The Problem of Nationalism in Global Health: Complications and COVID Vaccination
The unprecedented toll of the Covid-19 pandemic is clear: more than 48 million cases, over 1.2 million deaths, and a 5.2% contraction in global GDP. Therefore, there is a strong imperative to find a vaccine that has the potential to put an end to the grim circumstances the world currently faces. However, in trying to protect populations, panic and frenzy among governments aiming to secure vaccine supplies have created the phenomenon of vaccine nationalism.
Global cooperation and equitable access to Covid-19 vaccines seem to be the most logical and effective way to curtail the virus. Indeed, the global impact of unequal distribution could cost the economy $1.2 trillion a year. Epidemiological experts have made clear that slowing transmission rates would be most successful in immunization programmes that prioritize vaccinating healthcare workers and people in high-risk groups on a global scale. Yet, many governments seem to be neglecting this advice in favour of prioritizing their own populations.
While the UK government has claimed that the first 100 million doses of the Oxford-AstraZeneca vaccine will be distributed amongst Britons, the CEO of India’s Serum Institute who are responsible for the vaccine candidate’s production- has already stated that “a majority of the vaccine, at least initially, would have to go to our countrymen before it goes abroad”. In a similar ‘my-country-first approach’ the Trump administration, under Operation Warp Speed, has struck a deal with Moderna to develop 100 million doses, which will be owned and distributed by the federal government. It seems that high-income countries in which pharmaceutical companies operate and that are endowed with high purchasing power have asserted some degree of sovereignty over vaccines produced within their jurisdiction. In directly negotiating for priority and advance orders, these countries essentially crowd out lower-income countries. This would seem to point to vaccine distribution as being the outcome of a given country’s economic clout rather than population vulnerability or transmission risk factors.
The development of vaccine nationalism hardly seems surprising, particularly given the pattern of self-interested behaviour throughout the pandemic. Earlier in the year, the international community experienced a shortage of Personal Protective Equipment (PPE) due to a sharp rise in demand coupled with panic buying of limited supplies and subsequent hoarding. Furthermore, in June the US bought up nearly all of the global supply of remdesivir, a key drug used in treating Covid-19 patients, creating a global shortage and thus precluding it as a treatment option in all other countries until September. No doubt, this would have led to more deaths than had there been equal access to the drug.
Such actions have created tensions and to some extent resentment among the international community, leading countries to turn more inward and individualistic. Governments are acting according to the raison d’etat, the national interest- that is, prioritising the needs of its citizenry- to the detriment of international cooperation. For some politicians, international condemnation over perceived unequal vaccine allocation is traded off as an acceptable cost for ensuring the domestic population is protected. This is particularly relevant to the Trump administration who- during a US election year- withdrew the US from the World Health Organization, after alleging it was under the control of the Chinese government. This seems to allude to the increasing political utility of the pandemic, whereby governments shift blame to foreign- and even domestic- opposition for their own failures. Therefore, while the promise of a vaccine presents a significant benefit to public health, it will also serve the twin purpose as a beneficial tool in power politics. However, it is this politicization of public health and neglect of institutions- a notable example being the NHS- that has led to disastrous governmental responses. Therefore, it would be a great injustice if governments that have failed in their Covid-19 policies to simply flex their economic muscle to obtain vaccines at the cost of countries such as New Zealand and Vietnam who have performed well throughout the pandemic. Perhaps an even greater injustice is that such a precedent would effectively condemn the world’s poorest nations to the back of the line for vaccines.
In an attempt to keep this rising tide of nationalistic behaviour at bay, the WHO in coordination with Gavi launched the COVAX Facility. The initiative intends to sign on countries to the programme in order to create equitable access to Covid-19 vaccines stocks and is touted as the only truly global solution to vaccine nationalism. Although it claims to be a lifeline for lower-income countries, a number of questions have been raised regarding the success of such a programme, particularly given the increased mistrust of international institutions and isolationism. Furthermore, in allowing governments to continue negotiating orders directly with pharmaceutical firms, the COVAX enterprise functions as an insurance policy and a ‘win-win’ situation for wealthy countries who can afford such transactions, therefore undercutting the premise of equity and equality. Indeed, the fact still remains that vaccination manufacture is highly exclusive to firms in a handful of high-income countries including Moderna (US), AstraZeneca (UK), BioNTech (Germany) and Sanofi (France). This effectively empowers the governments of these countries to call the shots if and when they produce successful vaccine candidates, again going some distance in undermining the idea of equitable allocation of vaccines.
In the end, it is clear that global crises require global responses. But it is also clear that unprecedented global demand far exceeds limited global supplies. Although it is true that there are significant scientific and logistical issues that need to be addressed, it appears that the politicization of the pandemic is sure to be the greatest challenge in equal vaccine distribution. As such, it seems that vaccine nationalism will ultimately prevail over vaccine multilateralism, jeopardizing international solidarity required to confront this crisis and crises of the future.
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