20201009213159 300x200 - Cross-national accessibility of COVID vaccines – nationalism versus multilateralism
Professor Zha Daojiong

Around the world, great hope is placed on vaccines as an instrument for dealing with the COVID-19 pandemic. With the winter flu season in the northern hemisphere and many societies still struggling with containing the spread of the virus, loosening of international travel restrictions continues to be limited, which in turn hampers the world’s return to normalcy.

Much progress has been achieved in the search for vaccines. Yet, vaccine production necessitates a constant process of refinement through research, clinical trials, and gathering of data to prove its safety and effectiveness. Only upon approval by national health authorities can a vaccine be mass-produced and then made available for mass inoculation, with the eventual goal of realizing mass immunity.

Around 40 candidate vaccines are registered with the World Health Organization (WHO), with nine of them – four by Chinese vaccine developers — in the third and final clinal trial phase. For any of these products to successfully reach the state of mass use, there is still a scientific process to complete. Some inevitably are to be eliminated.

Production of a vaccine is a demanding endeavor in terms of financial and technological input. Quality assurance is a necessary precondition, which must result from proven health safety and effectiveness on human participants in the development process. Only a few countries have the resources to produce vaccines to meet demand for immunization of their own populations.

Accordingly, some countries opt to partake in vaccine development initiated in other countries, including bottling and transportation. Some other countries will have to procure from available international pool of successful vaccines. The WHO’s vaccine prequalification offers a technical reference for such procurement.

Globally, gaps between demand for vaccines and available dosages are a predictable reality, at least in the initial stage, partly due to uncertainty a producer faces in marketable doses of a product. To address this foreseeable challenge, the WHO, in collaboration with the Global Alliance of Vaccines and Immunization (GAVI) and the Coalition for Epidemic Preparedness Innovations (CEPI) offered the Covax Facility arrangement. The facility envisions making available two billion doses of COVID vaccines for use in middle- and low-income developing countries, covering some 20 percent of their total populations.

Against the odds, vaccine nationalism is a common choice of action by developed countries equipped with the scientific and technological capacity as well as financial resources to cover the associated costs. Although no vaccine has yet received approval for use, with only candidate vaccines that meet technical standards for emergency use, several developed country governments have signed advance purchase agreements with vaccine developing corporations to satisfy future needs of their respective domestic populations. The United States, Great Britain, European member states, and Japan are said to have secured right to 130 million doses potential COVID vaccines.

Accessibility is but one of the many challenges the world is facing in vaccine distribution. If COVID vaccines are sold at market price levels, most low-income and some mid-income countries will encounter the predicament of affordability. To be fair, though, even with commonly available vaccines, affordability is a long-standing challenge for developing economies. GAVI, an alliance of vaccine producers, addresses the matter by dividing developing country beneficiaries into two categories, with one having to pay full costs and the other subsidized prices.

Covax Facility is a multilateral arrangement. Its proponents champion it as the biggest effort at international cooperation since the Paris climate agreement. Emergence of the arrangement manifests acceptance of treating international health as a public good, which China champions. Product developers and users negotiate through the platform to realize the goal of mutual protection.

Vaccine nationalism, meanwhile, has its historical precedent. To deal with the H1N1 pandemic in 2009-2010, a small number of developed economies chose to bond with each other on the merit of research and paying capabilities, with a few even hoarding successful vaccines. Developing economies were offered the product only after deployment needs had been met in developed ones, by which time the pandemic had come to an end. There resulted a surplus and waste of vaccines. As such, vaccine nationalism can be a double-edged sword.

COVID-19 is an entirely different challenge, unprecedented in one century. Economies will be tempted to ensure and expand domestic capacities of vaccine production. But a scenario cannot be ruled out whereby curbs are imposed on global movement of materials for vaccine ingredients, packaging, and injection. That will be another form of vaccine nationalism. After all, cross-national flow of vaccine products is a component of international competition in trade and investment, which comes with its share of frictions and conflicts over product branding and extended economic and political interests.

In the real world, public health is a sphere in which geopolitically motivated maneuvering takes place. Procurement of a vaccine, when a product’s nationality becomes a core choice factor, can become yet another manifestation of vaccine nationalism. For a procurement decision to be made without due regard to scientific facts behind pathobiology would be against common sense in therapeutic terms. It might earn some momentary gains in political maneuvering but amount to irresponsibility towards citizens so affected.

According to publicized information, in the Covax Facility, China is not going to receive preferential treatment when it comes to per unit price of participating vaccines, reflecting the fact that its per capita income is in the upper level of middle income economies. But China stands to have an opportunity to function as both a product supplier and purchaser under the platform, especially in the event of domestic product falling short of meeting demand. As a supplier, joining group negotiation can help save time and human resource input that comes with relying on bilateral channels.

A multilateral arrangement for COVID vaccine distribution, meanwhile, should not be viewed as a confrontation with acts of vaccine nationalism. The prevailing COVID-19 challenges are such that spread of the virus pays no regard to an individual’s nationality, nation-state boundaries, or gaps in aggregate or individual capacity to afford a product. The sooner and the more societies reach the stage of herd immunity through effective immunization by vaccination, the greater for realization of hope for trade and travel to restore normalcy among various economies. In this sense, practices of multilateralism in vaccine access and affordability are also in line with protecting an economy’s own public health security.

As a matter of fact, many nations, including members of the European Union, have opted to join multilateral vaccine arrangements, in addition to pursuing bilateral means of product acquisition.

The world’s search for etiological origins of the COVID-19 virus is still under way. Whether or not future demand for a COVID vaccine will evaporate, like that in the wake of the SARS pandemic in 2002-2003, remains an unknown as well.

All in all, the world is witnessing a race between vaccine nationalism and multilateralism. Being part of a multilateral arrangement is one way to prepare for multiple future scenarios.

(Zha Daojiong is a Professor in the School of International Studies, Institute of South-South Cooperation and Development, Peking University.)

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