national trade (dominated by the merchants and financiers of the most powerful countries in the world). The Rome Declaration remains on the position of refusing to attribute this primacy to the UN in general, and to the WHO in particular, as requested, especially in recent years, by 100 or more states, hundreds of Nobel Prize winners, scientists, personalities from the world of culture and thousands of associations and organisations, including trade unions. The acceptance of the primacy of the UN and the WHO implies that the rules on this matter will be established in compliance with the Universal Declaration of Human Rights of 1948 and the international treaties on civil, social and political rights of the 1970s.  The signatories of the Rome Declaration are well aware that since 1994, the year of its creation, the WTO has been the scene of continuous hard struggles by the vast majority of member states against the most powerful states to defend their rights to life and their economic and social sovereignty, which have been systematically dismissed in the WTO treaties.

3. Therefore, claiming that the objective of the global fight against the pandemic pursued by the most powerful states of the G20 remains that of “leaving no one aside” is an act of hypocrisy. The reality Shows that the strategy to combat the pandemic, which was adopted a year and a half ago in the name of fair and affordable access to vaccines and in compliance with the WTO/TRIPs treaties, has helped to sideline hundreds of millions of people who, as of 21 May 202, are excluded from vaccines (only 1% of the African population has been vaccinated) and, above all, from health care in general. According to the WHO, more than half of the world's population is still without basic health coverage in 2020, and the pandemic has made the situation worse.

4. The Declaration confirms that, today, the key solution chosen by those in power is to increase the production of vaccines and to distribute and administer them as widely as possible, as quickly as possible and on an equitable, safe and efficient basis, for the benefit of the populations of the poorest low-income countries (92 countries in the world) and middle-income countries (more than 30). This apparently reasonable choice is a mystifying and unacceptable choice because it postulates the acceptance and the maintenance of the gulf and the inequalities between the rich and 'developed' countries of the North, particularly the 'West', and the poor, underdeveloped or less developed countries. Prioritising on production and distribution of vaccines substantially means to maintain the structural supremacy and power of the rich countries in the financial, technoscientific, productive and commercial fields. It means that private companies from the developed world remain the absolute owners of knowledge about life, the owners of patents, the producers of vaccines, the leaders of international trade, the providers of medical and health services, the controllers of health markets, the masters of the digitalisation of health systems...  So, In the spirit of the Rome Declaration the best practical solution is that the rich countries (continue to) “help” the poor countries. In this context, the life of billions of people and their future is obligatorily depending, and will depend, on aid, “charity” and benevolence from the rich and the powerful. What an indecent and cynical conception! Let’ give one good example. At the last meeting of the general council of WTO-TRIPs the representative of the USA said that Biden Administration is open “now that the full access to vaccines has been ensured for the American citizens” to consider means and ways to lifting WTO rules on intellectual property right with the aim to foster affordable access to vaccines to all peoples in need. To sum upon on this point, all that remains for the poor countries is waiting for receiving vaccines and access to the other medical tools offered by the rich countries. To this end, however, they must be recognised by COVAX as eligible for assistance from the rich. COVAX is the mechanism set up by the countries of the “North”, run by two public-private organisations, CEPI and GAVI, whose aim is to encourage the sharing of research and development and the purchase/distribution of vaccines for the benefit of poor countries.  Bought vaccines are transferred as free aid to the populations of low-income countries, and as reduced-price aid to those of middle-income countries.

The COVAX mechanism has proved unsuitable for two main reasons. Firstly, because rich countries and private philanthropic bodies such as the Gates foundation have not fed COVAX finances as expected. To do well, COVAX would need more than $40 billion. They have received only $12 billion. Secondly, COVAX is based on the maintenance of the patent system that makes vaccines and medical devices absolute private property for 20 years, thus giving -as we have seen - political decision-making and operational power over life and health to private multinational companies. COVAX has no political power, no autonomous power of negotiation and decision. It depends on the good will of pharmaceutical oligopolies and of the strongest States.

5. This brings us to the controversial point concerning the provisional suspension of patents. This was the most anticipated point of the G20 Global Health Summit. The G20 formally opted not to decide and to postpone the debate to the 7-9 June meeting of the WTO General Council. In fact, the postponement was necessary not because of disagreement between some states (such as South Africa, India, Russia, Indonesia and China...) on the one hand, and the EU, the UK, the US, Japan, on the other. But to give the EU and the US time to agree on a common position based, as proposed by the EU, on a third way solution between rejecting and approving the suspension. The European Union is overwhelmingly opposed to suspending the patent regime and even more so to abolishing it. It therefore seeks to overcome the difficulties by shifting the debate to the definition of a new global treaty on common global monitoring and response system to current and future pandemics. The present system has admittedly demonstrated its weakness and inefficiency. In the mind of the European Union leaders, the new treaty could adopt a model of common monitoring and responses system closer to the intra-European coordination system set up in the context of the recent creation of the European Health Union.

This is also the position Mario Draghi seems to be taking. During his initial Summit speech he expressed his support for a suspension of patents "on condition that it is targeted and limited in time". The same applies to the US position, as expressed in Rome by the US Vice-President Kamala Harris  (who was a little disappointing). Among the members of the G20, only South Africa has a clear position on ensuring the health of its citizens and other African countries. India is rather ambiguous. In Modi's ultra-nationalist and competitive strategy, the suspension rather serves the objective of reinforcing India's growing role as the world's leading producer of low-cost vaccines through the private enterprise Serum Institute of India. This strategy has the support of Oxford University and Astra Zeneca, which last year signed a deal for more than 1.2 billion doses of its vaccine to be produced by the Serum Institute of India. India has a strategy of economic expansion in the sector to compete with China. For its part, Indonesia, another member of the G20, has made clear its desire, thanks to the reduction of patent constraints, to become the main hub of South East Asia, in competition with China and India.

In short, not all that glitters is gold outside the North/Western countries when it comes to economic strategy in the global pharmaceutical industry.

6. The state of art above described will perpetuate until the public authorities of the most powerful countries in the world have dissociated and liberated themselves and their public health policy from the state of subservience to their big multinational pharmaceutical and chemical companies and financial groups, following the massive privatisation of national health systems and the legalisation of private patenting for profit. The Rome Declaration did not write a single line about the subservience of the public powers. And pour cause. As everyone knows, the public authorities have practically financed in toto (the case of the Astra Zeneca vaccine,) and in large part (the case of Pfizer, Moderna, Johnson & Johnson vaccines, ...) the design, development, production and marketing of vaccines. If there are vaccines, this is not thanks to the companies mentioned but to the large sums of public money injected by the States in the sector (we are talking about tens and tens of billions of dollars), through many ways, including the decisive one of the "Advanced Market Commitments", i.e. the guaranteed commitments of public purchase of billions of doses produced by companies.

The scandal here is that the companies have pocketed everything and, without any major investment, have already made billions in profits to distribute to their shareholders, without the states, the citizens whose public money has been poured into the coffers of the multinational companies, having obtained any direct financial benefit in return. The states have spent and continue to spend and the companies continue to make profits.

In this context, the sovereignty of the people, of the citizens, is reduced to zero. Hypocrisy, cynicism and indecency prevail.

In conclusion, again after the G20 Global Health Summit, it is clear that the future of the realisation of the universal right to health and the future of the earth life is not yet on track in the interests of all the earth's inhabitants and in harmony with respect for the rights of nature.

- Riccardo Petrella, Roberto Morea and Roberto Musacchio, respectively president of Agora of the Earth’s Inhabitants, president of Transform.Italia, former MEP and member of Transform.Italia