tag:theconversation.com,2011:/ca-fr/topics/vaccine-nationalism-88612/articlesVaccine nationalism – La Conversation2022-08-11T16:21:42Ztag:theconversation.com,2011:article/1882062022-08-11T16:21:42Z2022-08-11T16:21:42ZEnduring colonialism has made it harder to end the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/478138/original/file-20220808-8055-ox4drg.jpg?ixlib=rb-1.1.0&rect=0%2C640%2C4795%2C2382&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 patients receive oxygen as they lie in their beds in the intensive care unit of a hospital in Machakos, Kenya, in August 2021. </span> <span class="attribution"><span class="source">(AP Photo/Brian Inganga)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/enduring-colonialism-has-made-it-harder-to-end-the-covid-19-pandemic" width="100%" height="400"></iframe>
<p>Rich countries are <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/who-warns-against-vaccine-hoarding-poor-countries-go-without-2021-12-09/">hoarding vaccine doses</a> while poor countries become <a href="https://english.elpais.com/usa/2021-11-29/low-vaccination-rate-in-poor-countries-creates-breeding-ground-for-coronavirus-mutations.html">breeding grounds</a> for new COVID-19 variants. </p>
<p>The World Health Organization’s <a href="https://www.who.int/initiatives/act-accelerator/covax">COVAX</a> — an abbreviation for COVID-19 Vaccines Global Access — warned that “no one is safe, until everyone is safe,” yet colonial attitudes are an obstacle to reining in the global pandemic.</p>
<p>COVID-19 has shown that global equity and inclusion are necessary to manage global crises. A major lesson from this pandemic is the need to decolonize transnational governance so that the world is better able to handle both future and current global crises and issues.</p>
<h2>COVAX’s naïve failure</h2>
<p>COVAX <a href="https://www.washingtonpost.com/world/2022/03/22/covax-problems-coronavirus-vaccines-next-pandemic/">has failed</a>.</p>
<p>It was supposed to provide vaccinations globally and equitably as well as serve as a mechanism through which both rich and poor countries would access vaccines. More than 80 per cent of the population in rich countries <a href="https://ourworldindata.org/covid-vaccinations#what-share-of-the-population-has-completed-the-initial-vaccination-protocol">is fully vaccinated</a>, compared to less than 10 per cent of the population in poor countries.</p>
<p>Credible reports say that poor countries have been affected the most by the global pandemic both in terms of <a href="https://doi.org/10.1038/d41586-022-01767-z">how deadly it has been</a>, <a href="https://www.oxfam.org/en/research/pandemic-greed">as well as economically</a>. </p>
<p>This summer, we’re seeing new pandemic waves <a href="https://www.bloomberg.com/news/articles/2022-07-16/europe-can-t-shake-covid-as-ba-5-variant-fuels-summer-wave-of-cases">in Europe</a> <a href="https://www.reuters.com/world/asia-pacific/fresh-covid-wave-sweeps-asia-nz-warns-pressure-hospitals-2022-07-14/">and Asia</a> driven by new SARS-CoV-2 variants first spotted in <a href="https://www.nature.com/articles/d41586-022-01730-y">South Africa</a>. </p>
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<img alt="A health-care worker in blue protective garb listens to the breathing of a woman wearing a mask and a pink shirt." src="https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3837&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A woman is screened for COVID-19 at a testing centre in Soweto, South Africa, in May 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Denis Farrell)</span></span>
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<p>COVAX is based on lofty ideals of equity and social justice. The initiative has <a href="https://www.healthaffairs.org/do/10.1377/forefront.20220609.695589">been necessary</a> to moderately balance the gap between rich and poor countries that would have fared worse had it not been launched. </p>
<p>But COVAX <a href="https://www.statnews.com/2021/10/08/how-covax-failed-on-its-promise-to-vaccinate-the-world/">has been called naïve</a> for relying upon the good will of rich countries for funding and on their willingness to wait patiently in line for their own populations’ doses.</p>
<p>COVAX’s good intentions have had to co-exist with “might is right” politics. Rich countries made their own deals and bought large amounts of vaccine supplies before they were even available. </p>
<p><a href="https://hbr.org/2020/05/the-danger-of-vaccine-nationalism">Vaccine nationalism</a> turned COVAX into a broker of charity. The colonial mentality believes it’s OK to cut deals with Big Pharma for vaccine doses ahead of populous poor countries, and to charitably donate to them their <a href="https://doi.org/10.1186/s12992-022-00801-z">soon-to-expire leftovers</a>.</p>
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<a href="https://theconversation.com/covid-19-vaccine-inequity-allowed-omicron-to-emerge-173361">COVID-19 vaccine inequity allowed Omicron to emerge</a>
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<h2>Colonial mentality</h2>
<p>Global capitalism as we know it emerged from a colonial world order set up for exploitation of people and lands. European countries kidnapped people from Africa and enslaved them as they dispossessed Indigenous Peoples. This created the extractive economy of today. </p>
<p>Racial classifications and racism have remained an enduring aspect of the modern world. <a href="https://www.connectedsociologies.org/curriculum/mmw/">Colonialism produced the initial and current gap between the rich and the poor world</a>, and racialized the latter. When the <a href="https://www.britannica.com/topic/mercantilism">mercantilist order of the colonial day</a> morphed into capitalism in the 1800s, the colonial mentality that simply assumes European superiority remained.</p>
<p>This has been the basis for the colonial upper hand of the West and the United States in the type of transnational governance that emerged after the Second World War (the United Nations and <a href="https://www.brettonwoodsproject.org/2019/01/art-320747/">Bretton Woods organizations</a>, including the World Trade Organization, the International Monetary Fund and the World Bank). This has also been the basis for the colonial mentality of today. </p>
<p>COVAX was conceived during the rich <a href="https://time.com/6096172/covax-vaccines-what-went-wrong/">World Economic Forum in Davos in January 2020</a>. As news of the virus emerged from China, two professional white men <a href="https://qz.com/2071543/why-the-covax-vaccine-program-failed/">sipped whisky and envisioned COVAX in a Swiss ski resort bar.</a></p>
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<span class="caption">Seth Berkley, CEO of the vaccine alliance Gavi, gestures as he speaks during a media interview in Switzerland in December 2021.</span>
<span class="attribution"><span class="source">(Salvatore Di Nolfi, Keystone via AP)</span></span>
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<p>Seth Berkley (CEO of the <a href="https://www.gavi.org/">Global Alliance for Vaccines and Immunization, or Gavi</a>) and Richard Hatchett (CEO of <a href="https://cepi.net/">the Coalition for Epidemic Preparedness Innovations, or CEPI</a>), heads of global vaccination networks, discussed pandemic scenarios. They knew the world would need a funding and distribution strategy for shots, so they started thinking about a global solution.</p>
<p><a href="https://cepi.net/wp-content/uploads/2021/09/Proposal-to-establish-a-globally-fair-allocation-system_March-25_2020.pdf">Hatchett wrote a white paper in March 2020</a> and those ideas were the basis for the creation of COVAX in April that year. All this sounds great, but colonial mentality ultimately prevented the success of their initiative. It stopped COVAX from emerging as the co-ordinator of sorely needed 21st-century solidarity. </p>
<h2>Decolonizing crisis governance</h2>
<p>People rarely hear the names of Berkley and Hatchett in the global public sphere. Berkley’s Gavi is a global vaccine alliance that brings together the <a href="https://www.gavi.org/our-alliance">public and private sectors</a>. Hatchett’s CEPI describes itself as a “<a href="https://cepi.net/about/whoweare/">global partnership</a> between public, private, philanthropic, and civil society organizations.” </p>
<p>Today, these two global organizations — supported by the World Health Organization — are dealing with the enduring pandemic. But their <a href="https://doi.org/10.1080/17441692.2021.1987502">transparency and accountability</a> have been questionable.</p>
<p>Gavi designed COVAX without oversight and “with a small group of like-minded advisors, primarily Global North philanthropists, academics, and consultants,” according to a <a href="https://www.doctorswithoutborders.org/latest/covax-broken-promise-vaccine-equity">Doctors Without Borders report</a>. The perspectives of low- and middle-income countries, civil society organizations or regional disease control groups weren’t considered in a meaningful way. </p>
<p>At the same time, <a href="https://doi.org/10.1016/S0140-6736(21)01378-7">pharmaceutical industry</a> representatives have had a seat at the table of major decision-making discussions, and this has helped maintain the status quo of their <a href="https://doi.org/10.1038/d41586-021-01242-1">intellectual property rights</a>.</p>
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Read more:
<a href="https://theconversation.com/perus-covid-19-vaccine-scandal-shows-the-shady-deals-made-with-pharma-companies-155623">Peru's COVID-19 vaccine scandal shows the shady deals made with pharma companies</a>
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<p>The world needs to move beyond myopic national self-interest. It has become apparent that in order to control the COVID-19 pandemic, equity and inclusion are urgently required. </p>
<p>Scientists anticipate <a href="https://www.idrc.ca/en/perspectives/no-one-safe-until-everyone-safe-global-research-global-crises">there will be new pandemics along with climate change crises</a>. This will hardly be the last global public-health emergency. </p>
<p>Out of self-interest, transnational governance needs to embrace true solidarity. World leaders must use <a href="https://www.dukeupress.edu/Assets/PubMaterials/978-1-4780-0149-2_601.pdf">a decolonialized</a> imagination to face these coming global challenges.</p><img src="https://counter.theconversation.com/content/188206/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monica Sanchez-Flores does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A major lesson from the COVID-19 pandemic is the need to decolonize transnational governance so that the world is better able to handle both future and current global crises.Monica Sanchez-Flores, Associate Professor of Sociology, Thompson Rivers UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733612021-12-14T16:01:04Z2021-12-14T16:01:04ZCOVID-19 vaccine inequity allowed Omicron to emerge<figure><img src="https://images.theconversation.com/files/437133/original/file-20211213-17-15ypeah.png?ixlib=rb-1.1.0&rect=56%2C44%2C1940%2C1197&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While people in the wealthy West have had preferred access to multiple rounds of vaccines, vast numbers of people, especially in Africa and on the Indian subcontinent, haven’t received a single dose.</span> <span class="attribution"><span class="source">(Pixabay/Canva)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/covid-19-vaccine-inequity-allowed-omicron-to-emerge" width="100%" height="400"></iframe>
<p><a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">Canada’s COVID-19 vaccination rate</a> is 76 per cent — <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=total_vaccinations_per_hundred&Metric=Vaccine+doses&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=Africa%7ECAN">10 times higher</a> than it is across the continent of Africa.</p>
<p>While people in the wealthy West have had preferred access to multiple rounds of vaccines, vast numbers of people, especially in Africa and on the Indian subcontinent, <a href="https://ourworldindata.org/covid-vaccinations">haven’t received a single dose</a>. This has permitted the virus to thrive and <a href="https://www.oxfam.org/en/press-releases/two-thirds-epidemiologists-warn-mutations-could-render-current-covid-vaccines">accelerated the process of mutation</a>, adding months and perhaps years to the pandemic.</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>Wherever COVID-19 has the chance to linger, <a href="https://www.theguardian.com/commentisfree/2021/nov/26/new-covid-variant-rich-countries-hoarding-vaccines">variants develop and travel</a>. This entirely predictable pattern is destined to repeat itself unless countries with resources <a href="https://news.un.org/en/story/2021/08/1098882">share vaccines</a> with others that cannot afford them. </p>
<p><a href="https://www.cbc.ca/radio/asithappens/as-it-happens-thursday-edition-1.6219522/rich-countries-only-shared-14-of-covid-19-vaccine-doses-promised-to-poorer-nations-report-1.6219969">Wealthy countries have yet to meet their pledges</a> to provide equitable global access to vaccines via <a href="https://www.unicef.ca/en/covax-ensuring-global-access-covid-19-vaccines?ea.tracking.id=20DIAQ01OTE&19DIAQ02OTE=&gclid=Cj0KCQiAzMGNBhCyARIsANpUkzP5fE37OazUDpzB8MnRHS-_hAe1K8l08m_x1dIRTGPh5YjyjSxW7QoaAjQMEALw_wcB">COVAX</a> (an international collaboration to procure and distribute COVID-19 vaccines) and other initiatives. The resulting lack of broad global vaccine coverage made the rise of another variant like Omicron inevitable. </p>
<p>For Canada, it is more critical than ever to carefully balance the supply of vaccines available for domestic use while prioritizing international sharing — and encouraging regional manufacturing. </p>
<h2>Millions of pre-ordered vaccine doses</h2>
<p>When the COVID-19 crisis started, major manufacturers pre-sold their vaccines to governments as they were being developed but before they were tested, as a way of funding their work, including clinical trials. </p>
<p><a href="https://theconversation.com/canadas-me-first-covid-19-vaccine-strategy-may-come-at-the-cost-of-global-health-146908">Canada and other developed countries ordered millions of doses</a>, enough to cover their populations many times over, with promises to share their excess vaccines with other countries. That has not happened quickly enough. While logistical, legal and other barriers did impede the wider distribution of vaccines, there appears to be <a href="https://globalnews.ca/news/8243635/bolivian-minister-canada-covid-vaccine-waiver/">a lack of will</a> to overcome them. </p>
<p>The momentum gained by accelerating the development of vaccinations has now been lost. </p>
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<a href="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hundreds of vials with red lids on a conveyor belt" src="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Vials waiting to be filled with Pfizer’s COVID-19 vaccine at a production plant in France. Developed countries pre-purchased millions of doses of COVID-19 vaccines while they were still in development.</span>
<span class="attribution"><span class="source">(AP Photo/Christophe Ena)</span></span>
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<p><a href="https://www.wsj.com/articles/pfizer-biontech-covid-19-vaccine-loses-significant-effectiveness-against-omicron-in-early-study-companies-say-11638964121">Third doses and booster shots</a> will be important to controlling both the ongoing threat of Delta and the spread of Omicron. Canadians should certainly heed public health guidance and get their shots when they are recommended. Once vaccine doses are in Canadian freezers and fridges they aren’t going anywhere, and declining a dose won’t mean that it is redistributed to other parts of the world that need them. </p>
<p>On a federal level, Canada should only buy what is needed domestically and commit to accelerating the distribution of vaccines elsewhere. The same is true for all wealthy countries.</p>
<h2>The rise of Omicron</h2>
<p>Watching the rise of Omicron is particularly frustrating. It has been apparent since the outset that the spread of COVID-19 needed to be slowed globally, precisely to prevent variants from emerging. That message should have been clearer after the spread of the agile <a href="https://www.ox.ac.uk/news/2021-07-23-alpha-variant-spread-super-seeding-event-warning-over-covid-19-variants">Alpha variant</a>. It should have been clearer still from the swift attack of the <a href="https://theconversation.com/why-is-delta-such-a-worry-its-more-infectious-probably-causes-more-severe-disease-and-challenges-our-vaccines-163579">Delta variant</a>.</p>
<p>Variants like Delta and Omicron will arise when the burden of infection is high and vaccination rates are low, as is the case with many countries in the Global South. <a href="https://theconversation.com/coronavirus-variants-have-new-names-we-can-finally-stop-stigmatising-countries-159652">Identifying variants by their country of origin</a> perpetuates a long legacy of <a href="https://theconversation.com/calling-covid-19-a-chinese-virus-is-wrong-and-dangerous-the-pandemic-is-global-134307">representing racialized people as originators or carriers of disease</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in lab coats, gloves and masks in a laboratory" src="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scientists at the Ndlovu Research Center in Elandsdoorn, South Africa, part of the Network for Genomic Surveillance in South Africa, which discovered the Omicron variant.</span>
<span class="attribution"><span class="source">(AP Photo/Jerome Delay)</span></span>
</figcaption>
</figure>
<p>In fact, the world has been served well by South Africa’s admirable investments in disease surveillance that turned up the newest COVID-19 threat.</p>
<p>There is no way to know where in the world the Omicron variant actually emerged, even though it was first detected in South Africa. South Africa has been down this road before with HIV, and had a <a href="https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/sars-cov-2-genomic-surveillance-update/">well-developed pandemic surveillance system that allowed it to detect this variant</a>. </p>
<h2>Investing in global health</h2>
<p>Canada has not historically invested in global health, infectious disease research or in vaccine innovation and manufacturing. </p>
<figure class="align-right ">
<img alt="A collage of world flags in the shape of a coronavirus" src="https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=755&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=755&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=755&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Regional manufacturing in Canada and abroad could enable quicker worldwide vaccine distribution.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>As a result, our country is <a href="https://www.cbc.ca/news/politics/domestic-vaccine-manufacturing-canada-1.6004427">a consumer of COVID-19 vaccines rather than a contributor to the global supply</a>. Despite having small manufacturing facilities that had capacity to contribute a few million doses, Canada lacked the political will to repurpose these facilities to assist with the global vaccine effort. </p>
<p>Regional manufacturing here and abroad could enable quicker worldwide vaccination. Vaccine manufacturers are already contracting local manufacturers in <a href="https://caravanmagazine.in/health/will-600-million-india-made-doses-of-johnson-and-johnson-vaccine-be-exported-to-rich-western-countries">India</a> and <a href="https://www.nytimes.com/2021/08/16/business/johnson-johnson-vaccine-africa-exported-europe.html">Africa</a> to make vaccine doses, but these doses are being shipped to the West instead of being available locally. Sharing knowledge and technology that can help countries in the Global South develop vaccines and vaccinate their own populations will have a greater long-term benefit for the world than trying to stop variants by closing borders.</p>
<p>As the crisis has worn on, we have <a href="https://www.ic.gc.ca/eic/site/151.nsf/eng/00006.html">invested in domestic manufacturing in Canada</a>, but it will take years to staff these plants with trained personnel, let alone create innovative vaccines that are more suitable for distribution to the Global South. </p>
<p>Rather than being consumers who contribute to inequitable vaccine distribution, we have an opportunity to weave vaccine equity into these investments. </p>
<p>We can commit to training people from countries where vaccines are needed most to equalize access to expertise. We can commit to global partnerships to distribute manufacturing equitably and we can be advocates for change. </p>
<p>As we rebuild and invest in vaccine development and production, we have an opportunity to become leaders in vaccine equity and reduce the burden of infectious disease now and in the future. </p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/173361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force, the Canadian Institutes for Health Research and the National Sciences and Engineering Research Council. She is on the Board of Directors for the Lung Health Foundation and has occasionally consulted with vaccine manufacturers. </span></em></p><p class="fine-print"><em><span>Chandrima Chakraborty receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p>In places with low vaccination rates, COVID-19 has the chance to linger, and variants develop and travel. Without global vaccine equity, this entirely predictable pattern will repeat itself.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityChandrima Chakraborty, Professor, English and Cultural Studies; Director, Centre for Peace Studies, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1587112021-04-14T14:27:08Z2021-04-14T14:27:08ZThe global approach to vaccine equity is failing: additional steps that would help<figure><img src="https://images.theconversation.com/files/394521/original/file-20210412-21-7uwfmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Paul Hennessy/SOPA Images/LightRocket via Getty Images</span></span></figcaption></figure><p>Accusations abound of <a href="https://foreignpolicy.com/2021/02/02/vaccine-nationalism-harms-everyone-and-protects-no-one/">vaccine nationalism</a> against states that stockpile vaccines and of vaccine apartheid, as COVID-19 vaccines become concentrated in rich countries. Calls for vaccine equity or justice demand vaccine allocation on account of need, based on the idea that no one is safe until everyone is safe. </p>
<p>At stake is our ability to ensure an end to the pandemic and restoration of the global economy via an end to border restrictions.</p>
<p>Efforts to address vaccine equity have focused on multilateral solutions such as the COVAX scheme and the suspension of intellectual property rights through the World Trade Organisation (WTO).</p>
<p>These initiatives differ in approach. But each is committed to pursuing solutions through global institutions.</p>
<p>Based on our work in global health and world trade governance, we question whether vaccine equity can be addressed via global institutions alone. All existing multilateral approaches have their limits: they are charitable, and depend on the alignment of powerful state interests. They also don’t address the central problem of how vaccines are manufactured and delivered around the world: supply chain governance. </p>
<p>We argue, therefore, that the fight for vaccine equity needs to stop looking to multilateral institutions for permission and instead focus on the policy tools that are already available to states.</p>
<h2>Shortcomings of COVAX</h2>
<p><a href="https://www.who.int/initiatives/act-accelerator/covax">COVAX</a> is a joint initiative by various global health bodies including the <a href="https://www.gavi.org/">GAVI Alliance</a> and the World Health Organisation. It has two primary functions: to generate development of COVID-19 vaccines; and to ensure vaccine equity by providing doses for 20% of the population of all the 190 eligible countries.</p>
<p>COVAX incentivises the research and development of COVID-19 vaccines and negotiates the price paid for them, helping to secure a better deal by negotiating as a bloc. COVAX is currently supporting the development of <a href="https://www.gavi.org/vaccineswork/covax-explained">nine vaccines</a>. </p>
<p>Getting the vaccine is only part of the issue. COVAX then commits to ensure equitable access to these vaccines. This is done through self-financing states who pay in to the model and can then draw from it to secure vaccines for 10-50% of their population; and through funded states where official development assistance is used to support the COVAX Advance Market Commitment mechanism that ensures the 20% doses figure for low- and middle-income states. </p>
<p>For high-income countries that participate in the scheme, COVAX provides an insurance mechanism should their bilaterally-agreed supplies fall short. For low-income countries, COVAX is a vaccine lifeline when the prices of bilateral agreements become too high.</p>
<p>Global health institutions and state leaders celebrate images of <a href="https://www.who.int/news/item/08-04-2021-covax-reaches-over-100-economies-42-days-after-first-international-delivery">COVAX vaccines arriving</a> in poor countries as evidence that this approach is fast moving, results-based and equitable. But these images mask several vaccine equity issues.</p>
<p>It is unclear that COVAX can secure the investment required to reach its goal of securing 2 billion doses by the end of 2021. COVAX itself has <a href="https://www.reuters.com/article/us-health-coronavirus-who-covax-idUSKBN29R1Q3">warned</a> of a US$27 billion gap needed to meet this ambition. Furthermore, doses for 20% of a population are insufficient.</p>
<p>When states are challenged on vaccine hoarding, priority deals, and bilateral price negotiations, they often point to COVAX as evidence of commitment to vaccine equity. Our criticism of COVAX is more than that it is just charity: COVAX is serving as a smokescreen to cover up vaccine nationalism.</p>
<h2>Intellectual property</h2>
<p>The cost of medicines is seen as the root problem of access to vaccines and technology. Hence the <a href="https://theconversation.com/dummys-guide-to-how-trade-rules-affect-access-to-covid-19-vaccines-152897">campaign</a> for a temporary suspension (waiver) of intellectual property rights protected under the Trade Related Intellectual Property Rights (TRIPs) agreement of the WTO for all medical products required to fight the pandemic. </p>
<p>South Africa and India put forward a proposal for a vaccine waiver supported by developing countries and civil society campaigns. However this was blocked by the EU, US, UK, and Switzerland among other high-income states. </p>
<p>Advocates argue that current intellectual property rights arrangements stifle competition, and keep essential and affordable medicines and other medical products out of the hands of those who need them most.</p>
<p>However, existing rules already allow countries to suspend the application of intellectual property rights in a public health emergency. The <a href="https://www.who.int/medicines/areas/policy/doha_declaration/en/">2001 Doha Declaration</a> on TRIPs and public health reaffirmed that countries can determine what constitutes a national emergency, and issue compulsory licences “under any conditions they deem appropriate”. </p>
<p>Compulsory licences allow private corporations or governments to produce and distribute a generic version of a patented product without the permission of the patent holder. An amendment passed in <a href="https://www.wto.org/english/tratop_e/trips_e/amendment_e.htm#:%7E:text=WTO%20members%20on%206%20December,health%20originally%20adopted%20in%202003.&text=Members%20who%20are%20yet%20to,WT%2FL%2F1081">2005</a> also allowed countries without domestic manufacturing capacity to import generic medicines in times of national emergency.</p>
<p>So issuing compulsory licences is one feasible strategy for speeding access to vaccines. </p>
<p>Most states won’t do this. They perceive themselves as having a lot to lose – damage to international reputation, and criticism from global health actors who put a premium on playing by their rules. </p>
<p>Some states such as Chile have mooted the idea of compulsory licences for COVID-19 vaccines. No state has issued them to date. But the combination of past precedent and the growth of the pandemic in low-income countries could bring new attention and urgency to the option.</p>
<h2>Supply chains and global governance</h2>
<p>While supply chains are truly global, their reach and control remains outside the realm of multilateral institutions. </p>
<p>COVID-19 vaccines and other medical products are supplied through highly complex transnational supply chains often spanning continents. Manufacture of vaccines requires the procurement of raw materials, consumables and reagents. This involves multiple suppliers from across the world. For example, <a href="https://www.astrazeneca.com/what-science-can-do/topics/technologies/innovating-production-and-manufacture-to-meet-the-challenge-of-covid-19.html">AstraZeneca</a> works with 20 partners from over 15 countries and 20 testing sites in the development of its COVID-19 vaccine. </p>
<p>These supply chains are set up, managed and coordinated through core corporations that are typically the intellectual property rights holders in the chain. </p>
<p>The set-up of supply chains for vaccines and other medical products affects their global distribution. Smaller corporations in the chain are dis-incentivised from undermining the commercial interests of the core corporation. Smaller corporations in low-income states are fearful of undermining the intellectual property rights system as it may affect their future revenue. Their states, however fearful they may be, need to be bold and provide the necessary cover by compelling the production of generic vaccines under a compulsory licence.</p>
<h2>What to do?</h2>
<p>To secure universal access to vaccines, states must take up the fight by using the existing rules to their advantage. These include:</p>
<ul>
<li><p>Issuing compulsory licences to produce their own vaccines. </p></li>
<li><p>Setting up bilateral agreements with those states that have production capacity. </p></li>
<li><p>Building vaccine blocks to negotiate and supply vaccines to territories. </p></li>
<li><p>Being prepared to disrupt power relations within supply chains by breaking confidentiality clauses in contracts and publishing what pharmaceutical companies want them to pay – or at least leak these contracts. </p></li>
</ul>
<p>Controversial, yes, but as previous cases such as the Indonesia virus sample sharing controversy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600156/">shows</a>, these controversies are produced by gross inequities within the system. </p>
<p>If countries want to solve the problem of vaccine equity they should stop seeing COVAX as the solution, and see it as the charity it is. And they should share vaccine intellectual property and technology without waiting for multilateral institutions to offer permission when the rules already make allowances for this. </p>
<p>Multilateral institutions rest on rules and norms. These exist for order and discipline, but on occasion can be used for justice when states do something brave.</p><img src="https://counter.theconversation.com/content/158711/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erin Hannah receives funding from the Social Sciences and Humanities Research Council (SSHRC) of Canada</span></em></p><p class="fine-print"><em><span>Silke Trommer receives funding from the Social Sciences and Humanities Research Council (SSHRC) of Canada. </span></em></p><p class="fine-print"><em><span>Sophie Harman receives funding from The Leverhulme Trust</span></em></p><p class="fine-print"><em><span>James Scott does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The fight for vaccine equity needs to stop looking to multilateral institutions for permission and instead focus on the policy tools that are already available to states.Erin Hannah, Department Chair/Associate Professor of Political Science, King's University College, Western UniversityJames Scott, Senior Lecturer in International Politics, King's College LondonSilke Trommer, Senior Lecturer Politics, University of ManchesterSophie Harman, Professor of International Politics, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1584362021-04-11T08:23:03Z2021-04-11T08:23:03ZSouth African case study sheds light on how vaccine manufacturing can be developed<figure><img src="https://images.theconversation.com/files/395239/original/file-20210415-18-yasgo4.jpeg?ixlib=rb-1.1.0&rect=0%2C7%2C4684%2C3104&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Workers pack syringes at India's biggest syringe manufacturer. Government support has been key to developing this capacity.</span> <span class="attribution"><span class="source">Photo by Sajjad Hussain/AFP via Getty Images</span></span></figcaption></figure><p>The uneven availability of COVID-19 vaccines has become an increasingly urgent and vexatious issue. But managing the problem of what’s been labelled <a href="https://www.itv.com/news/2021-04-06/international-monetary-fund-decries-covid-vaccine-nationalism-and-urges-wealthy-countries-to-share-stocks">“vaccine nationalism”</a> is proving a hard nut to crack.</p>
<p>Shortages of medicines and vulnerable supply chains for critical medicines are issues for nearly all developing countries. In Africa, in particular, there’s <a href="https://www.orfonline.org/expert-speak/expanding-pharmaceutical-local-production-in-africa-an-idea-whose-time-has-come-49805/">limited manufacturing capacity</a>. Over 20 countries don’t have any capacity at all. And many regions continue to import at least <a href="https://www.orfonline.org/expert-speak/expanding-pharmaceutical-local-production-in-africa-an-idea-whose-time-has-come-49805/">95% of their pharmaceutical requirements</a>. </p>
<p>Understanding why this is the case is key. After all, there is ample evidence that governments can be effective economic actors. This includes being able to exercise large influence on the manufacturing sector. They can, for example, build capacity through incentives, regulation and policy. <a href="https://www.businesslive.co.za/bd/world/2021-03-12-governments-target-production-as-vaccine-nationalism-grows/">Experiences from other countries</a> show that public investment and public procurement in the domestic pharmaceutical sector can create capacity and markets.</p>
<p>So why hasn’t this happened on the continent? </p>
<p>Typically, these products are technology and capital intensive. They require highly skilled personnel and reliable supply chains for key raw materials and specialised equipment. And the initial investment in people and infrastructure necessitates long term stable markets with sufficient volume to justify the risk. </p>
<p>The absence of this security, even in the continent’s larger markets, such as South Africa, Nigeria and Egypt, limits expansion of this critical sector. </p>
<p>We conducted a study to understand the extent to which gaps in the availability of financing were constraining the development of manufacturing capacity for vaccines and other health equipment. Our <a href="https://nova-worldwide.com/OSF-PHP_report">findings</a> show how governments, firms and donor agencies should align their efforts to support diagnostics, vaccines and therapies as a critical resource. </p>
<p>We identify a number of approaches that should be explored. These include joint plans for regional production hubs, pooled procurement, direct grants, periods of market exclusivity, international technology transfer and redirecting of international development aid. </p>
<h2>Investigation</h2>
<p>As part of the <a href="https://nova-worldwide.com/OSF-PHP_report">study</a>, we looked at two case studies in South Africa: <a href="https://www.ketlaphela.co.za/">Ketlaphela Pharmaceuticals</a> and the <a href="https://www.biovac.co.za/">Biovac Institute</a>. </p>
<p>Ketlaphela is a state owned company. It was created to manufacture active pharmaceutical ingredients and medical products mainly for communicable diseases such as HIV/AIDS, TB and malaria. It has yet to produce any pharmaceuticals.</p>
<p>Biovac is public-private partnership between the South African government and a consortium of healthcare companies. Its capacity is small compared to the COVID-19 vaccine market. Nevertheless it holds <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-018-0303-3">three important lessons</a> on how a country like South Africa can go about building this kind of capacity.</p>
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Read more:
<a href="https://theconversation.com/vaccine-production-in-south-africa-how-an-industry-in-its-infancy-can-be-developed-153204">Vaccine production in South Africa: how an industry in its infancy can be developed</a>
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<p>Firstly, it provided long term market security. This was done through an effective 15-year contract with the National Department of Health. Second, it allowed Biovac to receive a price premium as a means of funding the company’s re-investment in vaccine manufacturing. And, lastly, it supported the establishment of a strong research and development capability. </p>
<p>To understand how these experiences checked out with the broader realities of pharmaceutical production across Africa, we mapped funding flows for pharmaceutical projects on the continent. We also interviewed stakeholders, including civil society advocacy groups and industry experts. And we talked to diagnostics, vaccines and therapies manufacturers across the continent to understand the on-the-ground realities. </p>
<h2>Barriers</h2>
<p>Conditions for the financing of diagnostics, vaccines and therapies manufacturing across Africa are clearly very diverse. Some countries have liquid financial markets, readily available foreign exchange and sophisticated financial systems. Others face real constraints in terms of access to capital and foreign exchange.</p>
<p>Similarly, we found that smaller producers faced different challenges to larger established producers.</p>
<p>Nevertheless, we did find some commonalities. </p>
<p>Companies reported clear discrepancies between political aspirations to reduce import dependency in healthcare, and day-to-day realities. In particular, businesses complained about factors that increased their cost of capital and made them less competitive. These were related to systemic or infrastructure failures that they had little control over. They included:</p>
<ul>
<li><p>high electricity costs and unreliable supply, </p></li>
<li><p>lack of clean water, </p></li>
<li><p>port delays, </p></li>
<li><p>weak infrastructure, and </p></li>
<li><p>the limited availability of skilled personnel. </p></li>
</ul>
<p>Our interviews confirmed that these additional costs made it harder for local companies to break even and recover working capital in highly competitive markets.</p>
<p>As a result, firms often retreated into narrower product categories. Or they closed, unable to compete without greater government support against Indian and Chinese companies. </p>
<h2>Some answers</h2>
<p>The study highlighted two critical areas as being fundamental in reforming the public support structures in favour of local companies.</p>
<p>In the first place, governments must use public procurement. They can do so by providing longer term supply contracts with strong offtake guarantees (take-or-pay). </p>
<p>Secondly, donor agencies need to review their procurement strategies and reconsider them in favour of local manufactures. These are presently based on accredited low-cost facilities, mainly in India and China. </p>
<p>This is more easily said than done. Nevertheless, the essential take home from the interviews was that when local firms could produce good quality products, they needed to be able to access markets without being ‘crowded out’ by larger companies that had economies of scale and scope. This could help create a wider range of suppliers from developing countries in the long run.</p>
<p>The role of international financing agencies is critical in building local resilience to global health emergencies. For instance, the Global Fund is responsible for <a href="https://www.theglobalfund.org/media/10103/corporate_2020resultsreport_report_en.pdf">financing and procuring 21%</a> of the drugs for the treatment of HIV. Similar figures are reported for TB and malaria. </p>
<p>Similarly, one of the objectives of Gavi’s Strategy for 2021-2026 (<a href="https://www.gavi.org/our-alliance/strategy/phase-5-2021-2025">GAVI 5.0</a>) is to shape healthy markets for vaccine products. This could be reviewed against these realities, especially given the supply constraints faced by the <a href="https://www.who.int/initiatives/act-accelerator/covax">COVAX</a> facility. </p>
<p>These agencies have the market power to diversify sources of supply without undermining the cost of public health services. The entities could work with national governments to build local capacity and increase resilience.</p>
<h2>Unlocking financial support</h2>
<p>Interestingly, the mapping of funding flows showed that there is investment capital available in global financial markets. This includes capital for African diagnostics, vaccines and therapies investment. </p>
<p>To the extent there are constraints on financing for manufacturing, this is not because of a global shortage of available capital. Institutions such as the World Bank, the International Finance Corporation and the African Development Bank have announced large commitments to support responses to COVID-19. Unfortunately, this funding has not yet been allocated to projects for African pharmaceutical manufacturing. </p>
<p>Likewise, foundations are financing research and development, advance purchase commitments of vaccines and diagnostics, and other efforts to address COVID-19. But they too have not materially funded projects to produce in Africa. </p>
<p>Given the devastating impact of the pandemic on the continent’s economies, international institutions and governments must work together to bring pharmaceutical manufacturing to African countries.</p><img src="https://counter.theconversation.com/content/158436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Richard Walwyn and his co-authors received funding from the Open Society Foundation for the research that led to this publication. </span></em></p><p class="fine-print"><em><span>Padmashree Gehl Sampath does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>African governments, firms and donor agencies should align their efforts to support the local manufacture of vaccines and other health equipment in African countries.David Richard Walwyn, Professor of Technology Management, University of PretoriaPadmashree Gehl Sampath, Fellow, and Senior Advisor, Global Access in Action Program, Berkman Klein Center, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1519342021-03-25T11:38:38Z2021-03-25T11:38:38ZWhy India is banking on health diplomacy to grow African footprint<figure><img src="https://images.theconversation.com/files/391375/original/file-20210324-15-1gbiqtr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Workers at India's biggest syringe manufacturer ramp up production in September 2020 in race to meet COVID-19 vaccine-driven demand.
</span> <span class="attribution"><span class="source">Photo by SAJJAD HUSSAIN/AFP via Getty Images</span></span></figcaption></figure><p>India has stepped up its global ambitions and foreign policy re-engagement with African countries in recent years. Its bilateral trade <a href="https://www.mea.gov.in/Speeches-Statements.htm?dtl/30924/">increased</a> from $7.2 billion in 2001 to $63 billion in 2017/18. India is now the third largest export destination and the fifth largest investor on the continent. </p>
<p>While it plays catch-up with China’s commanding presence in Africa, India has signed numerous new bilateral agreements. It has also strengthened its diplomatic presence and is actively furthering trade, infrastructure and private sector investments. </p>
<p>In our <a href="https://www.sum.uio.no/english/research/projects/indaf/">research under a multi-year project</a>, we found that New Delhi promotes an alternative model of development. It showcases the successes of its Green Revolution and advances in information, communication and technology. But it also highlights its ability to develop “Triple A” technology – affordable, appropriate, adaptable. </p>
<p>India’s expertise in <a href="https://www.cambridge.org/core/journals/biosocieties/article/abs/first-world-health-care-at-third-world-prices-globalization-bioethics-and-medical-tourism/1DD37C055DF0FFE983C5018776426C69">affordable healthcare</a> has assumed increased significance during the ongoing pandemic. New Delhi is already reaping the benefits of an <a href="https://www.thehindubusinessline.com/news/national/indias-vaccine-maitri-initiative-earns-praise-at-wto/article33979754.ece">ambitious diplomatic initiative</a> to deliver Made-in-India vaccines to developing countries. </p>
<p>India is one the <a href="https://www.bbc.com/news/world-asia-india-55571793">largest producers</a> of drugs globally. It manufactures 60% of the world’s vaccines. Many African countries have purchased or <a href="https://www.ndtv.com/india-news/sent-229-lakh-covid-vaccine-doses-to-other-countries-foreign-ministry-2369480">received these as gifts</a>.</p>
<p>New Delhi’s capacity and willingness to produce and share COVID-19 vaccines have further boosted the country’s diplomatic heft and recognition as a <a href="https://www.project-syndicate.org/commentary/india-covid19-vaccine-diplomacy-by-shashi-tharoor-2021-03">global power</a>.</p>
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Read more:
<a href="https://theconversation.com/interested-in-vaccine-rollouts-across-africa-heres-a-map-to-guide-you-156802">Interested in vaccine rollouts across Africa? Here's a map to guide you</a>
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<h2>India’s Africa policy</h2>
<p>India’s historical footprint in Africa differs from that of other powers. New Delhi offered support for African countries in their struggle against colonial rule. Indo-African partnership followed in the post-colonial period. This was cemented by <a href="http://ris.org.in/others/NAM-RIS-Web/NAM-Articles/Harshe-India%20Non-Alignment-EPW-1990-min.pdf">solidarity with and support for the Non-Aligned Movement</a> and the fight against racism. </p>
<p>India also offered support for <a href="https://www.mea.gov.in/Portal/ForeignRelation/India-SouthAfrica_Relations.pdf">South Africa</a> in its struggle against apartheid. In addition, New Delhi points to the presence of a <a href="https://mea.gov.in/images/attach/NRIs-and-PIOs_1.pdf">sizeable Indian diaspora</a> and their <a href="https://www.vifindia.org/sites/default/files/final-an-overview-of-indian-diaspora-in-africa.pdf">economic and philanthropic contributions</a> on the continent. </p>
<p>Since the early 1990s, India has moved from idealism to pragmatism and the explicit pursuit of commercial interests. The change was driven by robust economic growth at home and the need to access raw materials and new markets. </p>
<p>India’s <a href="https://www.springer.com/gp/book/9788132226185">push</a> for South-South cooperation relies on three broad elements. The first is a shared identity as part of the “Third World”. Second is expertise in cost-effective development technologies. Third is a recurrent articulation of the principles of mutual respect and solidarity. </p>
<p>Its long history of being <a href="https://www.journalofdemocracy.org/articles/poverty-inequality-and-democracy-growth-and-hunger-in-india/">democratic and its successes in reducing poverty and preventing famines</a> have also bolstered the legitimacy of its developmental approach in the Global South. </p>
<p>Since 2018, the India-Africa partnership has been based on a set of <a href="https://pib.gov.in/PressReleasePage.aspx?PRID=1540025">principles</a>. These have emphasised “local priorities”. They call for joint efforts to reform global institutions, combat climate change and fight global terrorism. They also highlight capacity building for agriculture, education, digital technology and cooperation on peacekeeping and maritime issues. </p>
<p>How and to what extent might Africa benefit from India’s growing interest? We identify three broad sets of health-related opportunities and benefits that may shape the future of India-Africa relations.</p>
<h2>Three major areas of collaboration</h2>
<p>The first relates to India’s formidable reputation as the <a href="https://www.business-standard.com/article/current-affairs/india-pharmacy-of-the-world-during-covid-19-crisis-says-sco-secy-general-120062100435_1.html">“pharmacy of the world”</a>. It has actively contributed to meeting <a href="https://in-pursuit-of-development.simplecast.com/episodes/rory-horner">global demand for vaccines, over the counter medicines and low-cost generic drugs</a>. The relatively low manufacturing costs make Indian products affordable throughout the world. </p>
<p>Almost 20% of India’s pharmaceutical exports, valued at US$ 17 billion, are to Africa. Southern and western regions of Africa are the largest importers of Indian medicines. These include antiretroviral (ARV) drugs that cost only a <a href="https://pharmaboardroom.com/articles/africa-the-global-launchpad-for-indian-pharma/">fraction</a> of those produced by Western companies. </p>
<p>The second relates to capacity building and collaboration in the health sector. Leading Indian <a href="https://www.eximbankindia.in/blog/blog-content.aspx?BlogID=7&BlogTitle=Healthcare%20in%20Africa,%20built%20by%20India">healthcare providers are collaborating with African partners</a>. Some have opened or plan to open speciality hospitals across Africa. </p>
<p>Since 2009, the <a href="https://au.int/en/flagships/pan-african-e-network">Pan-African E-Network</a> supported by India has offered tele-medicine services. This also connects Indian hospitals and educational centres with their counterparts in Africa. With its state-of-the-art medical facilities, which offer services at competitive costs, India has also emerged as an attractive destination for “medical tourism”. </p>
<p>The third relates to India’s active “medical diplomacy”. Africa’s reliance on a <a href="https://theconversation.com/the-world-needs-pharmaceuticals-from-china-and-india-to-beat-coronavirus-138388">cheap supply of essential medicines in addition to an affordable COVID-19 vaccine</a> is only likely to increase in the near future. </p>
<p>But Africa’s success in containing pandemics such as Ebola offers lessons to India, too. An illustrative example is Senegal, which has adapted its experiences <a href="https://www.worldometers.info/coronavirus/country/senegal/">from the 2014 Ebola outbreak to fight COVID-19</a>. Numerous additional lessons on disease control from African countries can also be scaled up to improve India’s health sector.</p>
<h2>Future collaboration on health</h2>
<p>India appears well-poised to share its digital capabilities for improved and affordable access to universal healthcare. New Delhi has revamped its tele-medicine and online video consultation infrastructure on the continent. This offers a cost effective and safe option for treating contagious diseases.</p>
<p>In the near future, India’s partners may benefit from its <a href="https://health.economictimes.indiatimes.com/news/health-it/india-to-become-the-world-leader-in-digital-health/55154100">online and mobile applications</a> to improve accessibility and affordability of healthcare. Online platforms can be used to <a href="https://main.mohfw.gov.in/Organisation/departments-health-and-family-welfare/e-Health-Telemedicine">access information</a> on blood banks, public hospitals, and organ donation. Mobile applications can help track the vaccine status of children and disease awareness. </p>
<p>But there are also some challenges that must be resolved. Combating the menace of counterfeit medicines on the African continent is one. In addition to existing measures to curb criminal activity, mobile apps can verify medicines to tackle the problem. </p>
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Read more:
<a href="https://theconversation.com/dummys-guide-to-how-trade-rules-affect-access-to-covid-19-vaccines-152897">Dummy's guide to how trade rules affect access to COVID-19 vaccines</a>
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<p>A major challenge is improving access to generic medicines through negotiated intellectual property rights waivers. At the World Trade Organisation, India and South Africa have taken a moral stance against <a href="https://www.bmj.com/content/372/bmj.n292">“vaccine nationalism”</a>. Their <a href="https://www.pharmaceutical-technology.com/features/wto-ip-waiver-proposal-covid19-vaccine/">joint proposal</a> in October 2020 for a temporary waiver on drugs and COVID-19 vaccines was nevertheless rejected by the organisation. </p>
<p>Since then, however, <a href="https://foreignpolicy.com/2021/03/10/wto-intellectual-propert-waiver-india-south-africa/">mainly African countries</a> have shown growing support for the proposal.</p><img src="https://counter.theconversation.com/content/151934/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Banik receives funding from the Research Council of Norway. </span></em></p><p class="fine-print"><em><span>Renu MODI receives funding from the Research Council of Norway, Oslo</span></em></p>There are three broad sets of health-related opportunities and benefits that may shape the future of India-Africa relations.Dan Banik, Professor of political science, Director of the Oslo SDG Initiative, Host of "In Pursuit of Development" podcast, University of OsloRenu Modi, Professor in African Studies, University of Mumbai Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565692021-03-05T04:51:46Z2021-03-05T04:51:46ZYes, export bans on vaccines are a problem, but why is the supply of vaccines so limited in the first place?<figure><img src="https://images.theconversation.com/files/387949/original/file-20210305-19-1u4frc6.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C3067%2C1922&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cecilia Fabiano/AP</span></span></figcaption></figure><p><a href="https://www.theage.com.au/world/europe/europe-blocks-250-000-astrazeneca-doses-bound-for-australia-20210305-p577z3.html">News of the blockage</a> of a shipment of 250,000 COVID-19 vaccines from Europe to Australia has caused concern and outrage. </p>
<p>The immediate problem will probably be quickly solved through diplomatic channels. Even if it is not, onshore manufacturing of the AstraZeneca vaccine will soon make up for any shortfall in Australia’s vaccine supply. </p>
<p>But to avoid these types of supply shortfalls in future, it’s important to address the underlying problems behind this example of vaccine nationalism. Australia is both a victim of these problems, as well as a contributor.</p>
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<h2>Why has Australia’s shipment of vaccines been blocked?</h2>
<p>Italy has blocked the shipment of AstraZeneca vaccines based on <a href="https://www.abc.net.au/news/2021-01-30/european-union-eu-coronavirus-vaccine-shipments-australia/13105718">export authorisation rules</a> introduced by the European Union in January. These rules require vaccine manufacturers in the EU to seek authorisation to export vaccines to some countries outside the bloc. </p>
<p>This is the first time this process has resulted in a planned delivery of vaccines being blocked. The EU could have objected to Italy’s action, but did not.</p>
<p>The EU introduced the authorisation requirement due to <a href="https://healthpolicy-watch.news/81767-2/">concerns</a> it was not receiving the quantities of the Pfizer and AstraZeneca vaccines that the companies had agreed to provide within certain time frames.</p>
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<span class="caption">Italy’s blocked vaccine export was the first intervention under the EU’s controversial export authorisation scheme.</span>
<span class="attribution"><span class="source">Cecilia Fabiano/AP</span></span>
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<h2>How much of a problem will the blockage be for Australia?</h2>
<p>The immediate problem will probably be quickly solved through diplomatic negotiations. The EU is also likely to face intense criticism and pressure from other countries that fear the more widespread use of export restrictions. </p>
<p>So, it’s unlikely the export ban on these 250,000 vaccines will remain in place for long, or that Australia will face further export restrictions.</p>
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Read more:
<a href="https://theconversation.com/vaccine-nationalism-will-block-our-path-out-of-the-pandemic-so-how-do-we-resist-our-tribal-instinct-155258">Vaccine nationalism will block our path out of the pandemic – so how do we resist our tribal instinct?</a>
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<p>Even if the shipment never arrives in Australia, onshore manufacturing of the AstraZeneca vaccine by CSL will soon fill the gap, with the first locally produced doses <a href="https://www.csl.com/news/2021/20210212-local-manufacturing-of-covid-19-vaccine-reaches-final-stages">expected to be available around the end of March</a>. Any resulting delay in the rollout of Australia’s COVID-19 vaccination program is likely to be shortlived.</p>
<p>But the blockage of a vaccine shipment points to bigger problems that threaten to undermine the global distribution of vaccines and the world’s recovery from the pandemic.</p>
<h2>The bigger picture of vaccine nationalism</h2>
<p>The global distribution of COVID-19 vaccines has so far been extremely inequitable. By November 2020, governments had negotiated pre-purchase agreements for almost 7.5 billion doses, 51% of which had been <a href="https://www.bmj.com/content/371/bmj.m4750">reserved</a> by wealthy countries representing only 14% of the global population. </p>
<p>In mid-January, the director-general of the World Health Organization warned of a “<a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board">catastrophic moral failure</a>”. He said that 39 million vaccine doses had been administered in high-income countries at that time, but just 25 doses had been provided in “one lowest-income country”. </p>
<p>At this rate, it could be 2023 or 2024 before vaccination brings the pandemic under control globally.</p>
<p>Studies by the <a href="https://www.rand.org/pubs/research_reports/RRA769-1.html">RAND Corporation</a> and the <a href="https://iccwbo.org/publication/the-economic-case-for-global-vaccinations/">International Chamber of Commerce</a> have found that hoarding of vaccines by wealthy countries could cost the global economy trillions of dollars. </p>
<p>Uncontrolled transmission of the virus in some parts of the world also raises the risk of more variants emerging that are resistant to existing vaccines.</p>
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Read more:
<a href="https://theconversation.com/herd-immunity-is-the-end-game-for-the-pandemic-but-the-astrazeneca-vaccine-wont-get-us-there-155115">Herd immunity is the end game for the pandemic, but the AstraZeneca vaccine won’t get us there</a>
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<h2>The underlying problem of artificial scarcity</h2>
<p>Much of the reporting on vaccine nationalism tends to focus on the hoarding of vaccines by particular countries. But we should question why the supply of vaccines is so limited in the first place.</p>
<p>This comes down to privately held monopolies on the intellectual property and other types of knowledge, data and information needed for making vaccines. While there is <a href="https://foreignpolicy.com/2021/03/01/to-democratize-vaccine-access-democratize-production/">manufacturing capacity available globally</a> to ramp up vaccine production, the exclusive rights to make and sell the vaccines are held by a small number of companies. This is despite a <a href="https://www.msf.org/governments-must-demand-all-coronavirus-covid-19-vaccine-deals-are-made-public">huge investment of public funding</a> in the development of many vaccines.</p>
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<span class="caption">It’s estimated most high-income countries will achieve widespread vaccination coverage by the end of 2021, but low- and middle-income countries will have to wait.</span>
<span class="attribution"><span class="source">John Locher/AP</span></span>
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<p>The intellectual property rights that impede rapid scaling-up of vaccine production are enshrined in the World Trade Organization’s <a href="https://www.wto.org/english/tratop_e/trips_e/intel2_e.htm">Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS)</a>. This agreement requires that WTO members make available 20-year patents for new pharmaceutical products, along with other types of intellectual property protection. </p>
<p>TRIPS includes safeguards like <a href="https://www.wto.org/english/tratop_e/trips_e/public_health_faq_e.htm">compulsory licensing</a>, which governments can use to enable patented inventions to be produced without the consent of the patent owner in situations like a public health emergency. </p>
<p>But these are time-consuming and difficult to use, and they only apply to patents and not the other types of knowledge, data and information that are needed to manufacture vaccines.</p>
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Read more:
<a href="https://theconversation.com/3-ways-to-vaccinate-the-world-and-make-sure-everyone-benefits-rich-and-poor-155943">3 ways to vaccinate the world and make sure everyone benefits, rich and poor</a>
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<h2>Australia’s support needed for global solutions to vaccine scarcity</h2>
<p>Two important mechanisms have been proposed to solve this problem of artificial vaccine scarcity and enable production of COVID-19 medical products to be rapidly scaled up. Neither has received Australia’s support to date.</p>
<p>India and South Africa <a href="https://healthpolicy-watch.news/77719-2/">put a proposal to the WTO</a> in October 2020 that certain intellectual property rights in the TRIPS agreement be waived for COVID-19 medical products during the pandemic. This proposal, known as the “TRIPS waiver”, is <a href="https://www.twn.my/title2/wto.info/2021/ti210220.htm">supported by many developing countries</a>, but opposed by the EU, US and other wealthy countries, including Australia.</p>
<p>The World Health Organization has also set up a mechanism for sharing intellectual property, knowledge and data for COVID-19 products, known as the <a href="https://www.who.int/initiatives/covid-19-technology-access-pool">COVID-19 Technology Access Pool (C-TAP)</a>. </p>
<p>C-TAP has been endorsed by 40 countries and many inter-governmental and civil society organisations, but lacks support from many high-income countries, including Australia. So far, it has been unused.</p>
<p>To address the real problems underlying the current supply blockage, Australia will need to reconsider its opposition to these proposed global solutions.</p><img src="https://counter.theconversation.com/content/156569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Gleeson has received funding in the past from the Australian Research Council. She has received funding from various national and international non-government organisations to attend speaking engagements related to trade agreements and health. She has represented the Public Health Association of Australia on matters related to trade agreements and public health.</span></em></p>Italy’s decision to block export of AstraZeneca vaccines to Australia will likely not impact our vaccine roll-out. But vaccine scarcity is a looming problem in other parts of the world.Deborah Gleeson, Associate professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1552582021-03-03T09:07:29Z2021-03-03T09:07:29ZVaccine nationalism will block our path out of the pandemic – so how do we resist our tribal instinct?<p>Most nations are currently focusing their efforts to defeat the pandemic within their own borders, under pressure to help their citizens first. But this is a global problem and governments need to work together to eradicate COVID. To avoid hardening attitudes against helping other countries, governments need to change how they talk about the pandemic. They must resist the urge to blame other countries. The emphasis must now be on the need for a global response. </p>
<p>We are psychologically driven to help people from our own tribe, or in-group, over <a href="https://link.springer.com/book/10.1007/978-3-319-53026-0">members of out-groups</a>. This is what we are now witnessing in the allocation of resources to fight COVID. Around the world, governments are trying to vaccinate their own populations first. There is, so far, little talk of helping other countries. </p>
<p>My research <a href="https://onlinelibrary.wiley.com/doi/10.1002/casp.2487">involving over 2,000 Britons</a> suggests that the UK population supports their government’s prioritisation of domestic vaccination. Most people surveyed supported investment in measures that would benefit British (in-group) people over offering financial aid to other countries in the EU or sub-Saharan Africa.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A graph showing that respondents were more positive about helping people in their own country than those in other countries." src="https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387030/original/file-20210301-22-1tfyw1b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Helping the in-group first.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>When asked whether they would donate money to help others who are struggling due to the pandemic, over 60% of British participants indicated that they would donate to help other British people, whereas less than 40% indicated that they would donate to help people in other countries. </p>
<p>If governments are to start cooperating more internationally, it is essential to shift public opinion away from such in-group favouring biases. But the survival of democratic governments depends on their popularity with the electorate. So it is vital for decision makers to draw on approaches that can counteract our human impulse for tribalism, and build public support for sharing resources across borders. </p>
<p>Hoarding vaccines is, ultimately, self-defeating. Vaccinating the entire population of one country is not going to guarantee lasting protection if the virus is allowed to run rampant in other parts of the world, mutating into potentially vaccine-resistant variants. </p>
<p>But the desire to protect the in-group is deep seated. When things go wrong, we find it much easier to blame others than look inwards. More than half of our research participants blamed other countries – not Britain – for the ongoing pandemic.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Figure.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A chart showing that most respondents blamed other countries for the pandemic rather than their own" src="https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387031/original/file-20210301-16-ye6mbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The blame game in action.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Shouldering a fair share of blame</h2>
<p>My research points to actions that can stop feeding self-defeating in-group tribalism. For a start, governments need to stop pinning the blame for the pandemic on other countries, as for example both the US and China have <a href="https://www.ft.com/content/f1b30f2c-84aa-4595-84f2-7816796d6841?shareType=nongift">done</a>. </p>
<p>In my studies, participants who blamed other nations for starting or spreading COVID were less willing to offer help across national boundaries. Blaming other nations not only reduced willingness to support those scapegoated nations, it decreased willingness to assist all other out-group countries, even those perceived as blameless. </p>
<p>Being honest about each nation’s own role in perpetuating the pandemic is also vital. British participants who were more aware of their own country’s role in spreading the virus were more likely to support global coordination and resource-sharing to defeat CCOVID. Honesty about <a href="https://www.bmj.com/content/372/bmj.n137.full">failings</a>, such as the delay in locking down in spring 2020, could help encourage an honest perspective about the British contribution to the problem. That, in turn, could boost public support for the need to act beyond British borders.</p>
<h2>Emphasising our common fate</h2>
<p>Being open to joint action to overcome this global crisis was also more common among participants who were aware of our interdependency with other nations. Clear messaging on this front will also be essential.</p>
<p>Current broad public optimism about the success of the British national vaccination programme is understandable but we must be clear that can only get us so far. To lend weight to the importance of an international perspective, politicians must go beyond platitudes and lip service. Words must be backed up, in practical terms. That means vaccine resource sharing. </p>
<p>Faced with a rampant virus, the temptation for all governments is to focus on protecting their own populations – to stick within in-group borders. For many nations, this approach is being justified by the argument that we need to make ourselves safe before helping others. But this can only be a short-term strategy. Unless we change the narrative, the longer-term strategy is at serious risk.</p>
<p>If we keep stoking in-group tribalism, governments risk resistance from a vaccinated electorate with little to no desire to help any out-group members in other countries. Faced with a COVID-ravaged economy, exhausted public health system and record levels of public debt there will be emotive arguments that we cannot afford to share our resources. We might prefer our own tribe but, to the virus, the world’s population is one big tribe. There is no out-group.</p><img src="https://counter.theconversation.com/content/155258/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hanna Zagefka does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Governments are naturally under pressure to focus on national rollouts. But the truth is none of us is safe until we’re all safe.Hanna Zagefka, Professor of Social Psychology, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1543512021-02-03T14:55:38Z2021-02-03T14:55:38ZThe UK should share the vaccine with the other countries – but only after all the vulnerable have been vaccinated<p>“We are all in this together”, except that we are not. One of the most widely used slogans of the pandemic might need to be adjusted. Maybe: “We are all in this together, until there is a way out.”</p>
<p>The way out is the COVID-19 vaccine. Or more precisely, the many COVID-19 vaccines. The UK has already approved three, with two more pending a decision by the drugs regulator. </p>
<p>Of these, one has been developed in the UK by the University of Oxford, with millions of pounds of funding from the UK government (aka, UK taxpayers), and made by the British/Swedish company AstraZeneca. Part of its manufacturing is in Europe, where Belgian plants have had <a href="https://www.pharmaceutical-technology.com/comment/covid-19-vaccine-manufacturing-disruptions/">production problems</a> that have threatened the future supply to the EU. </p>
<p>Three vaccines are produced by US pharmaceutical companies (Pfizer, Moderna and Novavax), although the Pfizer vaccine has been developed in partnership with the German biotechnology company BioNTech, and the Novavax one is being made in the UK. One vaccine is made by Janssen, based in Belgium but owned by the American firm, Johnson & Johnson. </p>
<p>These geographical details might seem superfluous, but they are already making post-Brexit vaccine distribution more complicated than it should be. In the meantime, the World Health Organization has expressed concerns over the fading commitment to Covax, the programme set up to guarantee equitable access to COVID-19 vaccines around the world.</p>
<p>This is the moment countries part ways in their fight against COVID-19. We are no longer in this together. That is because we never chose to be in it together. We just happened to find ourselves in a pandemic that didn’t spare anyone. Now that we do have some choice, each country is taking care of their own first.</p>
<h2>Vaccine nationalism</h2>
<p>According to vaccine nationalism, each nation should prioritise vaccinating their own people over giving vaccines to other countries struggling with supplies. </p>
<p>The UK has more availability than most other countries and a strong claim to keep the vaccines, considering the substantial contribution of UK taxpayers to research on the Oxford vaccine. </p>
<p>To date, the UK has vaccinated, with at least one dose, roughly as many people as <a href="https://ourworldindata.org/covid-vaccinations">all European countries together</a>. And in most areas of England, more than 80% of people aged 80 or over and in care homes have received <a href="https://www.bbc.co.uk/news/health-55274833">at least the first dose</a>. Vaccination delays in other countries translate into lives lost. So once the UK has vaccinated its most vulnerable people, there is a question whether it should give some of its vaccines to other countries.</p>
<p>Governments have special responsibilities towards their own. Basic requirements of trust and fairness towards their own taxpayers justify some degree of vaccine nationalism. </p>
<p>However, these “special” responsibilities do not mean that countries only have responsibilities towards their own. The line between nationalism and mere selfishness is often thin, but it exists. This is why, for example, once countries have provided for the basic needs of their citizens, they often destine part of public money to foreign aid. Vaccines should be seen as a kind of foreign aid, for the same reasons.</p>
<p>But importantly, in this case, the divide between national interest and global interest might be less marked than the “nationalism” terminology suggests. </p>
<h2>Long-term interests</h2>
<p>Prioritising vaccine distribution in the UK will serve the short-term goal of protecting the NHS. At the moment, this is realistically all the UK can aim for. And indeed, that is what the government has a moral obligation to do.</p>
<p>Yet this short-term goal does not significantly contribute to containing the pandemic. For that, we need a collective effort. </p>
<p>One important consideration is that the burdens of pandemic measures are mostly borne by young generations: they have more to lose and less to gain from restrictions, given the significantly lower risks of COVID-19 and the higher cost of restrictions for them, such as the risk of job redundancy.</p>
<p>Young generations’ interests are part of the longer-term interests that have so far been sacrificed, possibly unfairly, but towards which governments also have special obligations. Younger people are likely to benefit more from a quicker return to normality than from earlier vaccination for themselves. </p>
<p>Once the elderly and vulnerable have been vaccinated, the priority should be to restore economic activities, international trade and freedom of movement across national borders to protect the actual long-term interests of the young. This is what governments owe to young generations so far disproportionately burdened by restrictions.</p>
<p>In a globalised world, these medium-term to long-term interests require that other countries also satisfactorily contain the virus and return to normality. It is in the UK’s long-term national interest that as many other countries as possible keep the infection under control through vaccines.</p>
<p>Ensuring that vulnerable people in other countries are vaccinated before young people in the UK would better serve young British people’s long-term interests.</p>
<p>A return to some form of normality that is only national is not a return to normality at all. National and global interests, in the long term, will inevitably converge.</p><img src="https://counter.theconversation.com/content/154351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alberto Giubilini receives funding from AHRC/UKRI and has previously received funding from the Wellcome Trust</span></em></p>Vaccines should be seen as a kind of foreign aid.Alberto Giubilini, Senior Research Fellow, Practical Ethics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1469082020-09-27T11:47:51Z2020-09-27T11:47:51ZCanada’s ‘me first’ COVID-19 vaccine strategy may come at the cost of global health<figure><img src="https://images.theconversation.com/files/359957/original/file-20200925-22-deh9w7.jpg?ixlib=rb-1.1.0&rect=79%2C0%2C4698%2C2988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research technician Leon McFarlane handles a blood sample from a volunteer in the laboratory at Imperial College in London, where a COVID-19 vaccine is under development, on July 30, 2020.</span> <span class="attribution"><span class="source">(AP Photo/Kirsty Wigglesworth)</span></span></figcaption></figure><p>When the throne speech was delivered on Sept. 23, Canada had already committed over $1 billion in advance purchase agreements with five drug companies for a minimum of <a href="https://www.ctvnews.ca/politics/canada-signs-deals-for-supply-of-sanofi-vaccine-candidate-antiviral-drug-to-treat-covid-19-1.5114927">154 million vaccine doses</a>, if and when these candidate vaccines are proven effective and safe. Two days later, Canada inked another agreement with another company for <a href="https://ipolitics.ca/2020/09/25/canada-signs-deal-with-astrazeneca-for-20m-doses-of-vaccine-candidate/">20 million more doses</a>, hedging its bets on which of the vaccine contenders will be the first to arrive. </p>
<p>In doing so, Canada joins the premier league of the vaccine nationalists, a handful of rich countries that has pre-purchased (so far) more than half the world’s expected <a href="https://www.oxfam.org/en/press-releases/small-group-rich-nations-have-bought-more-half-future-supply-leading-covid-19">short-term supply of vaccines</a>. </p>
<p>It is understandable that countries want to ensure their ability to protect their citizens’ health. But most of the world’s population lives in countries without the same financial resources to play the global “me first” vaccine contest. Efforts to elevate national interests over collective global health result in slower progress and limited global capacity to pool resources, while placing the interests of wealthy countries over others, with devastating effects. </p>
<p><a href="https://www.mobs-lab.org/uploads/6/7/8/7/6787877/global_vax.pdf">Recent modelling</a> compared two scenarios for allocating the first three billion doses of a vaccine that is 80 per cent effective. The “unco-operative” scenario — in which two billion doses went straight to high-income countries, and the rest to everybody else — would lead to 28 per cent more deaths than a “co-operative” scenario, in which the three billion doses are distributed globally, proportional to population size.</p>
<h2>What can Canada do?</h2>
<p>To begin, our pledge to the World Health Organization’s <a href="https://www.gavi.org/covid19/covax-facility">COVAX Facility</a>’s Advanced Market Commitment (AMC). should, at a minimum, match what we invest in procuring vaccine for use within Canada. The facility manages the world’s largest and most diverse portfolio of vaccine candidates. High-income countries like Canada that join COVAX have the option to purchase approved vaccines through the facility, even if they have already entered into bilateral purchase agreements with vaccine companies. On Sept. 25, Canada announced that it would do so, committing $220 million to <a href="https://www.theglobeandmail.com/politics/article-canada-commits-440-million-to-global-covid-19-vaccine-program-and/">purchase 15 million more vaccine doses</a> from the facility if and as they are approved.</p>
<p>Arguably of more importance, the facility’s AMC will provide vaccines to more than 90 eligible poorer countries unable to afford them on their own. The AMC needs to raise $2 billion by December to do so, with the short-term goal of immunizing three per cent of all COVAX countries’ populations. As of Sept. 21, only $700 million <a href="https://www.gavi.org/vaccineswork/covax-explained">had been promised</a>. On Sept. 25, <a href="https://ipolitics.ca/2020/09/25/canada-signs-deal-with-astrazeneca-for-20m-doses-of-vaccine-candidate/">Canada committed $220 million to the AMC, on top of $25 million</a> it had already given. This is welcome and commendable, but it is also inadequate. </p>
<p>The AMC’s longer-term aim is <a href="https://www.sciencemag.org/news/2020/09/who-unveils-global-plan-fairly-distribute-covid-19-vaccine-challenges-await%22%22">to reach 20 per cent</a> — a goal that will allow health-care workers and vulnerable populations in poor countries to receive vaccines — but this will depend entirely on how generously high-income countries, philanthropists and drug companies donate to the AMC.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5opR6x6NMpQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">COVAX aims to ensure global equitable access to COVID-19 vaccines.</span></figcaption>
</figure>
<p>Much more AMC funding is needed now, and going forward. We argue that Canada should commit a dollar-per-dollar amount to the AMC based on what it spends on its own vaccine purchases. This would mean providing up to $1 billion more than its current AMC pledge, with funds flowing through our country’s official development assistance (ODA) envelope. Canada has global obligations under international declarations to do so. </p>
<p>Canada says it is a voice for <a href="https://www.international.gc.ca/world-monde/issues_development-enjeux_developpement/human_rights-droits_homme/advancing_rights-promouvoir_droits.aspx?lang=eng">equity and human rights</a>, at home and on the global stage. Actions speak louder than words. Canada in recent years has not been particularly generous in its overseas assistance. We ranked 17th out of 30 of the OECD club of <a href="https://public.tableau.com/views/ODA-GNI_15868746590080/ODA2019?:display_count=y&publish=yes&:origin=viz_share_link?&:showVizHome=no#1">donor nations</a> in 2019, contributing just 0.27 per cent of our gross national income, with <a href="https://donortracker.org/country/canada?gclid=CjwKCAjwwab7BRBAEiwAapqpTMrXoRhTX4FvKLNU-8Q285iaTh7FE1IIILlq14Xac5sgfhmNno5MzhoCX6gQAvD_BwE">no forseeable increase</a>. A $1 billion immediate AMC top-up would still not lift us to our long-pledged 0.7 per cent ODA target.</p>
<p>One billion dollars sounds like a lot of money. But it is only <a href="https://www.bankofcanada.ca/2020/07/fad-press-release-2020-07-15/">one-fifth the amount the federal government has borrowed weekly</a> since March from the Bank of Canada (which it owns) to finance its pandemic assistance programs. Most less-endowed countries lack the same ability to borrow indefinitely from their own central banks and instead must turn to foreign creditors, with the debt-burden risks that entails. Or do without.</p>
<h2>Vaccine manufacturing</h2>
<p>According to the CEO of the world’s largest vaccine maker, the Serum Institute of India, even with expanded global capacity, it may take until 2024 before there are <a href="https://www.sfgate.com/science/article/Pharma-CEO-Serum-Institute-of-India-vaccine-15566294.php">enough doses for the world’s population</a>. In addition to ensuring more generous support for the COVAX Facility, Canada can also ramp up its own vaccine manufacturing capacity. It’s already on a pathway to do so, with the government’s $126-million investment for a <a href="https://nrc.canada.ca/en/covid-19-response-building-infrastructure">new facility in Montréal</a>. The facility’s goal is to produce two million vaccine doses per month for domestic use by summer 2021. </p>
<p>Why not double-down on this investment, and reserving half the output for AMC use to meet urgent global needs? This would signify to all Canadians the importance of a collective response to this pandemic. </p>
<h2>Public health is global</h2>
<p>As the world eagerly awaits arrival of an effective vaccine, it’s important to remember three things. First, the longer-term effectiveness of any vaccine will remain uncertain for some time. Second, even if herd immunity to COVID-19 eventually develops, there will almost certainly be <a href="https://time.com/5820607/nathan-wolfe-coronavirus-future-pandemic/">another novel infection</a> in the not-so-distant future. Third, one way to deal with both future pandemic risks and the present short supply of COVID-19 vaccine is to embrace the range of <a href="https://doi.org/10.1016/S0140-6736(20)31927-9">non-pharmaceutical interventions</a> that can flatten and even contain infectious curves. This is especially so in those countries that are home to the half of humanity who still lack access to essential health care. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gov. Gen. Julie Payette, wearing a white suit, sits in the ornate chair reserved for the governor general, on a raised platform. The prime minister sits in front of her on the left, with a man wearing a uniform behind him. They all wear black face masks." src="https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/359955/original/file-20200925-14-2w4vw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gov. Gen. Julie Payette and Prime Minister Justin Trudeau wait during the throne speech in the Senate chamber in Ottawa on Wednesday, Sept. 23, 2020. The speech noted Canada’s commitment to ensuring global access to a COVID-19 vaccine</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<p>All countries need stronger public health workforces: more nurses, testers, contact tracers and community health workers. All countries need <a href="https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(uhc)">universal health coverage</a>, one of the Sustainable Development Goal targets to which the world (Canada included) committed to achieve by 2030. But it is the poorer half of humanity who needs this more urgently.</p>
<p>So, if Canada and other rich countries in their vaccine nationalism continue inadvertently to crowd out access for poor countries, they should compensate by massively underwriting the investments such countries need to provide the social protection, income support and food security basic to their citizens’ health, and to strengthen their health systems with the public health capacity to suppress outbreaks as they arise. </p>
<p>It is in our own national interest to do so. As the Sept. 23 <a href="https://www.canada.ca/en/privy-council/campaigns/speech-throne/2020/stronger-resilient-canada.html">throne speech</a> concluded:</p>
<p>“We cannot eliminate this pandemic in Canada unless we end it everywhere.”</p><img src="https://counter.theconversation.com/content/146908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ronald Labonte receives funding from Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, International Development Research Centre, National Institutes of Health, National Medical Health and Research Council, and Australian Research Council. He is an active member of the Canadian Coalition for Global Health Research, the international Peoples Health Movement, and co-leads the Global 1 Health Network on the Global Governance of Infectious Disease and Antimicrobial Resistance. </span></em></p><p class="fine-print"><em><span>Katrina Plamondon receives funding for research and knowledge translation activities from the Michael Smith Foundation for Health Research, the Canadian Institutes for Health Research, the Vancouver Foundation, the Canadian Partnership for Women and Children's Health-Canadian Collaborative for Global Health, the BC Support Unit, and the Kelowna General Hospital Foundation. She has also been the Principal Investigator for grants funded by the International Development Research Centre and the Global Health Research Initiative. Dr. Plamondon is Registered Nurse, member of the Nurses & Nurse Practitioners of British Columbia, member of the Canadian Society for International Health, and an active member of the Canadian Coalition for Global Health Research, currently serving as co-chair of the University Advisory Council. </span></em></p><p class="fine-print"><em><span>Mira Johri is on the Board of Directors of the Canadian Coalition for Global Health Research and serves as an Independent Expert to Gavi, the Vaccine Alliance. No personal remuneration is received for these roles. Her research is currently funded by the Canadian Institutes of Health Research, the Bill and Melinda Gates Foundation, IC-IMPACTS Network Centre of Excellence, and Grand Challenges India. </span></em></p><p class="fine-print"><em><span>Srinivas Murthy receives research funding from the Canadian Institutes of Health Research and the Wellcome Trust. He receives salary support through the University of British Columbia as the Health Research Foundation chair in pandemic preparedness research. </span></em></p>With $1 billion in advance purchase agreements for COVID-19 vaccines, Canada has joined the vaccine nationalists: rich countries buying up more than half the global short-term supply of vaccine.Ronald Labonte, Professor and Distinguished Research Chair, Globalization and Health Equity, L’Université d’Ottawa/University of OttawaKatrina Plamondon, Assistant Professor, School of Nursing, Faculty of Health & Social Development, University of British ColumbiaMira Johri, Professeure titulaire, École de santé publique, Université de MontréalSrinivas Murthy, Clinical associate professor, Faculty of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1450562020-09-07T20:12:56Z2020-09-07T20:12:56ZWhy ‘vaccine nationalism’ could doom plan for global access to a COVID-19 vaccine<figure><img src="https://images.theconversation.com/files/356683/original/file-20200907-20-1dgxi07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Russian Direct Investment Fund/EPA</span></span></figcaption></figure><p>Within days of COVID-19 being declared an international public health emergency on <a href="https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)">January 30</a>, multiple groups of <a href="https://www.uq.edu.au/news/article/2020/02/significant-step%E2%80%99-covid-19-vaccine-quest">scientists began working on a vaccine</a>. At the same time, governments began working on back-room deals to lock in their access to these vaccines ahead of anyone else.</p>
<p>With “<a href="https://theconversation.com/politics-with-michelle-grattan-jane-halton-on-the-risk-of-vaccine-nationalism-142830">vaccine nationalism</a>” increasingly becoming a concern, several international organisations (including the World Health Organization)
have put their diplomatic weight behind the <a href="https://www.gavi.org/covid19/covax-facility">COVID-19 Global Access (COVAX) initiative</a>. This encourages countries to sign up to a deal that is designed to make 2 billion doses of vaccines available by the end of 2021. </p>
<p>So far, <a href="https://www.who.int/news-room/detail/24-08-2020-172-countries-and-multiple-candidate-vaccines-engaged-in-covid-19-vaccine-global-access-facility">172 countries</a>, including Australia, have signed up to the initiative; they must now make that commitment binding by September 18 and start paying into a fund to support vaccine research by October 9.</p>
<p>There are a couple notable exceptions. Last week, the United States <a href="https://www.washingtonpost.com/world/coronavirus-vaccine-trump/2020/09/01/b44b42be-e965-11ea-bf44-0d31c85838a5_story.html">opted out of the plan</a>, seeking instead to go it alone. Russia, too, has <a href="https://www.washingtonpost.com/world/2020/09/03/why-coronavirus-vaccine-nationalism-is-winning/">decided against joining</a>, and China has yet to commit.</p>
<p>This means some of the world’s largest countries have refused to participate, weakening the collective aims of the COVAX initiative by buying up vaccine stock.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1300878414765789184"}"></div></p>
<h2>Why vaccine hoarding is a concern</h2>
<p><a href="https://indianexpress.com/article/explained/what-is-vaccine-nationalism-how-does-it-impact-the-fight-against-covid-19-6561236/">Vaccine nationalism</a> is when governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries.</p>
<p>Though we expect governments to make these arrangements to protect their citizens, the downside is it creates supply problems that leave poorer countries without access to life-saving vaccines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/creating-a-covid-19-vaccine-is-only-the-first-step-itll-take-years-to-manufacture-and-distribute-144352">Creating a COVID-19 vaccine is only the first step. It'll take years to manufacture and distribute</a>
</strong>
</em>
</p>
<hr>
<p>Because no one knows which vaccine will be effective, some wealthy countries are <a href="https://www.wsj.com/articles/in-race-to-secure-covid-19-vaccines-worlds-poorest-countries-lag-behind-11598998776">hedging their bets</a> by buying up vast quantities of multiple vaccines, before scientists have completed clinical trials and proven the vaccines to be safe or effective.</p>
<p>In total, wealthy countries have <a href="https://www.wsj.com/articles/in-race-to-secure-covid-19-vaccines-worlds-poorest-countries-lag-behind-11598998776">already signed</a> deals to secure 3.7 billion doses from western drug-makers, according to a report last week.</p>
<p>To date, the United Kingdom has been the worst offender, with a recent estimate showing it has <a href="https://www.nature.com/articles/d41586-020-02450-x">pre-ordered enough vaccine for five doses per person</a>. The government has also <a href="https://www.ft.com/content/99f167ea-875b-4add-b3e2-749d208619f6">announced plans</a> to sign additional agreements with manufacturers to lock in even more supplies.</p>
<p>Last week, Canada also signed deals with two companies to secure a <a href="https://www.theglobeandmail.com/canada/article-ottawa-signs-covid-19-vaccine-deals-with-two-us-companies/">guaranteed 88 million doses</a>, enough for every citizen to be vaccinated at least twice.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/356688/original/file-20200907-24-l4zmd7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The chair of the UK Vaccine Taskforce says the country is ‘not pursuing a strategy of vaccine nationalism’.</span>
<span class="attribution"><span class="source">Andrew Parsons/Downing Street Handout/EPA</span></span>
</figcaption>
</figure>
<h2>Is COVAX the ‘fastest way’ to end the pandemic?</h2>
<p>The WHO has made a push to get all countries to support the COVAX initiative, with Director-General Tedros Adhanom Ghebreyesus <a href="https://news.un.org/en/story/2020/08/1070912">stressing</a> it is </p>
<blockquote>
<p>the fastest way to end this pandemic. </p>
</blockquote>
<p>Certainly, COVAX is a step in the right direction. The initiative effectively creates the world’s largest advance market commitment for vaccines, outstripping any deals countries make independently. </p>
<p>Low-income countries that have signed up to the plan will also gain access to safe and affordable vaccines they might otherwise be prevented from accessing for years.</p>
<p>While the WHO and its main partners — the global vaccine alliance GAVI and the Coalition for Epidemic Preparedness Innovations — are certainly to be congratulated for launching this initiative, it is not the cure-all some are claiming it to be, for several reasons.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whoever-invents-a-coronavirus-vaccine-will-control-the-patent-and-importantly-who-gets-to-use-it-138121">Whoever invents a coronavirus vaccine will control the patent – and, importantly, who gets to use it</a>
</strong>
</em>
</p>
<hr>
<h2>The problems with a global vaccine bank</h2>
<p>The first challenge is that COVAX does not prevent countries signing their own independent deals with manufacturers, as the UK, Canada and <a href="https://www.abc.net.au/news/2020-09-06/free-coronavirus-vaccine-to-be-made-available-throughout-20212/12635174">recently Australia</a> have done. This could place additional strain on what are expected to be already limited supplies.</p>
<p>These deals are expected to further <a href="https://news.un.org/en/story/2020/08/1070912">drive up prices</a>, potentially making them even more unaffordable for many poorer countries. </p>
<p>While some manufacturers have pledged to make the vaccines <a href="https://observer.com/2020/08/covid19-vaccine-price-comparison-moderna-pfizer-novavax-johnson-astrazeneca/">available on a not-for-profit basis</a>, others have not. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-oxford-deal-is-welcome-but-remember-the-vaccine-hasnt-been-proven-to-work-yet-144726">The Oxford deal is welcome, but remember the vaccine hasn't been proven to work yet</a>
</strong>
</em>
</p>
<hr>
<p>A second problem is the commitment for 2 billion doses by the end of 2021 is far too small, given most of the vaccines currently in Phase 3 clinical trials require up to <a href="https://www.businessinsider.com.au/coronavirus-vaccine-booster-follow-up-shots-needed-over-time-2020-7?r=US&IR=T">two or three doses to confer immunity</a>. </p>
<p>When divided among all the countries that have signed up to COVAX, it means each country will receive a very small supply. As a result, this could encourage governments to seek out additional independent deals to meet the demands of their populations.</p>
<p>A third issue is that while COVAX is wisely not putting all its eggs in one basket — it is <a href="https://news.un.org/en/story/2020/08/1070912">supporting nine vaccines in development</a> and evaluating another nine for possible support — the 2 billion doses will likely be sourced from multiple manufacturers. </p>
<p>As a result, some governments may not be happy with the vaccine they are allocated under the plan, particularly if one vaccine appears to be more effective than another or is produced by a country they don’t trust. </p>
<p>This could lead to disagreements and vaccines sitting unused while the politics are sorted out.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/356727/original/file-20200907-24-12f968a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The University of Queensland’s vaccine is one of the nine supported by CEPI as part of the COVAX initiative.</span>
<span class="attribution"><span class="source">Glenn Hunt/AAP</span></span>
</figcaption>
</figure>
<h2>What the absence of the US means</h2>
<p>President Donald Trump’s decision to not join COVAX is potentially one of the most serious, as it has implications for the US and the world.</p>
<p>By refusing to join COVAX, the US has intentionally excluded itself from a <a href="https://www.washingtonpost.com/world/coronavirus-vaccine-trump/2020/09/01/b44b42be-e965-11ea-bf44-0d31c85838a5_story.html">raft of promising vaccines that are still under development</a>. That is a particularly risky strategy, especially if the current US vaccine candidates are shown to be less effective than others. </p>
<p>While this could be rectified by Trump arranging separate deals with COVAX-supported vaccine developers to gain access, it would likely prove a very costly exercise that would also see the US having to wait until other countries’ vaccine orders are filled. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/356719/original/file-20200907-22-g92l4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Phase 3 clinical trials of a vaccine being developed in the US by Moderna and the National Institutes of Health began in late July.</span>
<span class="attribution"><span class="source">Hans Pennink/AP</span></span>
</figcaption>
</figure>
<p>Some experts have pointed to the fact that by potentially missing out on the first round of vaccines, the US economy will suffer and <a href="https://thehill.com/policy/healthcare/514657-us-wont-join-global-coronavirus-vaccine-initiative">lengthen the pandemic</a>. Others have highlighted the “go it alone” approach further tarnishes the United States’ reputation as a <a href="https://www.rollingstone.com/politics/politics-news/covid-19-trump-who-covax-alone-1053970/">reliable partner</a>.</p>
<p>Either way, it seems rather short-sighted given the <a href="https://www.inquirer.com/health/coronavirus/trump-world-health-organization-coronavirus-covid-19-vaccine-20200901.html">WHO has already stressed</a> that countries need not choose between COVAX and signing independent deals with vaccine manufacturers.</p>
<h2>A good first step, but more action is needed</h2>
<p>A COVID-19 vaccine is likely going to be the only way the world will return to any semblance of normal life. Every country needs access to a safe and effective vaccine, and the COVAX initiative currently offers the best way to achieve that. </p>
<p>By itself, COVAX will not be enough. We need a global commitment and framework for how governments will rapidly upscale manufacturing and distribution of a safe and effective vaccine. </p>
<p>Let’s hope we can come together sooner rather than later to see such an agreement come to pass.</p><img src="https://counter.theconversation.com/content/145056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Kamradt-Scott is an Associate Professor in the Centre for International Security Studies, University of Sydney, and a Non-Resident Fellow of the United States Studies Centre. He receives funding from the Australian Research Council and the Canadian Institute for Health Research. Adam is also a director of the Global Health Security Network. </span></em></p>More than 170 countries have signed up to the Global Access (COVAX) initiative, but vaccine hoarding has already begun by many wealthy countries — leaving poorer nations potentially in the lurch.Adam Kamradt-Scott, Associate professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1443522020-08-17T06:00:01Z2020-08-17T06:00:01ZCreating a COVID-19 vaccine is only the first step. It’ll take years to manufacture and distribute<p>The world is hoping a safe and effective COVID-19 vaccine will soon become available. So far, <a href="https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html">more than 160 candidate vaccines</a> are in development.</p>
<p>Some 31 of these have entered human clinical trials. One of them is Russia’s “<a href="https://theconversation.com/russias-coronavirus-vaccine-hasnt-been-fully-tested-doling-it-out-risks-side-effects-and-false-protection-144347">Sputnik V</a>”, which was granted approval by the country’s health ministry last week. But the World Health Organisation (WHO) and a <a href="https://www.nature.com/articles/d41586-020-02386-2">large number of international experts</a> have urged Russia to conduct more testing to ensure the vaccine’s safety before using it.</p>
<p>But even if this candidate and others are proven to be safe and effective, developing the vaccine is just the first step. </p>
<p>Some of the biggest challenges in getting everyone vaccinated still lie ahead.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/russias-coronavirus-vaccine-hasnt-been-fully-tested-doling-it-out-risks-side-effects-and-false-protection-144347">Russia's coronavirus vaccine hasn't been fully tested. Doling it out risks side effects and false protection</a>
</strong>
</em>
</p>
<hr>
<h2>Challenge 1: manufacturing the vaccine</h2>
<p>The first major challenge after a vaccine is developed is to produce enough of it to start vaccination programs. <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30466-6/fulltext">One estimate</a> puts global vaccine production capacity at up to 6.4 billion doses per year, though this is based on single-dose influenza vaccines. </p>
<p>But some of the COVID-19 vaccines currently in development require <a href="https://jamanetwork.com/journals/jama/fullarticle/2769612">two or three injections</a>. This means, if the same technology for COVID-19 vaccines is required as for influenza vaccines, global production is severely reduced.</p>
<p>It has been estimated that to achieve sufficient levels of immunity among the global population with a two-dose vaccine, we would need <a href="https://www.abc.net.au/news/2020-06-09/who-will-get-coronavirus-vaccine-first/12316656">between 12 billion and 15 billion doses</a> – roughly twice the world’s current total vaccine manufacturing capacity. </p>
<p>Shifting to exclusively manufacture a COVID-19 vaccine will also mean <a href="https://www.nature.com/articles/d41586-020-01063-8">shortages of other vaccines</a> such as those for preventable childhood diseases such as measles, mumps and rubella. So prioritising COVID-19 could cost many other lives.</p>
<h2>Can we buy vaccines in advance?</h2>
<p>Given these production constraints, governments have previously tended to sign advance purchase agreements with vaccine manufacturers to guarantee access. These commercial-in-confidence agreements are usually signed in secret, often with different prices being charged to different governments depending on whether they are the first customer or 30th and their ability to pay. </p>
<p>It also means countries that can afford to buy vaccine stocks in advance get first access, leaving poorer nations to miss out or be forced to wait years. This has happened on at least two previous occasions.</p>
<p>In 2007, Indonesia found it couldn’t purchase H5N1 influenza (bird flu) vaccines despite being one of the worst-affected countries at the time. This was because several other richer countries had already organised advanced purchase agreements, and led Indonesia to temporarily withhold sharing virus samples with the WHO in retaliation. And in 2009, rich nations bought up almost all the stock of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30763-7/fulltext">H1N1 influenza vaccines</a>, crowding out less-developed nations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C2950%2C1994&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352626/original/file-20200813-22-dv8p5z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A ‘my country first’ policy means richer countries can secure supply of vaccines at the expense of poorer countries.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/MwPkry9H4gI">Morning Brew/Unsplash</a></span>
</figcaption>
</figure>
<p>Most of the world’s leaders, including Australia’s Prime Minister Scott Morrison, have stated that a successful COVID-19 vaccine <a href="https://www.theaustralian.com.au/news/latest-news/australia-pledges-to-share-coronavirus-vaccine-pm/news-story/c1e5f9dd7856db018b7c311918a52579">should be shared equitably</a>. In July, Australia was one of 165 countries to join the “COVAX” initiative launched by the WHO, global vaccine alliance GAVI, and the Coalition for Epidemic Preparedness Innovations. The initiative aims to deliver 2 billion doses of a COVID-19 vaccine <a href="https://www.gavi.org/news/media-room/more-150-countries-engaged-covid-19-vaccine-global-access-facility">by the end of 2021</a>.</p>
<p>Countries representing 60% of the world’s population have signed up to this initiative, but not everyone has and we’ve already seen a number of instances in which governments have <a href="https://www.bmj.com/content/368/bmj.m1100">sought to gain priority access over others</a>. The problem with this <a href="https://www.sciencemag.org/news/2020/07/vaccine-nationalism-threatens-global-plan-distribute-covid-19-shots-fairly">vaccine nationalism</a> is that rather than being based on equity or need, it will create global supply problems with those countries that have special deals getting access to the vaccine first.</p>
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Read more:
<a href="https://theconversation.com/how-vaccine-nationalism-could-block-vulnerable-populations-access-to-covid-19-vaccines-140689">How 'vaccine nationalism' could block vulnerable populations' access to COVID-19 vaccines</a>
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<h2>Challenge 2: distributing the vaccine</h2>
<p>The second key challenge is distributing the COVID-19 vaccine. Most vaccines need to be transported in cold storage, which presents a problem for many parts of the world where <a href="https://blogs.worldbank.org/energy/what-would-it-take-deploy-covid-19-vaccines-through-sustainable-cold-chains">electricity failure</a> is a common feature of daily life. </p>
<p>The WHO has estimated up to <a href="https://www.unenvironment.org/news-and-stories/story/why-optimized-cold-chains-could-save-billion-covid-vaccines">50% of vaccines are wasted every year</a>, often because of inadequate temperature control in supply chains. </p>
<p>With the marked reduction in international passenger air travel, the movement of cargo has also slowed. This will <a href="https://www.supplychaindive.com/news/coronavirus-vaccine-supply-chain/579835/">need to be addressed</a> with airlines ahead of any attempts to distribute the vaccine.</p>
<p>Beyond the initial transport from the manufacturer, getting the vaccine to rural and remote communities requires sophisticated logistical services, which many <a href="https://www.devex.com/news/sponsored/opinion-why-a-strong-cold-chain-is-more-critical-than-ever-to-defeat-covid-19-97026">poorer countries lack</a>.</p>
<p>Without substantial investment to strengthen international and national supply chains, it will be years before vaccines can reach everyone who needs them.</p>
<h2>How is Australia placed?</h2>
<p>In Australia, <a href="https://www.dailymail.co.uk/news/article-8625881/Australia-not-coronavirus-vaccine-year-doctor-says.html">criticism has emerged</a> the government hasn’t done enough to secure access to vaccines, with some reports also suggesting <a href="https://www.theguardian.com/australia-news/2020/aug/14/australia-lagging-on-contributions-to-global-body-funding-covid-vaccine-research">New Zealand has invested more</a> in global vaccine initiatives. </p>
<p>But Federal Health Minister Greg Hunt <a href="https://www.smh.com.au/politics/federal/advanced-negotiations-australia-aiming-to-lock-in-covid-19-vaccine-deal-20200816-p55m9g.html">said on Sunday</a> that Australia is in “advanced negotiations with a range of different companies with regards to a vaccine,” one of which is reportedly the University of Oxford’s <a href="https://www.abc.net.au/news/2020-07-20/coronavirus-vaccine-oxford-university-can-train-immune-system/12475332">candidate</a>.</p>
<p>While some might argue more needs to be done to secure a COVID-19 vaccine for Australians, it’s not necessarily the best move to enter into advanced purchase agreements. They are expensive, and there’s no guarantee the candidates Australia signs up for will be safe and effective.</p>
<p>Nevertheless, the government’s approach has been to avoid putting all its <a href="https://9now.nine.com.au/a-current-affair/coronavirus-australian-vaccine-covax19-hamstrung-by-lack-of-funding/04b598a5-ecf1-4485-aa30-d750342b1068">eggs in one basket</a>, supporting multiple vaccine initiatives. It has also supported multilateral initiatives such as granting <a href="https://indopacifichealthsecurity.dfat.gov.au/cepi-and-finddx-receive-additional-australian-funding">more than US$10 million to CEPI</a>, one of the key organisations managing the COVAX initiative.</p>
<p>It’s also good to see the government is willing to support initiatives such as COVAX that aim to make the vaccine available to those countries with limited means to pay. While some may see this as excessive altruism, it’s in Australia’s broader interest, given borders are likely to <a href="https://www.theguardian.com/australia-news/live/2020/jun/26/coronavirus-australia-lastest-updates-national-cabinet-scott-morrison-melbourne-victoria-daniel-andrews-testing-arts-theatre-live-news">remain closed until a vaccine</a> has been made widely available. The quicker the world is vaccinated, the sooner we can reopen our borders.</p>
<p>What this means for the average Australian is that we should get ready for a long wait. Even if the Australian government signs an advanced purchase agreement to secure priority access to a safe and effective COVID vaccine, initial supplies are going to be extremely limited. </p>
<p>Priority groups like frontline health-care workers will get first access, followed by those who are more vulnerable to serious illness. If you’re otherwise fit and healthy, you should be prepared that it could take up to a few years after vaccines become available. </p>
<p>If they become available sooner, it will only be because countries have agreed to work together like never before. Let’s hope they can do it.</p>
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<strong>
Read more:
<a href="https://theconversation.com/vaccine-progress-report-the-projects-bidding-to-win-the-race-for-a-covid-19-vaccine-141412">Vaccine progress report: the projects bidding to win the race for a COVID-19 vaccine</a>
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<img src="https://counter.theconversation.com/content/144352/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Kamradt-Scott is an Associate Professor at the University of Sydney, and a Non-Resident Fellow at the United States Studies Centre. He receives funding from the Australian Research Council and the Canadian Institute for Health Research. Adam is also a director for the Global Health Security Network that organises the Global Health Security conferences. </span></em></p>A two-dose coronavirus vaccine would mean we need to produce 12-15 billion doses. This is roughly twice the world’s current total vaccine manufacturing capacity.Adam Kamradt-Scott, Associate professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1433662020-07-27T09:42:07Z2020-07-27T09:42:07ZCoronavirus: how countries aim to get the vaccine first by cutting opaque supply deals<figure><img src="https://images.theconversation.com/files/349380/original/file-20200724-37-yuky4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The rush to be first. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/syringe-vaccine-against-coronavirus-on-background-1694086498">Ivan Krivenko</a></span></figcaption></figure><p>The University of Oxford <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext">recently published</a> promising news about the <a href="https://theconversation.com/oxford-immunologist-on-coronavirus-vaccine-our-early-results-look-highly-promising-141558">results from</a> the phase one/two trials of the vaccine it is developing for COVID-19. The clinical trials, involving 1,077 volunteers in the UK aged 18-55, showed that the AZD1222 vaccine appeared to be safe and generated the all-important dual antibody and <a href="https://theconversation.com/coronavirus-b-cells-and-t-cells-explained-141888">T-cell immune response</a>. </p>
<p>Yet <a href="https://www.statnews.com/2020/07/20/study-provides-first-glimpse-of-efficacy-of-oxford-astrazeneca-covid-19-vaccine/%5D">as encouraging</a> as <a href="https://www.bbc.co.uk/news/uk-53469839">this is</a>, the public-partnership that underpins the project is a concern. Much of the funding came from the UK government, which <a href="https://www.gov.uk/government/news/funding-and-manufacturing-boost-for-uk-vaccine-programme">announced a</a> £65.5 million grant to the University of Oxford in March. Other funding had already come from outside the UK, including from the German Centre for Infection Research (DZIF) and the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) so this was not solely a UK initiative.</p>
<p>Also in March, Oxford reached a licensing agreement with AstraZeneca to commercialise and manufacture the vaccine. But despite this work being largely paid for by the public purse, very little is known about the details of this partnership. There is a lot we don’t know about who will own the intellectual property, how it will be shared and at what price it will be sold. The same is equally true of numerous other public-private partnerships to develop a COVID-19 vaccine. </p>
<p>And while this global pandemic surely demands a globally coordinated response, governments have instead been clamouring to secure their own supplies of the vaccine.</p>
<h2>Vaccine nationalism</h2>
<p>If the Oxford/AstraZeneca vaccine proves successful, the company has undertaken to manufacture up to 30 million doses that will be available for people in the UK by September. This is <a href="https://www.gov.uk/government/news/funding-and-manufacturing-boost-for-uk-vaccine-programme">part of an agreement</a> to deliver 100 million doses in total that would be made available to other countries, but the UK will get access first. </p>
<p>In the same vein, the UK <a href="https://www.bloomberg.com/news/articles/2020-07-20/u-k-orders-90-million-vaccine-doses-from-pfizer-valneva">has placed</a> advance purchase orders for two other vaccine prospects: 30 million doses for the one being developed by Pfizer and BioNTech, and 60 million for another from Valneva of France. Again, these agreements lack transparency. We don’t know, for example, whether the taxpayer will still pay if the drugs don’t work. </p>
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Read more:
<a href="https://theconversation.com/vaccine-progress-report-the-projects-bidding-to-win-the-race-for-a-covid-19-vaccine-141412">Vaccine progress report: the projects bidding to win the race for a COVID-19 vaccine</a>
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<p>We are seeing the same kind of approach elsewhere. In May, the <a href="https://www.hhs.gov/about/news/2020/05/21/trump-administration-accelerates-astrazeneca-covid-19-vaccine-to-be-available-beginning-in-october.html">US reached</a> its own supply agreement with AstraZeneca for AZD1222. The Americans are investing US$1.2 billion (£942 million) in return for a 30,000-person vaccine trial in the US, and the manufacturing capacity to produce at least 300 million doses, with the first doses to be delivered as early as October. Similarly, the US <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-agreement-us-government-600">has a supply deal</a> with the Pfizer/BioNTech project. </p>
<p>Elsewhere, AstraZeneca has <a href="https://www.ox.ac.uk/news/2020-06-14-astrazeneca-supply-europe-400-million-doses-oxford-university-s-vaccine-no-profit">agreed</a> to supply 400 million doses of AZD1222 to Europe starting from the end of the year through the Inclusive Vaccines Alliance (IVA), set up by Germany, France, Italy and the Netherlands. </p>
<p>When Ursula von der Leyen, the European Commission president, unveiled the EU <a href="https://ec.europa.eu/commission/presscorner/detail/en/ip_20_1103">vaccine strategy</a> days later, <a href="https://www.politico.eu/article/vaccine-alliance-casts-shadow-over-commissions-new-strategy/">reportedly to</a> ensure that the union was not left behind in the vaccine race by big spenders like the US, she hailed the IVA as an important step towards joint action between the member states. Tellingly, there was no mention of access to AZD1222 for countries outside the EU. </p>
<p>For other countries, AstraZeneca <a href="https://www.astrazeneca.com/media-centre/press-releases/2020/astrazeneca-takes-next-steps-towards-broad-and-equitable-access-to-oxford-universitys-covid-19-vaccine.html">announced a</a> US$750 million agreement in June with CEPI and Gavi, the Vaccine Alliance, to make, procure and distribute 300 million doses of AZD1222 with delivery starting at the end of the year. AstraZeneca <a href="https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/astrazeneca-serum-institute-of-india-sign-licensing-deal-for-1-billion-doses-of-oxford-vaccine/articleshow/76202016.cms?from=mdr">also signed an agreement</a> with the Serum Institute of India to sub-license AZD1222 to supply 1 billion doses to low- and middle-income countries, with a commitment to provide 400 million by year end. In all cases, little is known about the terms of the agreements. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman scientist working in lab" src="https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349381/original/file-20200724-35-jsn3cs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Lab-orious work.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/syringe-vaccine-against-coronavirus-on-background-1694086498">Gorodenkoff</a></span>
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<p>One important aspect of this lack of transparency concerns pricing. For example, the deals with the IVA and CEPI/Gavi say AstraZeneca will supply the vaccine at no profit during the pandemic. This leaves open the prospect that “no profit” will cease to apply if the World Health Organization <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">declares that</a> this is no longer a pandemic. Because the terms of these agreements have not been fully disclosed, we just don’t know. </p>
<h2>Alternatives</h2>
<p>Without doubting the <a href="https://www.astrazeneca.com/media-centre/press-releases/2020/astrazeneca-takes-next-steps-towards-broad-and-equitable-access-to-oxford-universitys-covid-19-vaccine.html">commitment of AstraZeneca</a> to its stated objective of broad and equitable access to this vaccine, these opaque agreements raise concerns about precisely how publicly funded research, conducted by publicly owned universities, is being privatised. </p>
<p>Other approaches are possible. Along with the UK funding package for the University of Oxford, <a href="https://www.gov.uk/government/news/funding-and-manufacturing-boost-for-uk-vaccine-programme">the government also allocated</a> £18.5 million to Imperial College London for a different COVID-19 vaccine project. Having completed clinical trials, <a href="http://www.imperial.ac.uk/news/199993/imperials-covid-19-vaccine-moves-next-phase/">Imperial announced</a> on July 17 that it was proceeding to the next trial phase, involving 105 participants aged 18-75. </p>
<p>Imperial <a href="https://www.imperial.ac.uk/news/198053/imperial-social-enterprise-accelerate-low-cost-covid-19/">has formed</a> a new social enterprise, VacEquity Global Health, to rapidly develop this vaccine and distribute it as widely as possible in the UK and overseas, including to low- and middle-income countries. This is in partnership with Morningside Ventures, a fund based in Hong Kong that invests in companies for the public good. </p>
<p>Rather than partnering with one company, the <a href="https://www.globalcitizen.org/en/content/imperial-college-london-covid-vaccine-big-pharma/">Imperial model envisages</a> links with multiple manufacturers and waiving royalties and charging a modest amount for its vaccine. Agreements to purchase, manufacture and distribute the vaccine are still being negotiated. </p>
<p>It remains to be seen whether this social enterprise approach proves more successful in achieving equitable access to COVID-19 vaccines in the longer term, but it seems more in line with how we should be tackling this crisis. </p>
<p>Public money invested in publicly funded institutions should be treated as a public good, not as private intellectual property rights to be licensed and traded by private companies without full and proper public scrutiny. The vaccine nationalism that we have seen in the past couple of months only encourages this. At the very least, these agreements need to be fully transparent to address these concerns.</p><img src="https://counter.theconversation.com/content/143366/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duncan Matthews does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Instead of a global response to the pandemic, we’re seeing an outbreak of vaccine nationalism.Duncan Matthews, Professor of Intellectual Property Law, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1406892020-06-17T12:16:53Z2020-06-17T12:16:53ZHow ‘vaccine nationalism’ could block vulnerable populations’ access to COVID-19 vaccines<figure><img src="https://images.theconversation.com/files/341877/original/file-20200615-65956-1c1ni1r.jpg?ixlib=rb-1.1.0&rect=35%2C0%2C5955%2C2586&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is the U.S. trying to jump the queue to get vaccines first?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/flag-formed-by-covid-19-vaccine-and-blood-test-royalty-free-image/1217239367?adppopup=true">Sono Creative / Getty Images</a></span></figcaption></figure><p><a href="https://milken-institute-covid-19-tracker.webflow.io">Hundreds of COVID-19 vaccine candidates</a> are currently being developed. The way emerging vaccines will be distributed to those who need them is not yet clear. The United States <a href="https://www.independent.co.uk/news/world/europe/coronavirus-vaccine-trump-germany-us-dietmar-hopp-carevac-a9404646.html">has now</a> <a href="https://www.bloomberg.com/news/articles/2020-05-13/u-s-to-get-sanofi-covid-vaccine-first-if-it-succeeds-ceo-says">twice</a> indicated that it would like to secure priority access to doses of COVID-19 vaccine. <a href="https://hbr.org/2020/05/the-danger-of-vaccine-nationalism">Other countries</a>, including India and Russia, have taken similar stances. This prioritization of domestic markets has become known as <a href="https://www.theguardian.com/world/2020/may/18/former-who-board-member-warns-world-against-coronavirus-vaccine-nationalism">vaccine nationalism</a>.</p>
<p><a href="https://www.slu.edu/law/faculty/ana-santos-rutschman.php">As a researcher</a> at Saint Louis University’s <a href="https://www.slu.edu/law/health/index.php">Center for Health Law Studies</a>, I have been following the COVID-19 vaccine race. Vaccine nationalism is harmful for equitable access to vaccines – and, paradoxically, I’ve concluded it is detrimental even for the U.S. itself.</p>
<h2>Vaccine nationalism during COVID-19</h2>
<p>Vaccine nationalism occurs when a country manages to secure doses of vaccine for its own citizens or residents before they are made available in other countries. This is done through pre-purchase agreements between a government and a vaccine manufacturer.</p>
<p>In March, <a href="https://www.independent.co.uk/news/world/europe/coronavirus-vaccine-trump-germany-us-dietmar-hopp-carevac-a9404646.html">the White House met</a> with representatives from CureVac, a German <a href="https://www.curevac.com">biotech company</a> developing a COVID-19 vaccine. The <a href="https://www.biopharmadive.com/news/coronavirus-curevac-trump-access-research-us/574181/">U.S. government is reported</a> to have inquired about the possibility of securing exclusive rights over the vaccine. This <a href="https://www.politico.eu/article/eu-weighs-into-german-american-spat-over-vaccine-company/">prompted the German government to comment</a> that “Germany is not for sale.” <a href="https://www.independent.co.uk/news/world/europe/coronavirus-vaccine-trump-germany-us-dietmar-hopp-carevac-a9404646.html">Angela Merkel’s chief of staff promptly stated</a> that a vaccine developed in Germany had to be made available in “Germany and the world.” </p>
<p>On June 15, the <a href="https://www.marketwatch.com/story/germany-investing-in-coronavirus-vaccine-maker-that-it-accused-the-trump-administration-of-trying-to-poach-2020-06-15">German government announced</a> it would be <a href="https://www.curevac.com/news/german-federal-government-invests-300-million-euros-in-curevac">investing</a> 300 million euros (nearly US$340 million) in CureVac for a 23% stake in the company.</p>
<p>In April, the CEO of Sanofi, a French company whose COVID-19 vaccine work has received partial funding from the U.S Biomedical Advanced Research and Development Authority, <a href="https://www.bloomberg.com/news/articles/2020-05-13/u-s-to-get-sanofi-covid-vaccine-first-if-it-succeeds-ceo-says">announced that the U.S.</a> had the “right to the largest pre-order” of vaccine. </p>
<p>Following public <a href="https://www.france24.com/en/20200514-france-says-unacceptable-for-sanofi-to-give-coronavirus-vaccine-to-us-first">outcry and pressure</a> from the French government, <a href="https://www.france24.com/en/20200514-france-says-unacceptable-for-sanofi-to-give-coronavirus-vaccine-to-us-first">Sanofi altered its stance</a> and said that it would not negotiate priority rights with any country.</p>
<p>In India, the <a href="https://qz.com/india/506247/how-an-indian-horse-breeder-built-asias-largest-vaccine-company/">privately</a> <a href="https://www.seruminstitute.com/">held Serum Institute</a> is developing one of the <a href="https://www.reuters.com/article/us-health-coronavirus-india-serum-insigh/how-one-indian-company-could-be-worlds-door-to-a-covid-19-vaccine-idUSKBN22Y2BI">leading</a> COVID-19 vaccine candidates. The Serum Institute signaled that, if development of the vaccine succeeds, <a href="https://www.reuters.com/article/us-health-coronavirus-india-vaccine/indias-serum-institute-to-make-millions-of-potential-coronavirus-vaccine-doses-idUSKCN22A2YY">most of the initial batches of vaccine</a> will be distributed within India. </p>
<p>At the same time, India, alongside the U.S. and Russia, <a href="https://hbr.org/2020/05/the-danger-of-vaccine-nationalism">chose not to join</a> the Access to COVID-19 Tools Accelerator, which was <a href="https://www.europeanpharmaceuticalreview.com/news/118549/who-launches-access-to-covid-19-tools-accelerator/">launched</a> by the World Health Organization to promote collaboration among countries in the development and distribution of COVID-19 vaccines and treatments.</p>
<h2>Vaccine nationalism is not new</h2>
<p>Vaccine nationalism is not new. During the early stages of the 2009 <a href="https://www.livescience.com/covid-19-pandemic-vs-swine-flu.html">H1N1 flu pandemic</a>, some of the wealthiest countries <a href="https://www.washingtonpost.com/wp-dyn/content/article/2009/05/06/AR2009050603760.html">entered into pre-purchase agreements </a> with several pharmaceutical companies working on H1N1 vaccines.
At that time, it was estimated that, in the best-case scenario, the <a href="https://www.washingtonpost.com/wp-dyn/content/article/2009/05/06/AR2009050603760.html">maximum number of vaccine doses</a> that could be produced globally was 2 billion. The U.S. alone negotiated and obtained the right to buy 600,000 doses. All the countries that negotiated <a href="https://www.wsj.com/articles/SB124243015022925551">pre-purchase orders were developed</a> economies.</p>
<p>Only when the 2009 pandemic began to unwind and demand for a vaccine dropped did <a href="https://www.kff.org/news-summary/nine-countries-pledge-h1n1-vaccine-donations-to-developing-countries/">developed countries offer to donate</a> vaccine doses to poorer economies.</p>
<h2>The problems posed by nationalism</h2>
<p>The most immediate effect of vaccine nationalism is that it further disadvantages countries with fewer resources and bargaining power. It deprives populations in the Global South from timely access to vital public health goods. Taken to its extreme, it allocates vaccines to moderately at-risk populations in wealthy countries over populations at higher risk in developing economies.</p>
<p>Vaccine nationalism also runs against the fundamental principles of vaccine development and global public health. <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3040974">Most vaccine development projects involve several parties</a> from <a href="https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html">multiple countries</a>. </p>
<p>With modern vaccines, there are very few instances in which a single country can <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3040974">claim to be the sole developer</a> of a vaccine. And even if that were possible, global public health is borderless. As COVID-19 is illustrating, pathogens can travel the globe. Public health responses to outbreaks, which include the deployment of vaccines, have to acknowledge that reality.</p>
<h2>How nationalism can backfire in the US</h2>
<p>The U.S. in notorious for its <a href="https://www.ft.com/content/e92dbf94-d9a2-11e9-8f9b-77216ebe1f17">high drug prices.</a> Does the U.S. government deserve to obtain exclusive rights for a vaccine that may be priced too high? Such a price may mean that fewer U.S. citizens and residents – especially those who are uninsured or underinsured – would have access to the vaccine. This phenomenon is a form of what economists call <a href="https://www.intelligenteconomist.com/deadweight-loss/">deadweight loss</a>, as populations in need of a welfare-enhancing product are priced out. In public health, deadweight loss costs lives.</p>
<p>This is not a hypothetical scenario. <a href="https://www.theverge.com/2020/2/27/21155879/alex-azar-coronavirus-vaccine-affordable-insurance">U.S. Secretary of Health and Human Services Alex Azar has told</a> Congress that the government will not intervene to guarantee affordability of COVID-19 vaccines in the U.S. </p>
<p>Secretary Azar has said the U.S. government wants the private sector to invest in vaccine development and manufacturing; if the U.S. sets prices, companies may not make that investment because the vaccines won’t be profitable. This view has been widely criticized. A commentator has called it “<a href="https://www.statnews.com/2020/03/05/coronavirus-vaccine-affordable-for-everyone/">bad public health policy</a>,” further pointing out that American taxpayers already fund a substantial amount of vaccine research and development in the U.S. Moreover, as legal scholars have pointed out, there are many <a href="https://pdfs.semanticscholar.org/d383/484a3a5c88ea853596e8bdebd00cca057e6c.pdf">regulatory perks</a> and <a href="https://www.yalelawjournal.org/article/innovation-policy-pluralism">other incentives</a> available exclusively to pharmaceutical companies.</p>
<p>If COVID-19 vaccines are not made available affordably to those who need them, the consequences will likely be disproportionately severe for poorer or otherwise <a href="https://www.heartlandalliance.org/covid-19-disproportionately-threatens-marginalized-and-vulnerable-populations/">vulnerable and marginalized</a> populations. COVID-19 has already taken a higher toll on <a href="https://www.npr.org/sections/health-shots/2020/05/30/865413079/what-do-coronavirus-racial-disparities-look-like-state-by-state">black and Latino</a> populations. Without broad access to a vaccine, these populations will likely continue to suffer more than others, leading to unnecessary disease burden, continued economic problems and potential loss of life.</p>
<h2>What needs to be done</h2>
<p>Nationalism is at odds with global public health principles. Yet, there are no provisions in international laws that prevent pre-purchase agreements like the ones described above. There is nothing inherently wrong with pre-purchase agreements of pharmaceutical products. Vaccines typically <a href="https://repository.law.umich.edu/mlr_online/vol118/iss1/5/">do not generate</a> as much in sales as other medical products. If used correctly, pre-purchase agreements can even be an incentive for companies to manufacture vaccines that otherwise would not commercialized. <a href="https://www.gavi.org/">Institutions like Gavi</a>, an international nonprofit based in Geneva, use similar mechanisms to guarantee vaccines for developing countries.</p>
<p>But I see vaccine nationalism as a misuse of these agreements. </p>
<p>Contracts should not trump equitable access to global public health goods. I believe that developed countries should pledge to refrain from reserving vaccines for their populations during public health crises. The WHO’s <a href="https://www.who.int/publications/m/item/access-to-covid-19-tools-(act)-accelerator">Access to COVID-19 Tools Accelerator</a> is a starting point for countries to test collaborative approaches during the current pandemic.</p>
<p>But more needs to be done. International institutions – including the WHO – should coordinate negotiations ahead of the next pandemic to produce a framework for equitable access to vaccines during public health crises. Equity entails both affordability of vaccines and access opportunities for populations across the world, irrespective of geography and geopolitics.</p>
<p>Insofar as the U.S. can be considered a leader in the global health arena, I believe it should stop engaging in overly nationalistic behaviors. Failure to do so harms patient populations across the globe. Ultimately, it may harm its own citizens and residents, and perpetuate structural inequalities in our health care system.</p>
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<p class="fine-print"><em><span>Ana Santos Rutschman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Should the US be able to pre-order vaccines for its citizens when other populations around the globe are at greater risk?Ana Santos Rutschman, Assistant Professor of Law, Saint Louis UniversityLicensed as Creative Commons – attribution, no derivatives.