by Isabella Garcia
The Limits of ‘Vaccine Nationalism’
Since the outbreak of Covid-19 in the early part of 2020, medical experts, scientists, pharmaceutical companies, international institutions, and governments around the world have mobilised their resources and expertise towards developing a successful vaccine. In the past couple of months these efforts have begun to materialise, with the results of three promising vaccines from Moderna, Pfizer- BioNtech and Oxford- AstraZeneca each showing high efficacy results. These results are undoubtedly a cause for celebration and tentative optimism as the hypothetical end of the Covid-19 now becomes a more concrete reality; nevertheless, the development of a successful vaccine raises ethical questions concerning its production, distribution, and accessibility. Indeed, “there has not been a more sought- after medical resource in our lifetimes than a safe and effective COVID-19 vaccine” (Gostin, Karim & Meier, 2020, p. 662). As a result, we are now witnessing what has been described as “vaccine nationalism” – the monopolisation and hoarding of global vaccines supplies by wealthy nations (Buranyi, 2020). For instance, Oxfam (2020) reports that high-income countries have brought up 50 per cent of the vaccine supply despite making up 13 per cent of the global population. Similarly, from November 2020, 80 per cent of the Pfizer-BioNtech and Moderna vaccine supply had been sold to high-income countries (Duke Global Health Innovation Center, 2020).
The hoarding of limited vaccine supplies is indicative of multiple issues concerning global health equity that pre-date the Covid-19 crisis. For example, prior to the pandemic at least 50 per cent of the world population were not receiving essential health care (Killen et al., 2020). Additionally, the Gates Foundation & the Institute for Health Metric and Evaluation have recently estimated that pandemic that the Covid-19 pandemic has set international development back 25 years in an astounding 25 weeks. The world’s poorest tend to be more vulnerable to diseases and viruses yet they are often excluded from receiving life-saving medical provisions; a key example being the delayed access of South Africa to antiretroviral drugs (ARVs) despite it having the highest rates of HIV/Aids in the world (Bingwaho, Mathewos, & Kadetz, 2020). In the context of the Covid-19 pandemic, poorer populations and those historically subject to marginalisation and discrimination are extremely high-risk due to systemic inequalities and barriers to access. These populations have limited access to clean water, food, medical supplies, health services, Covid-19 tests, and tend to live and work in compact spaces making social distancing impossible. Therefore, how the Covid-19 vaccine is distributed is central to fighting against global inequality and poverty and is not simply a logistical question. High-income countries must recognise that vaccine nationalism is fundamentally unfair and short-sighted; with the World Health Organisation (WHO) estimating that at least 70 per cent of the world’s population will need to be vaccinated to reach global ‘herd immunity’.
Current modelling indicates that there will not be enough supply of vaccines to cover the global population until 2023 or 2024. However, many high-income countries have purchased huge quantities of vaccine doses in advance, which could vaccinate their populations many times over. For example, Canada could hypothetically vaccinate its entire population five-times over (Duke Global Health Innovation Center, 2020). Therefore, as it stands, low-risk people in wealthier countries will be vaccinated before high-risk individuals in poorer countries. Whereas, positioning global health equity as a guiding principle in the widespread rollout of the Covid-19 vaccine, would mean ensuring that global risk and exposure factors are taken into account when producing, purchasing, allocating, and distributing vaccine supplies.
Health as Human Right
Throughout the past three decades pursuing an equitable response to major health threats that humanity has faced such as Ebola, Swine Flu and HIV, has been an afterthought rather than a foundational guiding principle. Moreover, historically the main players in vaccine research, production and distribution – pharmaceutical companies – have abused their power by leveraging subsidies and exploiting the sick for profit (Bingwaho, Mathewos, & Kadetz, 2020). Thus Increasingly, human rights activists are calling upon wealthier nations and pharmaceutical companies to produce and distribute vaccines equitably in line with international human rights law. The UN Human Rights Guidelines for Pharmaceutical Companies concerning Access to Medicines, asserts the human rights responsibilities that pharmaceutical companies have to make essential medicines widely available to the global south, as well as stipulating that the 171 UN member-states are responsible for enforcing these obligations (Santoro and Shanklin, 2020). Defining widespread access to Covid-19 vaccines as a ‘human right’ is a significant step towards advancing the goal of global health equity: “to call something a ‘human right’ is to say that it imposes duties upon others across national borders to honour that right. Human rights are moral rights. Human rights exist regardless of whether a particular national government in actuality protects those rights” (Santoro, 2009, p. 15). Thus, defining health as a right must be central to vaccine innovation and roll-out.
Progress towards this goal depends upon international cooperation, pooled resourcing, and transparency from multiple actors across the public and private sectors. A major development has been the COVAX Facility scheme led by Gavi- the Vaccine Alliance, the WHO, and the Coalitions for Epidemic Preparedness Innovations (CEPI), which aims to pool country resources together to mass purchase the Covid-19 vaccine and to distribute it equitably. Currently, 178 countries are signed up to the initiative (notably the US is not) and low-income countries will be funded by the scheme to protect 20% of their populations, while self-financing countries can purchase different levels of coverage (Amnesty, 2020). This type of cooperation will be critical for ensuring equitable distribution of Covid-19 vaccines and treatments to low-income and middle-income countries. However, the COVAX scheme is not exempt from critique, as it allows wealthier self-financing countries to purchase doses that cover up to 50% of their population, whereas low-income countries will only receive 20% funded coverage because they cannot afford to purchase any more (Amnesty, 2020). Another issue that undermines equitable distribution relates to drug patents; pharmaceutical companies do not have to share their research with other companies, and they determine the cost of their drugs and who they sell it to. As it stands, AstraZeneca is the only pharmaceutical company who have committed to providing their vaccine to low and middle-income countries on a non-profit basis during the pandemic. It is important then to push towards defining the Covid-19 vaccine as an ‘essential’ medicine under international human rights law as this definition can help tackle the legal barriers associated with intellectual property right laws. Gostin et al., (2020) suggest that “human rights law provides an international legal foundation for the progressive realization of vaccine access” (p.623). Re-building a global society in a post-pandemic world upon a more equitable basis will firstly depend upon how we act now in our response to distributing successful vaccines, thus it is essential that this is a rights-based response that puts people over profit, and international solidarity over protectionist nationalism.
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