Vaccine Nationalism & How it impacts the Covid-19

COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2, first appeared in the Chinese province of Wuhan in late December 2019 and has since spread rapidly across North America, Europe, Asia, and the rest of the world. Aside from the health consequences, the COVID-19 epidemic has also wreaked havoc on the global economy.

What is Vaccine nationalism?

Covid-19 pandemic has introduced new words like “social distancing”, “pandemic”, “work from home”, “Lockdown”, “Quarantine” etc. These words were not part of our daily lingo. Now there is a new word called “vaccine nationalism”. 

Vaccine nationalism is the tendency in which a country keeps the doses of vaccines for its own citizens before they are made available for other countries. This is done by the advanced agreement between the manufacturer of the vaccine and the government before the purchase of the vaccine. Sometimes it is also called vaccine diplomacy.

Vaccine nationalism [1]is not new. During the time of the H1N1 2009 flu pandemic, many wealthiest countries enter into an advanced agreement with many pharmaceutical companies and keep the doses of vaccines for their own citizens. At that time, it was calculated that the overall number of vaccine doses that could be delivered globally in the best case was around two billion. The United States alone secured and acquired the right to purchase 600,000 doses. Many of the countries involved in the advanced order negotiations were developed economies.

Vaccine nationalism is not good because of the various harmful consequences of it. It is harmful to the unbiased access to vaccines. Countries which have fewer resources and economically weak their citizens suffer most.

Though every country has a right to provide vaccine to its citizens on a priority basis but when countries hoard more than required vaccines for themselves just as the USA is doing right now is an example of vaccine nationalism.

“Anything that restricts the ability to get these products out will affect our ability to control this disease and prevent variants emerging. The world is going to have to collaborate to get out of this”                                                                                                  Bruce Aylward

Dangers of Vaccine Nationalism

Firstly, to begin with, the race between powerful countries such as China, Russia, and United States to see who can produce a vaccine first might aid in the effective production of potential vaccines. However, geopolitical rivalry can force countries to speed up their trials and press for faster and riskier regulatory approvals to meet public demand. If it is discovered that any of these vaccinations have serious side effects or are ineffective, public confidence in vaccines will be further eroded, complicating national vaccination plans.

Second, the public’s focus is currently on vaccine production. However, once effective and safe vaccine candidates have been identified, they must produce it in Masses and administered. Vaccine production is a complicated process. The infrastructure required will vary depending on the type of vaccine produced, and poorer countries that lack the necessary systems to produce and administer doses manufactured in various environments, which are mostly found in wealthier countries. Furthermore, vaccine components are typically sourced from various geographical locations that specialize in particular stages of the manufacturing process.

Finally, to ensure the availability of a vaccine, several governments, often from richer nations, have entered into direct bilateral agreements with vaccine candidate producers to guarantee a supply for their populations. As wealthy countries compete for scarce vaccine supplies, this patchwork of bilateral agreements may have a negative impact on vaccine accessibility and cost. A “my nation first” approach could result in poor vaccine distribution, supporting low-risk individuals in Resourceful countries over high-risk individuals in less resourceful  countries.

International initiatives to coordinate a global Corona virus response are still underway. The COVAX Facility, a collaboration between the World Health Organization and other international organizations including the Global Alliance for Vaccinations and Immunization, seeks to provide fair access to vaccines around the world by pooling resources. These services, on the other hand, initially suffered. From the wealthy countries’ shaky commitments Although the Corona virus crisis is primarily a public health problem, it is also a financial one, with national governments investing trillions of dollars to mitigate the negative economic consequences. However, if the virus is not controlled in all parts of the globe, the global Economy would most likely be harmed, and global supply chains will be disrupted.

Vaccine nationalism [2] is a dangerous move because it is a wrong way to reduce the transmission of the virus because if some resourceful country has the power to get the more vaccine and small countries have less resources so their citizens will suffer the most. It leads to the inequality among countries which have less resources and also it impacts the disruption of global supply chain and as result it impact in the economies all over the world.

Vaccine nationalism only prolonged the pandemic and problems for the poor countries. It leads to get a smaller number of supplies for the small countries and only helps the virus to spread.  It also not leads to poorer countries to suffer but rich countries also suffer in the monetary terms and growth of every country will impact with this. As we know that because of the financial problem small counties were not able to stock the large amount of vaccine and they were basically depended on the big countries for their help.

During the Pandemic many developed countries like the USA, Canada, Japan, UK, agreed in the bilateral agreement with pharmaceutical companies to secure the future supplies of vaccines. As a result, by January 2021, several countries had secured roughly 60% of the 7 billion vaccines that had been produced, while accounting for just 14% of the global population. Canada, for example, has requested five times the number of vaccinations needed for its entire population. All of this indicates that by the end of 2021, at least 90% of citizens in low-income countries will have not been vaccinated.

Resourceful countries have also united in opposing work on a temporary waiver of some commitments under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). South Africa and India proposed the proposal in October 2020, intending to make it easier for developing countries to manufacture Corona Virus vaccines and similar drugs. The United States, the United Kingdom, and the European Union have argued ineffectively, in our view, that such a move would stifle innovation by preventing pharmaceutical companies from investing in SARS-CoV-2 vaccine research and development.

Legal Barriers in COVID-19 Vaccination

Law can be a barrier to equity, justice, & global health, as well as an enabler. The impact of legal health determinants on the pandemic is apparent when law is used as a mechanism to mandate or restrict global fair access to Corona Virus vaccines. Vaccine nationalism, which involves governments seeking to secure first access to potential vaccines through APAs with vaccine manufacturers, contributes to barriers to fair access.

APAs could benefit a country’s interests, but given the unpredictability of individual Corona Virus vaccine producers and the global spread of SARS-CoV-2, they pose a danger and erode international cooperation. Importantly, Legal bilateral agreements like these are likely to worsen inequities among countries and, as a result, increases the pandemic’s period.

By re-establishing international unity norms, committing to global equitable vaccine access programmes, and setting the groundwork for a post-pandemic period based on multilateralism and collaboration, multilateral legal agreements, on the other hand, could pave the way for global health security and justice.

In a meeting of the WHA in May, 2020, former & Current leaders from around the world guarantees that global equitable access to vaccines as global public goods. In this meeting China’s President told that any vaccine developed by china will be “global public good”, and will contribute to “ensuring accessibility and affordability in developing countries”. In this meeting the only resolution they adopted was recognition of immunisation rather than vaccine themselves, as a global public good. All around the world there are 170 COVID-19 vaccine candidates in development out of which only 8 candidates are in a 3rd phase trials as of now some resourceful countries using APAs get the more than 2 billion doses of future COVID-19 vaccine.

APAs are the legal contracts where one party, like government, purchases a specific number of doses from the manufacturer under the license agreement between the producer and buyer. Bilateral agreements are often used to ensure priority access to manufacturing & vaccines capabilities. Countries whose governments disagree with the effectiveness & ethics of APAs, or who lack the financial resources to purchase vaccines at affordable prices in commercial negotiations, risk losing out on vaccines when they first become available, as well as suffering access delays while manufacturing capacity is first filled by orders from rich countries.

During H1N1 pandemic in the 2009 flu, some APAs held by wealthy nations have been used to ensure priority vaccine entry, rendering vaccine acquisition in other nations more challenging. Due to pre-existing obligations under APAs, more than 56% of pandemic influenza vaccine producers surveyed by the World Health Organization were unable to agree to guaranteeing 10% of real-time vaccine supply for procurement by UN agencies in 2009. Governments who sign APAs for applicant vaccines with little proof of protection or effectiveness risk not getting timely or sufficient access to effective vaccine candidates.

While APAs aren’t often legal means for vaccine nationalism, they may be used by global health organizations to procure vaccine for poor countries as part of an Advance Market Commitment. Donor-funded AMCs have been used by global wellness organisations including Gavi and The Vaccine Alliance to admit into APAs with vaccine makers to deliver a guaranteed amount of doses to nations with small profit-based markets. Pneumococcal vaccines for children and Ebola vaccines are also made using AMCs. Gavi launched the Covid Vaccine Global Access AMC in June 2020, which will use funds from donors & HIC governments to buy a guaranteed supply of Corona Virus vaccines doses for distribution to LMICs through the COVAX Facility.

The COVAX Facility, co-led by Gavi, CEPI, and WHO and launched in April 2020, is a forum that allows all interested governments to gain access to a diverse range of COVID vaccines when they become accessible, distributing risk through various vaccine manufacturers. The COVAX Facility intends to have adequate COVID vaccine doses for minimum twenty percent of the populations of partnering nations by the end of 2021, with a total of 2 billion doses.

COVAX has been chastised by civil society for negotiating profit-making prices rather than vaccines at cost as a global public good, for lack of fairness in vaccine manufacturer contracts, for limitations on civil society involvement, for failure to address potential intellectual property rights impacts on pandemic vaccines, and for governance issues such as WHO and limited experience.

The EU has declined to use the COVAX Facility to purchase vaccines, claiming that bilateral APAs allow it to obtain vaccines more quickly and at a lower cost. While 172 countries are in talks to join the COVAX Facility, the WHO Director-General stated on August 24, 2020 that more support, especially from Rich and powerful countries, is “urgently required” to “secure enough doses to carry out the vaccines” and address equal vaccine access to all the counties. Despite not using the COVAX Facility to purchase its own COVID-19 vaccines, the EU pledged €400 million to participate in addition to current APAs on August 31, 2020.

COVID-related concerns about allocation 19 vaccinations have prioritised vulnerable populations, as well as health-care and critical personnel, for fair distribution within nations. Justice, on the other hand, necessitates taking into account the fair distribution of vaccines throughout nations. Under the Pandemic Influenza Preparedness (PIP) Framework, the one only legal international instrument for the equal global distribution of vaccines, World Health Organisation plans to distribute pandemic vaccines secured under contracts with manufacturers to countries based on public health risk and needs.

However, in a pandemic with a limited supply of available vaccine, public health needs are unlikely to drive decisions, particularly in the starting stages of vaccine distribution, when supply is limited and demand is high across many countries. COVID also lacks an international legal instrument that has been agreed to by all WHO member states, unlike pandemic influenza. There is still no public international agreement about how vaccines from the COVAX Facility should be delivered.

The World Health Organization has introduced a Global System to Ensure Equal and Fair Distribution of COVID Vaccines, demonstrating how a global access mechanism would distribute risk and maximize equitable allocation between countries; however, the legal methods and form for putting such a structure in place has not been made public.

Despite the absence of a formal international agreement for COVID vaccines, 171 countries are still bound by the International Covenant on Economic, Social, and Cultural Rights (1966), which requires them to take action to realize the right to health and the right to benefit from scientific research and its applications without discrimination, both individually and by international assistance.

In the sense of COVID, respecting, preserving, and fulfilling these rights will entail ensuring that COVID vaccines are affordable, suitable, and of good quality in all countries. Multilateral commitment is needed to help avoid an additional legal risk resulting from vaccine nationalism, such as the use of government export controls, which could make multilateral and some bilateral APAs ineffective. During the 2009 H1N1 influenza pandemic, governments in HICs worked with vaccine manufacturers to limit vaccine exports until domestic needs were met.

As a consequence, vaccine nationalism in the country of producer could embargo or requisition vaccines, delaying global delivery. Any international governance framework for Corona vaccines, whether it is the COVAX Facility or a new system, can succeed only if there is global momentum and dedication to global equitable Corona virus vaccine access, particularly from high income countries.

Despite this, many HICs are now pushing the proliferation of bilateral APAs, establish nationalism, and directing vaccine delivery in the future. Countries were meet in November 2020 for the second portion of the pandemic segmented WHA. This meeting may be the last opportunity for all countries to adopt an international instrument and agree on a Corona virus vaccine mechanism before they become eligible.

Even if it is just a non-binding resolution, any international Corona virus vaccine allocation process must establish governance principles such as openness, participation, & accountability,  as well as identify policymakers, increase country commitments to financing and reasonable behaviour, and establish principles and a system for fair distribution within and, more importantly, between countries. To protect human rights and ensure openness, accountability, engagement, and equality, such an agreement is required.

Finally, at the G20 meeting in late November 2020, HICs will have a critical opportunity to choose the world we will live in effective COVID-19 vaccines are developed: one in which law is a tool for achieving global health justice & equality, rather than an obstacle. ALP has also worked as a consultant for WHO and Gavi, The Vaccine Alliance. ME-T has also advised the World Health Organization (WHO) on ensuring equal access to pandemic influenza vaccines. AM and CW declare no conflicting interests. ALP, ME-T, and MR are funded by the Arts and Humanities Research Council of the United Kingdom 

Conclusion

Vaccine nationalism has influenced the initial reaction to the pandemic in virtually any developing world. In search of political, fiscal, and short-term health benefits, governments have increasingly prioritised their own citizens over those from developed countries. Various global as well as regional attempts to ensure and promote a more structured vaccine distribution system have overwhelmingly failed so far though. Despite of certain indications that the circumstances can improve in the upcoming time, we are also far from a viable approach.

Surprisingly, vaccine imperialism appears to be a practise exclusive to prosperous Western nations. Aspiring powers like Russia and China have taken a completely different approach, seeing the vaccination scare as a chance to advance instead of a setback to their geopolitical goals. As part of the vaccine strategy, these nations will offer COVID-19 vaccinations to developed or low-income nations in order to reinforce existing relationships or form new alliances. They intend to do so despite the reality that respective local markets are already undersupplied. This may mean that geopolitical competition is the only solution to vaccine nationalism.


[1] REBECCA WEINTRAUB, ASAF BITTON, AND MARK L. ROSENBERG, “The Danger of Vaccine Nationalism” Harvard Business Review.   https://hbr.org/2020/05/the-danger-of-vaccine-nationalism# May 22, 2020 (last Accessed at: 13May 2021)

[2] JAMES DARWIN N LAGMAN, “Vaccine nationalism: a predicament in ending the COVID-19 pandemic”, Journal of Public Health. 18 March 2021, https://doi.org/10.1093/pubmed/fdab088 (last accessed at: 13 May 2021)

Author: Shivanshu Agarwal from Kirit P Mehta School of Law, NMIMS.

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