Vaccine nationalism and congestion continue to contribute to the long-running COVID-19 pandemic, threatening a global plan to distribute COVID-19 vaccines fairly and effectively. Both phenomena reveal the current limitations of global health governance and the failure of countries with good resources to detect whether it is in their interest to vaccinate the world.
Necessary But Not Enough
There is a big difference in the proportion of people vaccinated against COVID-19 compared to low-income and high-income countries: in early 2022, more than 80 percent of the population in high-income nations are vaccinated compared to less than 10. percentage of the population in low-income countries. This difference in vaccine status reflects the difference in vaccine access.
One mechanism created to prevent such unvaccinated access to vaccines worldwide was COVID-19 Vaccines Global Access (COVAX), a multilateral vaccination mechanism led by Gavi, the Coalition for Epidemic Training Innovation and the World Health Organization (WHO). The pandemic was created to give COVAX access to COVID-19 vaccines to people around the world and to work as a mechanism for governments and key actors to work together to control the pandemic.
COVAX supports the acquisition and acquisition of COVID-19 vaccine for 92 low- and middle-income countries, and at the same time supports the recruitment of more than 97 middle- and high-income nations; efforts of this ambition and scale were unprecedented in health care worldwide. In early 2022, COVAX distributed more than a billion vaccine doses to 148 nations, mostly in low- and middle-income countries, and revealed that the participation of high- and middle-income countries was more rhetoric than reality. .
So we have to ask, if one of the main missions of COVAX was to prevent large differences in vaccination rates in the world, what is behind the persistent inequalities we see today? And, is COVAX really a disappointment, despite the distribution of more than a billion doses of vaccine in 148 countries, especially in low- and middle-income countries?
In fact, many politicians, politicians and advocates have been quite critical of COVAX, its supply system, governments and the public for communication and its government. Many believe that COVAX’s goal has been ambitious without securing funding and providing supplies of vaccines; some believe that COVAX has not placed its weight behind intellectual property exceptions and has not been transparent about its contracts with pharmaceutical companies.
However, the nationalisms and walls of vaccines that we have seen over the last year and a half represent a broader problem than COVAX. Vaccine nationalism and overcrowding occur when governments sign agreements with pharmaceutical manufacturers to have vaccines and increase supply in their country, including securing supply far from the projected needs of their population. The goal is to supply and integrate the nation as quickly as possible, regardless of the distribution limits that this may impose on the world.
We believe that this global protectionism has undermined the allocation mechanism and efforts of COVAX. If the founders of COVAX have a responsibility here, it is because rich countries have too much confidence in solidarity with the poorest countries in a global pandemic, even though that solidarity will also benefit the citizens of rich countries. In this respect, his criticisms are partly correct. Clearly, the CEPI, the WHO and Gavi and their leaders expected too much from rich countries; they expected too much funding, too much logistical support, too much willingness to wait in line. Moreover, many criticisms of COVAX underestimate, or disregard, its very real contributions to helping the world get vaccinated, even if it is not in a way that is strongly driven by equity.
One of us, Yoo, and colleagues evaluated the equity in allocating and distributing COVID-19 vaccines to 148 countries and territories participating in COVAX. The research has just been published in the journal Bulletin of the World Health OrganizationDespite the challenges it has encountered, COVAX has been the only vital source to help balance the global differences in the distribution and distribution of COVID-19 vaccines. We also found that countries with low gross domestic product (GDP) per capita had a higher benefit than those with higher incomes than COVAX vaccines. This benefit was further increased as we adjusted for the country’s population aged 65 and over.
That is, COVAX has been needed to vaccinate the world, but it is not enough. Its failures are the failures of a global health paradigm that focuses on solidarity rather than charity for too long, elevating the concept of response above building resilience. COVAX alone would probably never be able to gather enough resources and mechanisms to distribute COVID-19 vaccines equitably around the world; In global health, efforts have never been made to achieve this goal or to reach it as quickly as many people — neither against HIV / AIDS, nor against malaria, nor against tuberculosis, nor against polio, nor about smallpox. The only disease that has been successfully eradicated from the world.
So how can we do better next time?
We believe that resolving inadequate access to vaccines (COVAX in its current role and efforts) goes beyond what is possible for COVID-19 or any public health threat. Leaders in high-, middle-, and low-income countries need to think bigger. Countries, especially high-income countries, must also comply with their obligations under the WHO International Health Regulations, in particular the binding obligations of States to “commit to co-operation”.
Basically, these differences are due in part to the fact that many high-income countries see valuable medical technologies as a scarce resource to be stored. Instead, they should recognize that this is not only a public good in the world, but that it is in their best interests. The loss of economic life and productivity in the world over the last two years should be sufficient proof of this reality. This is due to the fact that the virus has a strong tendency to produce variants and that these variants do not take into account national boundaries.
What would that recognition look like in practice?
First, high-income countries should participate in COVAX without even signing exclusive vaccine purchase agreements.
Second, large revenues should guarantee funding for COVAX over a three-year (or longer) period of time, similar to the Global Fund and the World Bank’s International Development Association renewal models. It is an imperfect model, but it is understood by a donor country.
And third, nations should protect the transfer of intellectual property rights and related technologies to qualified vaccine manufacturers in low- and middle-income countries (LMICs) so that vaccine doses to people in LMICs are closer to home.
These few suggestions do not indicate the exact list of legal and structural reforms needed to ensure that the next pandemic does not create the same inequality and injustice that is visible today. It is clear that policies and decisions — COVAX, WHO, and many other entities that make up our global public health and training system — did not work as we had anticipated in the years before this pandemic. Hopefully we know how to do better next time. We have the tools to advance global opportunity, equity and solidarity. And we need to do that in favor of the lives and livelihoods of people around the world.