Vaccine nationalism

Hundreds of COVID-19 vaccine candidates are currently being developed. The United States has now twice indicated that it would like to secure priority access to doses of COVID-19 vaccine. Other countries, including India and Russia, have taken similar stances. This prioritization of domestic markets has become known as vaccine nationalism.

Background

• Vaccine nationalism is not new. During the early stages of the 2009 H1N1 flu pandemic, some of the wealthiest countries entered into pre-purchase agreements with several pharmaceutical companies working on H1N1 vaccines.
• At that time, it was estimated that, in the best-case scenario, the maximum number of vaccine dosesthat 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 pre-purchase orders were developed
• Only when the 2009 pandemic began to unwind and demand for a vaccine dropped did developed countries offer to donatevaccine doses to poorer economies.
  
  

What is Vaccine nationalism?

• 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.
• This “vaccine nationalism” is not only morally reprehensible, it is the wrong way to reduce transmission globally.
• If countries with a large number of cases lag in obtaining the vaccine and other medicines, the disease will continue to disrupt global supply chainsand, as a result, economies around the world.

Vaccine nationalism during COVID-19

• In March, the White House metwith representatives from CureVac, a German biotech company developing a COVID-19 vaccine.
• The S. government is reported to have inquired about the possibility of securing exclusive rights over the vaccine.
• This prompted the German government to comment that “Germany is not for sale.” 
• On June 15, the German government announced it would be investing 300 million euros (nearly US$340 million) in CureVac for a 23% stake in the company.
• 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, announced that the U.S.had the “right to the largest pre-order” of vaccine.
• Following public outcry and pressure from the French government, Sanofi altered its stance and said that it would not negotiate priority rights with any country.
• In India, the privately held Serum Institute is developing one of the leading COVID-19 vaccine candidates.
• The Serum Institute signaled that, if development of the vaccine succeeds, most of the initial batches of vaccinewill be distributed within India.
• At the same time, India, alongside the U.S. and Russia, chose not to join the Access to COVID-19 Tools Accelerator, which was launched by the World Health Organization to promote collaboration among countries in the development and distribution of COVID-19 vaccines and treatments.
  
  

The problems posed by nationalism

Nationalism is at odds with global public health principles. Yet, there are no provisions in international laws that prevent pre-purchase agreements. The problems posed by nationalism are as below:

• Issue for countries with fewer resources: The most immediate effect of vaccine nationalism is that it further disadvantages countries with fewer resources and bargaining power.
• Deprives access to public health: It deprives populations from timely access to vital public health goods.
• Injustice with needy countries: Taken to its extreme, it allocates vaccines to moderately at-risk populations in wealthy countries over populations at higher risk in developing economies.
• Against fundamental principles: Vaccine nationalism also runs against the fundamental principles of vaccine development and global public health. Most vaccine development projects involve several parties from multiple countries.

What needs to be done?

• Pledge to refrain from reserving vaccines: At such a time, developed countries should play a major role, they should pledge to refrain from reserving vaccines for their populations during public health crises. 
• Coordinated efforts: Countries need a global coordinated effort to estimate and account for the available global workforce of vaccinators, operationalize mass vaccination programs, implement plans for equitably allocating vaccines on a prioritized basis, and verify the delivery of vaccines. 
• Global framework for equitable access: 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.
• Ensuring equity: Equitable distribution and access should be ensured. Equity entails both affordability of vaccines and access opportunities for populations across the world, irrespective of geography and geopolitics.

Conclusion

With modern vaccines, there are very few instances in which a single country can claim to be the sole developer 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.  Countries around the world should stop engaging in overly nationalistic behaviors.  Failure to do so will harm patient populations across the globe. Ultimately, it may harm everyone, and perpetuate structural inequalities in our health care system.