The COVAX Initiative: How Vaccine Nationalisation is Hurting Covid Recovery

(Photo: IVOX News)

By Sara Seth – Contributor

The COVID-19 vaccines have provided much needed hope to a world devastated by the pandemic, but how different is the picture for those living in the poorest countries of the world? With early estimates suggesting that Sub-Saharan Africa may not have widespread access to the vaccine until as late as 2023, the road to normalcy looks to be a lot longer for those in less developed countries.

Enter COVAX, an initiative co-led by Gavi, the Vaccine Alliance, CEPI and WHO, which aims to equitably distribute the vaccine around the globe. COVAX’s aim is to centralise distribution so that everyone, no matter their nationality, can get fast and equitable access to the vaccine. But, competition from individual countries making direct deals with vaccine companies is making the likelihood of COVAX’s success much smaller.

Ideally, the COVAX Facility would procure vaccines for all participating countries and then distribute them equally across the globe after approval, focusing first on the most vulnerable in all countries. However, rich countries have generally made direct deals with vaccine companies and are buying into the COVAX Facility simply as a backup. The COVAX AMC is a branch of the initiative within the Facility which focuses on the 92 poor countries eligible for Official Development Assistance, meaning that they would not have to pay for the vaccine. It provides hope for a swifter end to the pandemic by aiming to deliver 1.8 billion doses to these 92 low- and middle-income countries, who would otherwise be unable to procure any doses.

Yet whilst rich countries are donating to the COVAX initiative by both buying into the facility and donating to the COVAX AMC, they have been subject to accusations of simultaneously undermining it by making bilateral deals with vaccine companies. According to the director general of the WHO, Dr Tedros Adhanom Ghebreyesus, the price of vaccines is driven up by these rich countries ‘queue jumping’. Furthermore, manufacturers are prioritizing vaccine approval in individual countries, rather than submitting dossiers to the WHO for vaccine approval, because the profits are higher.

However, an even more pressing problem faces poorer countries, which is that of physical availability. Demand currently far outstrips supply, and if countries are buying up supplies through bilateral deals then that leaves no vaccines on the market to be bought by the COVAX AMC initiative. A Duke University study found that, as of mid-January, a group of rich nations representing a mere 16% of the world’s population had bought up 60% of the global vaccine supply. Moreover, it seems that they have bought far more than they could possibly use, with Canada, for example, having purchased enough supplies to vaccinate its entire population five times. The US and the UK follow with about four times and three times as much as they need, respectively. And so, whilst these countries have been donating and using a rhetoric of global partnership, unified action, and solidarity, this could be undermined in practice by their hoarding of global supplies. It is all well and good to give money to COVAX so that they can purchase vaccines, but if there are no vaccines left to be purchased then the donations are perhaps no more than an exercise in ethical window dressing.

Of course, these countries will not use more than they need and will eventually give the surplus away, but this gives way to a situation where the young and healthy in rich countries will be vaccinated before the elderly and vulnerable in poorer ones. This can be seen already in the fact that more than 39 million vaccine doses have been given 49 high income countries, whilst only one of the lowest income countries has given out any vaccine doses, and the number stands at a measly 25.

Whilst it seems an immoral position to vaccinate the healthy before those in need, it is only natural and expected for countries to prioritise their own citizens. It is understandable that moral imploration is not enough to persuade richer countries to stop making bilateral deals and obtain vaccines through the centralised COVAX initiative, but it seems that it would actually be economically beneficial as well, meaning that it would also make sense to increase the equality of distribution even from a self-interested position.

Director general of WHO Tedros Adhanom Ghebreyesus has warned that this so called ‘vaccine nationalism’ is a counterproductive position and will only prolong the pandemic by keeping huge parts of the global economy at a standstill. By concentrating vaccines in rich countries poorer ones will take longer to get back on their feet, slowing the overall global economic recovery and in turn costing an estimated $1.2 trillion per year (according to RAND Europe). Whilst it is completely understandable that rich nations will prioritise their own citizens, they must see that there are no real winners unless significant efforts are made to increase rollout to even just the most vulnerable of the world’s poor.

And so, what are the possible ways forward? Although WHO is hoping for higher income countries to redirect vaccines bought for their own populations to the citizens of other countries, this seems highly unlikely due to political fallout that would probably occur as a result if vaccines earmarked for their own citizens were given away. An alternative solution is proposed by the Peoples Vaccine Alliance, a group with growing support from many past and present world leaders, which campaigns for the Intellectual Property and technology for vaccine production to be shared freely. They argue that not only should the IP be shared because it is a global public good, but also because the pharmaceutical companies have received huge public funding for the vaccine development so shouldn’t get absolute control over the vaccine. Again, the likelihood of this happening seems low since powerful states in the WTO, such as the UK, strongly oppose proposals to waive IP rights.

It thus seems likely that the coronavirus pandemic will fall victim to the vaccine nationalism that characterised many other health crises before, such as the 2009 H1N1 flu pandemic and the HIV/AIDS crisis. However, this time, the severity of the virus means that inequitable vaccine access would not only be a moral failure, as it was in the past, but also an economic one. The huge cost of vaccine nationalism means that this time around, countries may actually be better off giving up some doses to other countries, and the sooner they realise this, the sooner the pandemic can come to an end.

https://www.economist.com/graphic-detail/2021/01/28/vaccine-nationalism-means-that-poor-countries-will-be-left-behind

https://globalhealth.duke.edu/news/ensuring-everyone-world-gets-covid-vaccine

https://www.bmj.com/content/371/bmj.m4809

https://www.politico.eu/article/who-chief-looming-catastrophic-moral-failure-in-coronavirus-vaccine-distribution/

https://www.rand.org/content/dam/rand/pubs/research_reports/RRA700/RRA769-1/RAND_RRA769-1.pdf

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board

https://www.oxfam.org/en/press-releases/campaigners-warn-9-out-10-people-poor-countries-are-set-miss-out-covid-19-vaccine#:~:text=The%20People’s%20Vaccine%20Alliance%20is,safe%20and%20effective%20vaccines%20can

https://www.theguardian.com/world/2020/nov/19/uk-faces-calls-drop-opposition-patent-free-covid-vaccines-wto

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