WHO Director-General Tedros Adhanom Ghebreyesus recently said vaccine nationalism will prolong the Covid-19 pandemic as he expressed concern that some countries are rolling out vaccine only for their own citizens while the world’s least developed nations only wait and watch. 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.
Speaking on the last day of the recent weeklong online Davos Agenda Summit of the World Economic Forum, Ghebreyesus said many countries are rolling out vaccines for their own people, but it is leaving the most vulnerable people of the world at a big risk. The pandemic, he said, has exposed and exploited the inequalities of our world. There is now the real danger that the very tools that could help to end the pandemic — the vaccines — may exacerbate those same inequalities.
He said vaccine nationalism will only prolong the pandemic, the restrictions needed to contain it, and human and economic suffering. He rightly argued that if we lose trust in international collaboration through vaccine nationalism, we will all pay the price in terms of a protracted recovery. He said the WHO is asking those governments that have already received deliveries of vaccines to vaccinate their health workers and older people, and share excess doses with Covax (an alliance of vaccine makers for Covid-19) so other countries can do the same.
The most immediate effect of vaccine nationalism is that it further disadvantages countries with fewer resources and bargaining power. It deprives populations in the Global South from timely access to vital public health goods. Taken to its extreme, it allocates vaccines to moderately at-risk populations in wealthy countries over populations at higher risk in developing economies.
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. 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.
If Covid-19 vaccines are not made available affordably to those who need them, the consequences will likely be disproportionately severe for poorer or otherwise vulnerable and marginalised populations. Nationalism is at odds with global public health principles. Yet, there are no provisions in international laws that prevent pre-purchase agreements like the ones described above. There is nothing inherently wrong with pre-purchase agreements of pharmaceutical products. Vaccines typically do not generate as much in sales as other medical products. If used correctly, pre-purchase agreements can even be an incentive for companies to manufacture vaccines that otherwise would not commercialised. Institutions like Gavi, an international nonprofit based in Geneva, use similar mechanisms to guarantee vaccines for developing countries.
Contracts should not trump equitable access to global public health goods. Developed countries should pledge to refrain from reserving vaccines for their populations during public health crises. Covax is a starting point for countries to test collaborative approaches during the current pandemic. But more needs to be done. 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. Equity entails both affordability of vaccines and access opportunities for populations across the world, irrespective of geography and geopolitics. The only exit strategy from this pandemic is to work together.