Author: Katie Ellig.
In a year as chaotic and devastating as 2020, the promise of a Covid-19 vaccine has been a source of hope worldwide. However, even amidst positive news from Pfizer, Moderna, AstraZeneca, and other vaccine developers, there are still many hurdles that stand in the way of global recovery. One of the biggest is vaccine nationalism.
What is vaccine nationalism?
Vaccine nationalism is the tendency of countries to protect their own interests, compete to secure doses of the limited initial supply of vaccines, and disregard the consequences for other countries, global health, and economic recovery in the process. While the development, manufacture, and distribution of a vaccine has been portrayed as the major hurdle to overcome the coronavirus pandemic, this “my-nation-first” mentality threatens to prolong the global recovery for years, even after the first vaccines are available. But protecting one’s own citizens first seems logical and inevitable. So why is vaccine nationalism a problem?
Vaccine nationalism: risks and consequences
It makes sense that governments feel pressure to ensure their citizens are vaccinated as soon as possible. But a lack of global cooperation will inevitably lead to serious consequences. While far from comprehensive, the following list provides a brief overview of some of the risks associated with approaching the global pandemic with a purely nationalistic mindset.
Prolonged global economic recession
A main justification for increased spending on vaccines has been to prevent further economic damage and mitigate one of the worst recessions in recent history. However, if only the highest-income countries have initial access to a vaccine — a likely scenario if countries continue signing bilateral agreements with vaccine providers — the global economy will suffer. A RAND Corporation study on the economic impacts of different vaccination scenarios found that even if all countries besides the lowest-income have initial access to a vaccine, the global economy still loses ~$153b/year, and high income countries would incur a loss of about $119b/year. Especially since the cost of immunising the populations of low-income countries is estimated at only $25b, this analysis indicates higher-income countries could invest significantly in equitable distribution of vaccines without being economically worse off. However, this is not the decision making framework most nations are currently using.
2. Unequal allocation of vaccines, with high health and economic costs
Currently, countries such as the United States, the UK, Canada, Japan, and EU members are signing direct deals with vaccine developers to secure enough initial doses to immunize their entire populations, regardless of risk level. As a result, it may be years before the highest-risk groups in middle and lower-income countries have access, even as low-risk groups are immunized in high-income countries. It is estimated that the pattern of bilateral agreements will price out or deny vaccine access to over 60% of the world’s population until 2022. This has clear human costs for middle and lower-income countries, but it also means global supply chains, tourism, and other cross-border industries will be disrupted for years. If countries instead collaborate to immunize the highest risk groups, such as health workers, regardless of nationality, many lives will be saved and the global economy will be able to restart more cohesively.
3. Fragmented vaccine supply chains, leading to global inefficiencies
Vaccine supply chains are inherently global, with no country having the inputs, production, and regulatory capabilities to complete the process end-to-end. In an “every-nation-for-themselves” scenario, countries with necessary inputs can use them as leverage to ensure they get initial access to the finalized vaccine. However, this can cause disruptions and shut-downs as nations negotiate and hold factors of production hostage. Additionally, it is almost guaranteed that some vaccines will be more effective for certain demographics, such as the elderly or children. Ideally, countries could take advantage of this information and access a portfolio of vaccines to effectively immunize their citizens. However, if one country secures the doses of an initial vaccine and withholds access from others, they are likely to retaliate with similar behavior later. This creates a scenario where countries can’t immunize their populations in the most effective way, again due to a competitive rather than collaborative approach to addressing the pandemic.
Attempts to overcome vaccine nationalism: COVAX
In an attempt to combat the effects of vaccine nationalism and promote equitable access to vaccines, COVAX was created as the “vaccine” pillar of the Access to Covid-19 Tools accelerator (ACT), launched in April 2020 by WHO and partners. COVAX is co-led by the Coalition for Epidemic Preparedness (CEPI), Gavi and WHO and functions as a global risk sharing mechanism for coordinating equitable distribution of eventual Covid-19 vaccines. With over 180 countries having committed to participate and contribute to the collective fight against Covid-19, COVAX is acting as a platform to support the research, development, and manufacture of the largest and most diverse portfolio of vaccines in the world. The goal is to ensure that all participating countries have equal access to these vaccines when they are ready, with a plan to have 2 billion doses available by the end of 2021.
For higher-income countries, the COVAX Facility provides access to a wide portfolio of potential vaccine candidates in exchange for their financial support, and offers security against betting on a single vaccine in a bilateral deal that could end up up failing. For lower-income countries, COVAX AMC, funded by official development assistance (ODA), private sector funding and philanthropy, provides equitable access to initial vaccines that most nations would be otherwise unable to afford.
Nationalism and the outlook for global vaccine access moving forward
While a large number of countries have committed to participate, some key global players like the US and Russia are notably absent from COVAX, pursuing instead their own bets on supplies for their citizens. China also waited until significantly after initial deadlines before finally committing in October. This lack of true global buy-in has hurt the funding needs and political strength of COVAX. Even among participants, countries are still aggressively entering into bilateral agreements to acquire top vaccine candidates. This creates little incentive to truly focus on collaborative behavior for fear of falling behind and not being able to secure vaccines for one’s country as quickly as a country acting with a nationalist mindset.
However, the fact that so many nations have joined the Facility, and that over $2b had been contributed to funding vaccine access for lower-income countries by mid-November 2020 represents some hope in a move toward more equitable distribution. While still insufficient to address the major challenges that will result from countries stockpiling doses for their citizens, and subsequently denying access to large portions of the world’s population, it appears to represent some acknowledgment that there are benefits of a collaborative approach to addressing the Covid-19 pandemic. The coming months will reveal how countries act when vaccines go into larger-scale distribution. We should hope that their actions push us towards a collective recovery, rather than the drawn-out inequality that many scientists and policy makers fear awaits a response fueled by vaccine nationalism.
References
Bollyky, T. J., & Bown, C. P. (2020, September/October). The Tragedy of Vaccine Nationalism. Retrieved 2020, from https://www.foreignaffairs.com/articles/united-states/2020-07-27/vaccine-nationalism-pandemic
Hafner, M., Yerushalmi, E., Fays, C., Dufresne, E., & Van Stolk, C. (2020). COVID-19 and the cost of vaccine nationalism (Rep. No. RR-A769–1). doi:https://doi.org/10.7249/RRA769-1
Mancini, D., & Peel, M. (2020, September 1). ‘Vaccine nationalism’ delays WHO’s struggling Covax scheme. Retrieved 2020, from https://www.ft.com/content/502df709-25ac-48f6-aee1-aec7ac03c759
Over US$ 2 billion raised to support equitable access to COVID vaccines with additional US$ 5 billion needed in 2021. (2020, November 13). Retrieved 2020, from https://www.gavi.org/news/media-room/over-us-2-billion-raised-support-equitable-access-covid-vaccines-additional-us-5
Comments