On 10 July, Dr Abraham Sokhaya Nkomo died of Covid-19 in Pretoria, South Africa. Abe Nkomo, as he was popularly known, was a giant of South African public life: a physician, an anti-apartheid organiser, a member of parliament, a diplomat and a longtime public health activist.
He received his first dose of the Pfizer vaccine on 9 June. On 24 June, his family noticed he had developed flu-like symptoms, and moved him to a hospital after he tested positive for Covid. At first, he seemed to be beating the infection. Soon, however, his oxygen levels dropped, and he needed a ventilator. He was then shifted into ICU, where his condition declined rapidly.
In the weeks leading up to his death, thousands of miles away, his youngest son, Marumo Nkomo, a councillor at the South African Mission in Geneva, was in frenzied talks at the World Trade Organization. As the trade representative for his country, Nkomo and his boss – the head of the mission, Xolelwa Mlumbi-Peter – were pushing the WTO to endorse a global waiver of pharmaceutical monopolies so that poor countries around the world could produce the vaccines they need. (Less than 3% of the African continent has been vaccinated to date, because rich countries have bought up and hoarded nearly the entire global supply). As his father’s condition deteriorated, Nkomo made the decision to fly home. Ten minutes after his plane touched down in Johannesburg, his brother called to tell him their father had died.
The story of the Nkomos lays bare the cruelty of this moment. As the richest countries on Earth (and the corporations domiciled within them) lock horns with some of the poorest, the ensuing standoff is taking an intensely personal toll.
“Dr Abe Nkomo was a slight man who was a giant in the hearts of people living with HIV,” Zackie Achmat, the legendary South African activist, told us. Achmat, who founded the Treatment Action Campaign and ignited a global movement against pharmaceutical monopolies on Aids medicines in the early 2000s, said that when Dr Nkomo ran the South African parliament’s health committee he had offered crucial support. “He fought for our access to medicines and championed legislative changes in the late 1990s that gave us the right to live. He fought against pharmaceutical industry profiteering. He understood the emergency we were in.”
Dr Nkomo was in good health and remained active until the very end of his life. He navigated the pandemic cautiously, avoiding large events, except once, when he travelled to Johannesburg for the funeral of his brother, who also died from Covid-19. Had he lived in the UK, the US, or Germany, Nkomo, who was 80, could have been fully vaccinated by January. Had he lived in India, he could have been vaccinated by March, in time for the onslaught of the Delta variant. Instead, because he lived in South Africa, he received his first dose in June – and did not live to get his second. “Every time I open my Facebook page, I learn that at least three or four people I know have died of Covid,” Achmat said. “It pains me that Dr Abe Nkomo, who did so much for public health in this country, did not get his vaccine in time.”
When South Africa and India proposed a waiver of pharmaceutical monopolies at the WTO in October 2020, it was to avoid exactly the situation we’re now in. Vaccines are in short supply owing to corporate monopolies that restrict who can make them, while existing supplies have been largely bought up by rich countries. The resulting global shortage is leading to deaths in poor countries that were wholly avoidable. Every rich country was initially against the waiver when it was first proposed, including the US government, then led by President Trump.
Never mind that a majority of the world’s population wanted the waiver. As long as rich countries opposed it, the WTO – which works on a consensus model in which every single member country must agree for a proposal to move forward – could not even begin discussing it. Never mind too that vaccinating more people everywhere is also good for people in rich countries. The less virus circulating, the lower its chances to mutate or evolve.
In May this year, the US government changed course and announced its support for a waiver, effectively giving the proposal a chance to live. It was a welcome move, but the euphoria was fleeting. The UK has continued to object, as has Switzerland and the EU, where Germany’s opposition has been particularly loud. “The opposition to our proposal is mainly ideological,” Mlumbi-Peter told us. When her office put forward the proposal last October, she was working with Mustaqeem de Gama, the former South African trade representative who Marumo Nkomo replaced this year. “But what we had in mind was to save peoples’ lives. If we were ideological, we would not be negotiating. We are prepared to compromise, but not to the extent that we end up with something that is meaningless. Our goal is to unlock global production.”
Unlocking global production has taken on a new urgency. Until recently, one theory was that western pharmaceutical companies would be finished with supplying rich countries soon, and could then concentrate on poor countries in the coming year. That theory imploded when rich countries authorised booster shots for some of their populations in the last few weeks – effectively delaying a first dose for the majority of the world in order to administer a third dose to a minority who are already vaccinated.
This week, the WTO will reopen for business after its customary summer holiday. Discussions on the waiver of pharmaceutical monopolies will begin immediately. Mlumbi-Peter is clear about what needs to happen. She wants the WTO to urgently formulate a response appropriate for the emergency we are in. “There has been no real engagement,” she says. “We need an actual text-based negotiation. We need a clear political message from the US saying they want to see an outcome; we don’t see the EU moving without the US. That would help us create a credible WTO response to Covid-19.”
As things stand, the burden of lifting global monopolies on coronavirus vaccines rests largely on Mlumbi-Peter and Marumo Nkomo’s shoulders. They have worked through devastating personal losses and professional hostility with an unflappable persistence. When – and if – they win, it will be too late to save the loved ones they have already lost in the pandemic. But it will still be in time for the rest of the unvaccinated world.
Achal Prabhala is the coordinator of the AccessIBSA project, which campaigns for access to medicines in India, Brazil and South Africa. Chelsea Clinton is an adjunct associate professor at Columbia University’s Mailman School of Public Health and the vice chair of the Clinton Foundation in New York City
