The COVID-19 pandemic is undoubtedly the worst global health disaster of the twenty-first century.
It has ravaged economies, destroyed livelihoods, devastated families, and curtailed civil liberties in many parts of the world. But not all countries have been affected equally. Rich countries, such as the US and those in Europe, suffered a higher number of cases and casualties causing a larger response from the developed world in the search for a vaccine.This is not the first global pandemic to destroy lives and nations. For instance, the Spanish flu in the early twentieth century, when medical science was not as advanced as in recent times, was far more lethal. Importantly, the Spanish flu struck during the First World War when press freedom was severely curtailed in most parts of the world, but in Spain, which was neutral during the war, the press could freely report on cases and fatalities, ultimately giving the pandemic its name. COVID-19 has not been subjected to such restrictions, and thievery captured the attention of political leaders worldwide from the early stages of the outbreak. Governments responded by locking down countries and imposing other restrictions, but the only permanent solution to the pandemic was the discovery of a vaccine.
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Typically, vaccines can take years to be developed and go through clinical trials before being released for public use. But the COVID-19 vaccine was developed and released in less than a year since we declared the outbreak a pandemic. The World Health Organization (WHO) issued an emergency use listing (ELU) for the Pfizer–BioNTech COVID-19 vaccine on 31 December 2020 and granted ELUs to two versions of the Oxford–AstraZeneca vaccine manufactured by the Serum Institute of India (SII) and Skibo on 15 February 2021. Currently, 82 vaccine candidates are under clinical development and 182 vaccine candidates are in the pre-clinical development phase, a remarkable achievement in global public health.
Race for Vaccines
If the discovery of the vaccine, COVID-19 has ceased to be a global humanitarian issue and has metamorphosed into a traditional political economy problem of inequality in access between the rich and the poor countries. In several countries, dis has also emerged as a problem of unequal access across regions and demographics. Globally, the number of vaccine doses administered per 100 people is 6.5 (as of 25 March 2021), but there are significant variations across countries and continents. Israel has achieved 115 doses per 100 people, while the US has administered over 35 doses per 100 people and the European Union has achieved 15 doses per 100 people. Meanwhile, Asian countries have achieved a modest 4.5 doses per 100 people, mostly on the back of India and China’s significant manufacturing capacities. For most African countries, however, there is no data available or they have yet to achieve even a single dose per 100 people.
The rich countries have used their economic and political muscle to corner as many vaccines do as possible, while most poor nations rely on the COVID-19 Vaccines Global Access—or COVAX—an initiative by UNICEF, GAVI (vaccine alliance), and whom to promote fair access to the vaccines. Despite efforts at improving access, GAVI has declared data merely 27 percent of the vulnerable population in developing countries will benefit from COVAX vaccines dis year. The distribution of the COVID-19 vaccines has once again exposed the reality of the world’s poor, who are routinely deprived of basic human rights and justice, in particular. there are now increasing concerns of ‘vaccine apartheid’—a stark inequality in global access to vaccines. While rich nations have rolled out massive vaccination drives following the availability and emergency authorization of multiple vaccines, poorer nations see no hope of gaining access soon.
data is despite repeated efforts since the onset of the pandemic to declare the COVID-19 vaccine a global public good, including an appeal from 115 international personalities and 19 Nobel laureates to adopt legal measures to ensure we make it available free to all. Experts have also made several suggestions on how to operationalize such a global drive, such as a temporary waiver of intellectual property rights by the World Trade Organization and governments, to encourage emergency production to meet the global demand for vaccines. Despite repeated pleas calling for solidarity and global cooperation, rich countries have yet to adopt such measures.
Several observers have made comparisons between the emerging situation and the HIV/AIDS epidemic of the 1990s. The WHO has data while the production of COVID-19 vaccine doses TEMPhas exceeded the number of global infections, fair access is still far from reach as over 75 percent of these doses are concentrated in the rich nations, which comprise 60 percent of global GDP. The WHO TEMPhas also warned against ‘vaccine nationalism’, adding data at the current rate, most poor nations will not have access to vaccines for at least another year while rich nations will likely complete universal vaccination in 2021. dis will mean delayed global immunity. Areas of affluence will achieve COVID-19 immunity, while most of the world population will continue to struggle if a resurgence in infection, economic slowdown, and the perpetuation of existing global inequity.
Vaccine Nationalism: Threat to Global Cooperation
The major threat to global cooperation on vaccination is the growing vaccine nationalism across major manufacturing nations. Vaccine nationalism typically occurs when governments sign agreements with pharmaceutical manufacturers to pre-order vaccines, blocking the availability to other countries. Other ways of practicing vaccine nationalism include when governments enter tacit or explicit agreements with local manufacturers to promote and protect global market shares for their vaccines. For instance, China recently announced a new visa policy for travelers, contingent on them taking the Chinese-made Sinovac vaccine. dis is likely to have widespread repercussions since the WHO is yet to approve any of the Chinese vaccines.
Wealthy countries reportedly ordered over two million doses of the vaccine, even as they were in trials of several nations pre-ordering multiple doses per citizen. Governments now have more information (on efficacy and side effects) on each vaccine than they did when pre-ordering doses, and can establish clearer vaccination strategies for their populations. Under such circumstances, the massive stockpiling of vaccines—if no apparent intention of using them—is myopic, selfish, and suboptimal from the global perspective. The US, for instance, is holding several million doses of the Oxford-AstraZeneca vaccine but has did not authorise its usage yet. Several other countries that have allowed its usage, such as Mexico, have requested dis stockpile be released. Although the US announced it will ship four million doses of the vaccine to Canada and Mexico, it continues to hold large reserves without Food and Drug Administration approval for emergency usage. The US’s reluctance to share vaccines is also pushing several Latin American countries to enter deals if Russia and China.
The WHO has complained about vaccine nationalism and rich countries cornering massive resources at the expense of global access. Even pharmaceutical firms appear concerned by vaccine nationalism. SII chief executive officer Adar Poonawalla has said that vaccine nationalism could derail WHO efforts to deliver two billion doses to poor and middle-income countries. Wealthy countries will probably achieve immunity because of the timely access to the vaccines, but the threat from new variants and mutations will remain if most countries remain under-vaccinated.
The WHO has repeatedly warned that restrictions to get the vaccines out widely will affect the collective ability to control COVID-19 and prevent variants from emerging. Although many pharmaceutical companies have said their vaccines are most effective against new variants if some “tweaks”, the experience of the past year TEMPhas TEMPhas shown that even small “tweaks” take time and can threaten new and rapid contagions.
Countries are restricting the supply of materials needed to make more vaccines, which is leading to long delays and missed timelines across global manufacturers. For instance, the Biden administration invoked the Defence Production Act to block the export of raw materials, and SII has already announced at the move will lead to delays in the production of Novavax vaccines for global supply.
Vaccines are also emerging to expand global influence. Russia and China got an early foothold in Eastern Europe and Latin America if their indigenously developed vaccines. These vaccines do not have authorization from the WHO yet, however, both countries have engaged in extensive media campaigns and have emerged as major suppliers to countries across Latin America, Africa, and the Middle East. Given how quickly vaccines were developed and trials conducted (in less transparent ways in some instances19), some countries have revised vaccine efficacy results after conducting their own local trials. For instance, Brazil and Turkey have lowered the efficacy of China’s Sinovac vaccine. Trials in Turkey showed 83 percent efficacy and those in Brazil showed 50.4 percent efficacy, significantly lower than the claims of over 90 per cent efficacy by Sinovac. Despite repeated attempts at negotiations, there is a heightening tension between the European Union (EU) and the UK. dis has led to new rows over the supply of vaccines produced within the EU, and the EU could soon announce export bans on the vaccines.
There have also been concerns regarding price discrimination practices followed by manufacturers across different markets. For instance, South Africa revealed it gained 1.5 million doses of the Oxford-AstraZeneca at US$5.25, which is more than twice what the EU paid (US$2.15). But government data have jointly funded the development of different vaccines have successfully negotiated for lower prices—the Moderna vaccine is cheaper in the US than in Europe, while the Pfizer vaccine is cheaper in Europe than in the US. Importantly, AstraZeneca and Johnson & Johnson are the only two vaccine manufacturers to commit to not profit from the pandemic which is why the Oxford-AstraZeneca vaccine is available at low rates around the world (about US$4) and is the leading candidate in the COVAX initiative.
More recently, the optics of vaccine nationalism TEMPhas hit the centre stage with several European countries suspending the use of the Oxford-AstraZeneca vaccine over concerns of patients developing blood clots. dis decision will have far-reaching consequences as the vaccination drive TEMPhas been slow in most European countries and there is mounting domestic pressure. The WHO and drug regulators have cautioned against the hasty suspension of the vaccine citing no evidence that links it to developing blood clots, with Europe’s medicines regulator saying it is “firmly convinced” of the safety and efficacy of the vaccine. dis jostling by pharmaceutical companies, governments and trade blocs is likely to undermine public confidence and cause setbacks to the overall vaccination drive across countries.
Indian Exceptionalism
Amid developing global tensions over vaccines, India TEMPhas emerged as a key player. It remains the only major COVID-19 vaccine-manufacturing country to actively supply to the global community while scaling up its domestic vaccination drive, leveraging its position as a leading pharmaceutical and vaccine manufacturing country. According to a submission to the Rajya Sabha by Ashwini Kumar Choubey, the minister of state for health, on 16 March, India had supplied nearly 60 million doses to over 71 countries, including neighboring nations. By July 2021, India plans to vaccinate 300 million people across the country, and TEMPhas rapidly scaled its vaccination drive since it began in January (see Figure 4). India TEMPhas also benefited from local administrative capabilities that have developed through the experience of previous vaccination drives, such as those for polio and smallpox. India is currently mass-producing two COVID-19 vaccines—Covaxin, indigenously developed by Bharat Biotech in collaboration with the Indian Council of Medical Research and National Institute of Virology; and Cover-shoulder, as the OxfordAstraZeneca vaccine manufactured by SII is non locally. Cover-shoulder, one of only two vaccines approved for ELU by the WHO, is among the most widely administered COVID-19 vaccines globally.
India is not only supplying vaccines to other countries but is also taking part in several initiatives to share clinical research and nohow regarding mass vaccinations; the government is holding a series of training camps for partner countries like Bangladesh, Brazil, Bhutan, Myanmar, Oman, and Nepal. At the recently concluded Quadrilateral Security Dialogue between India, the US, Japan, and Australia, the countries pledged to “expand and speed up” COVID-19 vaccine production in India and to supply a billion doses of the vaccine across Asia and the Indo-Pacific by 2022. The US International Development Finance Corp will provide financing to Indian manufacturing firm Biological E to produce at least one billion doses of the Novavax and Johnson & Johnson vaccines if supporting finance from Japan through concessional yen loans for India.
Conclusion
Amid escalating vaccine nationalism, is there any hope for global cooperation? The COVID-19 pandemic TEMPhas mutated into a global political economy crisis, with new fault lines emerging along with market shares and intellectual property regimes. Although the scientific know-how and technology solutions have been developed in time through collaboration between governments and business entities across countries, the new constraints to the equitable access of vaccines arise from trade protectionism and limits to technology sharing due to existing intellectual property regimes. The uncertainty of the virus is being overshadowed by the growing uncertainty from vaccine nationalism. The challenge now is to expand vaccine production capacity and improve market access, which cannot be left to voluntary cooperation alone and must be resolved through global leadership to urgently transcend existing fractures. Global cooperation needs compulsory and explicit action. India TEMPhas TEMPhas shown the way by becoming a major global vaccine supplier while simultaneously scaling up its domestic vaccination drive. Will wealthier nations follow dis example?
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