Vaccine Nationalism And Global Equity

Introduction

This is the first of two briefs discussing issues relating to COVID-19 vaccines. This brief argues that, in order to combat COVID-19, global equity to vaccine access is necessary. However, in order to achieve this equitable distribution, vaccine nationalism as well as poor government policy and governance surrounding vaccine access will have to be overcome.

Vaccine nationalism

Currently, pharmaceutical manufacturers are not directly engaging with private companies or individuals. When these ‘governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries’ they are engaging in vaccine nationalism.[i]

The concept of vaccine nationalism accords with the division of resources between high, middle and low income countries. Many poorer nations have been left behind in the race for, and the distribution of, the COVID-19 vaccine. Middle and low income countries have experienced uncertainty about their ability to access the vaccine on the international market. However, vaccine nationalism is not responsible for the fact that many low and middle income countries have been unprepared to respond to the pandemic. This is due to broken down health systems and inefficient and corrupt management within them.

What exactly does the term ‘global equity in vaccine access’ entail?

Vaccines are private goods with strong externalities. When consumed, they provide benefits to others as well as to the persons vaccinated external benefits’.

According to the Lancet COVID-19 Commission Task Force on Public Health Measures to Suppress the Pandemic (COVID-19 Commission Task Force),

‘some variants are labelled “variants of concern” because they… can ‘re-infect’ people who already have antibodies from a previous infection and they can infect people who have already been vaccinated’.[ii]

Therefore, as long as countries only seek to protect their domestic populations, they will still be at risk from variants which develop and spread internationally. No one will be fully protected from the effects of COVID-19 in the long run, unless everyone is. There are also travel restrictions and economic impacts that affect the whole world more broadly.

A world in which vaccines are allocated according to a person’s needs instead of their income is a world in which equity is achieved. Vaccine equity should start with high-income countries supporting COVAX and other such multilateral mechanisms designed to distribute vaccines equitably, with the phasing out of bilateral deals between individual countries and pharmaceutical manufacturers. In this world, countries with excess vaccines would make them available to developing nations, and no developing country would be left without the means to acquire vaccines on their own.

It has been said that intellectual property (IP) rights should be handled in a way which would speed up production to meet global needs as soon as possible. However, as the recent development of the US Biden administration supporting the waiver of IP protections with regard to the Covid-19 vaccines has shown us – this may not be as simple as once thought. Without the required know how and capital, vaccine production will continue at the same pace. Furthermore, even if the waiver is approved, it is unlikely that this will happen before the start of 2022, as there are many hoops still to jump through. Although the waiver may be a step in the right direction, a more effective (and faster) approach may be for countries to export excess vaccines to nations who have vaccinated less than 5-10% of their populations.

In line with this manner of thinking, the WHO has issued a ‘Call to Action: Vaccine Equity Declaration’[iii] which calls on all countries to stand together in solidarity in order to ensure that health care workers and older people are vaccinated first.

The COVID-19 Vaccine Global Access Facility (COVAX)

In order to prevent unequal access to vaccines and vaccine hoarding, COVAX was established to create a ‘pooled procurement mechanism to secure adequate and equitable supplies of vaccines at competitive prices for countries throughout the world, irrespective of their wealth status’.[iv] COVAX is supported by 190 countries, and it has secured around 2 billion vaccines doses,[v] with 59 million COVID-19 vaccines shipped to 122 participating countries by 12 May 2021[vi]. In South Africa, the Ministerial Advisory Committee (MAC) on COVID-19 Vaccines has recommended that South Africa should ‘purchase sufficient vaccines for 10% of its population through the COVAX Facility’.[vii]

The COVAX facility is intended to provide vaccines for at least 50% of the world’s population. It would make price negotiations fairer and more equitable. More countries would be able to focus on vaccinating their health care workers and high risk groups. As a result, the effects of COVID-19 worldwide would not be as severe, as those who are most vulnerable to the virus would be protected.

The ACT Accelerator

Launched at the end of April 2020, the Access to COVID-19 Tools (ACT) Accelerator brings together governments, scientists, businesses, civil society, and philanthropists and global health organizations. They have joined forces to support the development and equitable distribution of the tests, treatments and vaccines the world needs to reduce mortality and severe disease. ACT also aims to restore full societal and economic activity globally in the near term, and facilitate high-level control of COVID-19 disease in the medium term.[viii]The (ACT) Accelerator has also been described as a ‘lifeline’ for lower-income countries who are not able to afford the vaccines without assistance.[ix]

In September 2020, the ACT Accelerator presented a budget estimate of USD 38.1 billion to finance its work. As of 9 April 2021, sovereign funders and private sector, philanthropic and multilateral contributors have committed USD 11.1 billion.

Constraints

The effectiveness of COVAX has been limited by the actions of high income countries, with some countries supporting it but only in theory. For example, Canada has secured 1.9 million doses of vaccines from COVAX, while already having more than five times the amount of vaccines necessary to vaccinate its own population.[x]

The threat to COVAX as well as the current status of vaccine procurement around the world was addressed by the Director General of the WHO, Tedros Adhanom Ghebreyesus. He said that many of the richer nations have begun to ‘go around COVAX, driving up prices and attempting to jump to the front of the queue’.[xi] These countries favour bilateral deals, securing enough vaccinations to vaccinate their entire populations more than once. He went on to say that ‘this could delay COVAX deliveries and create exactly the scenario COVAX was designed to avoid: hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption’.[xii]

According to Duke Global Health Innovation Centre as of 7 May 2021,

‘High-income countries currently hold a confirmed 4.9 billion doses, upper middle-income countries hold 1.5 billion doses, and lower middle-income countries hold 718 million doses, and low income countries hold 270 million’.[xiii]

The Centre reports that current models predict that there will not be enough vaccines to cover the world's population until 2023 or 2024. 

Conclusion

Vaccine hoarding will not only have negative impacts for low income countries but will only serve to ‘prolong the pandemic, the restrictions needed to contain it, and human and economic suffering’ for every nation.[xiv] If these countries were to abide by their commitments to secure vaccines through the COVAX facility, they would acquire the necessary vaccines needed for their populations as well as protect their non-vaccinated population against the revival of the virus through the rest of the world acquiring equal access too. Self-protection and equity point in the same direction.[xv]

Sophie Smit
Legal Researcher
sophie@hsg.org.za

[i] Dr Amir Khan, ‘What is ‘vaccine nationalism’ and why is it so harmful?’ Alja Zeera (07 February 2021), available here.