In the global fight against the menacing COVID-19 pandemic, discovering a viable vaccine is only going to be the tip of the iceberg. The biggest challenge, once workable vaccines get approved, will be meeting the vast and urgent need for the drugs in the face of (initially) limited supplies. Public health experts around the world have said that deciding who gets access to the vaccine in the initial stages of distribution should be fairly simple and straightforward: starting with frontline healthcare workers, followed by those most at risk and the elderly (who are highly vulnerable to the virus), and then the rest of the population. However, monetary advantage and countries’ increasingly inward-looking national strategies may mean that the vaccine becomes promptly available to only those who can afford it, rather than those who need it the most.
Experts have warned against “vaccine nationalism” to address the coronavirus crisis, arguing that it would only prolong the situation, rather than tackling the issue swiftly and effectively. Countries like the United States (US) and those in the European Union (EU) have already entered into advanced purchase agreements (APAs) with leading vaccine manufactures within their borders, wherein governments commit to buying a specific number or a certain percentage of doses of potential vaccines at a set cost if they are developed, get licensed, and gain approval for manufacturing.
However, critics have argued that focusing solely on national interest in the midst of an international crisis is not only “morally reprehensible”, but is also an ineffective way to reduce global transmission of the virus, which should be the main focus of any COVID-19 response. This is important because, if countries with a large number of cases and higher rates and transmission do not receive the vaccine on time, the disease will continue to spread and disrupt global supply chains, thereby exacting a negative toll on already vulnerable economies around the world.
While vaccine nationalism is a worrying development, it certainly isn’t an out of the ordinary response to a viral outbreak. John Nkengasong, the Director of the Africa Centres for Disease Control and Prevention, said in an interview with Science Magazine that the adverse impacts of such a narrow and personal profit-driven approach were felt in previous public health crises as well. Pointing to the antiretroviral (ARV) drug treatment for HIV, which came to the fore in 1996, he said that, though it saved many lives, it took more than seven years for the medicines to become widely accessible in Africa, which was the hardest hit continent. This was because large pharmaceutical companies (like Pfizer, for instance) with patents on the drugs were able to set prices as high as they needed to recoup their R&D investments, which meant that the cost of the medicines was as high as $10,000 per patient per year, making them completely unaffordable for poorer nations, whose populations had no health insurance and had to pay out of pocket.
Similarly, according to The Lancet, during the 2009 H1N1 influenza pandemic, more than 50% of vaccine manufacturers surveyed by the World Health Organization (WHO) were unable to commit to supplying 10% of their production to UN agencies, not only due to existing bilateral APAs with high-income countries but also because of governments restricting the export of vaccines. When western nations did finally agree to release 10% of their vaccine stocks to send to other countries, it was only after they were certain that domestic needs had been met and it was clear that the virus was not as potent as it was first thought to be.
Though hoarding potential vaccines may seem like the best way to avoid scrambling for the drugs at the last minute, it isn’t a fool-proof measure. Not all vaccines will receive approval for mass manufacturing, and nations have no prior guarantee that the ones they’ve entered into agreements with will work. Furthermore, rushing through potentially faulty vaccines could also strengthen the already deeply concerning anti-vaxx movement, which will create a whole new monster of problems of its own.
To avoid such a risk, the WHO is encouraging states—regardless of any APAs they may be a party to—to invest in the COVID-19 Vaccines Global Access (COVAX) facility, an international initiative that aims to provide equitable (and assured) access to COVID-19 vaccines, once developed, to all member countries, regardless of their purchasing power status. Coordinated by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the WHO, the facility will subsidize the drugs for lower and middle-income nations and seeks to have enough doses of COVID-19 vaccines for at least 20% of all participating countries’ populations, with a goal of 2 billion doses by the end of 2021. The COVAX effort is also appealing because it will simultaneously invest in more than a dozen vaccines, rather than just a few, thereby maximizing the chances of early access.
Though nearly 172 countries have expressed interest in joining the global effort, not all are convinced. The US announced earlier this month that it would not take part in the initiative, stressing its disdain for “multilateral organizations influenced by the corrupt World Health Organization and China”. Russia has followed suit, instead focusing on accelerating the manufacture and distribution of its home-bred “Sputnik V” vaccine, despite warnings that there wasn’t sufficient evidence to support its efficacy. Though China has said that it would support international efforts to tackle the virus, it has not yet committed to COVAX. Beijing has, however, shifted to vaccine diplomacy to repair its reputation, by stating that any vaccine developed by the country would be a “global public good” which would contribute to ensuring “vaccine accessibility and affordability in developing countries”. In the case of the EU, though the bloc has declined to use the COVAX facility to purchase vaccines, it has pledged €400 million to the initiative “to scale up development and manufacturing of a global supply of vaccines”.
Although the universal acceptance of the initiative has been impeded by nationalism, the facility has also drawn criticism from civil society and some global health experts like Kate Elder, from MSF’s Access Campaign, who says that it could be better in being more transparent regarding the exact parameters considered before entering into agreements with certain vaccine producers, the regulatory approvals that will be needed for vaccine eligibility, the nature of the procurement mechanism that will be used and the specific roles that the WHO, Gavi and other bodies will undertake in coordinating the entire process. Nevertheless, there remains an understanding that COVAX may be the world’s best shot at equitable distribution of COVID-19 vaccines.
The battle against the COVID-19 pandemic will be the biggest test of not just global leadership, but multilateralism as a whole. The virus has not discriminated against any one region per se; it has exacted horrific consequences on nations across the globe, and if countries cannot come together to address this crisis in collaboration with each other, it paints a worrying picture for international cooperation going forward. The next session of the World Health Assembly (WHA) is set to take place from November 9-16; global powers must use the opportunity to reaffirm their support for multilateral cooperation and convince their allies and others to do the same. Nationalization of drugs and other medical supplies will only slow the fight against the novel coronavirus because, as WHO Director Tedros Ghebreyesus right said, “No one is safe until everybody is safe.”
Vaccine Nationalism and its Impact on The Global Fight Against COVID-19
Nationalization of drugs and other medical supplies will only slow the fight against the novel coronavirus.
September 22, 2020
SOURCE: PEW RESEARCH CENTER/GETTY IMAGES