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The Malaise of the Me-first Syndrome

Countries embracing ‘vaccine nationalism’ in their race for a cure are forgetting that the bedrock of clinical research in pandemic times is 'the global public good.'

Analogies abound to describe the phenomenon of ‘vaccine nationalism’ with countries spurred by extreme nationalism to be the first to find one. As if there is national honour at stake in the war against COVID19.  The aptest one is the image of cabin pressure drop in an airliner and passengers rushing to put their own mask before bothering to assist others, even their own family members.

While the fervour to be the first to find the elusive vaccine is well understood in a world riven by extreme nationalism, however, it is in no way helping the cause of mankind.   This ‘my country first’ approach has major implications for lower-income countries with few resources to manufacture or back a vaccine producer. With the U.S. and the UK already competing to lock-in early access, without an international commitment to distribute vaccines globally in an equitable manner, the grim prospect of a "vaccine auction" with access first only to the highest bidder stares the poorer countries in the face.  Will this mad rush for profits drive the prices beyond the reach of low and middle-income countries? 

With the world more divided now than ever before, precipitated by the intensifying cold war between the U.S. and China, the greatest fear is that the vaccine itself could become a weapon in this competition.  Geopolitical considerations are now deeply intertwined with the search for a cure. Governments are turning inward and pursuing the classic game theory of the ‘prisoner’s dilemma’.  

A GRIM PICTURE AHEAD

Several reports, notably by Foreign Affairs and Bloomberg, paint a grim picture where countries without access to initial stockpiles, are predicted to search for other forms of leverage, including blocking exports of critical vaccine components, leading to the breakdown of supply chains for raw ingredients. This also brings into question important humanitarian concerns, particularly equitable access to the vaccine and other healthcare facilities in war zones and refugee camps across the Middle East, or in lower-income and developing countries in Asia, South America and Africa. 

In a domino effect, the consequences will be far-reaching, with long-term economic, diplomatic, and strategic effects. The severity of the pandemic and its destructive potential should inject a sense of empathy in the vaccine-developing countries, and it would be highly immoral if not downright cruel to deny the vaccine on pecuniary or geopolitical considerations.

According to Thomas Bollyky and Chad Brown in Foreign Affairs, the result of ‘vaccine nationalism’ will be “not only needless economic and humanitarian hardship, but also intense resentment against vaccine-hoarding countries, which will imperil the kind of international cooperation that will be necessary to tackle future outbreaks and other global crises like climate change.” In the interim, healthcare workers, the elderly and other high-risk individuals in poorer countries will go unprotected, which will extend the pandemic, increase its death toll, and further compromise already fragile healthcare systems and economies.

Top contenders in the race for a vaccine are China, Russia, the U.S, UK, EU and India. 

Seeking to counter criticism over being the epicentre of the pandemic and mishandling the early outbreak, China is attempting to ‘rebrand’ itself by pledging to make any vaccine manufactured in China, a ‘global public good’. However, there are concerns over quality, mechanisms and testing periods.

Russian State television has for several months now promoted the idea of Russia leading the competition. According to reports, Russia plans to launch a nationwide vaccination campaign in October with a vaccine that has yet to complete clinical trials, raises international concerns surrounding transparency and methods.

The United States bought up virtually all the supplies of Remdesivir, one of the first drugs proven to work against COVID-19, leaving none for the rest of the world for the next three months. As part of its Operation Warp Speed, it has now committed billions of dollars to vaccine companies, with the priority of supplying American citizens first.

The United Kingdom has already secured the highest number of potential COVID-19 vaccine doses per capita, ahead of the U.S., having signed a deal with GlaxoSmithKline Plc and Sanofi for as many as 60 million doses as well as heavy investment in the Oxford trials. The licence given to Serum Institute of India has a clause assuring certain numbers for UK, before they can be issued to others.

The European Union imposed export controls on local supplies of personal protective equipment, ventilators, and medicines during the first four months of the pandemic, and (in conjunction with the 750 billion Euro Recovery Deal signed last month) have partnered with other vaccine producers like Pfizer, Sanofi and AstraZeneca. 

The Serum Institute in India is developing one of the leading COVID-19 vaccine candidates and has signalled that most of the initial supply of a successful shot would be distributed within India.

According to Jen Kirby at Vox, international cooperation is of utmost importance given the complexity of vaccine supply chains.  With different countries specialising in separate parts, there is a need to coordinate efforts and logistics. Drawing parallels to the H1N1 or swine flu virus outbreak of 2009, when hoarding of vaccines was practised by nations, experts predict the current scenario to be much worse, because of the large-scale spread of COVID-19, already described as the ‘worst health crisis of this century’. Given the impossibility of shutting down international trade and travel, every country will continue to remain vulnerable to the virus till total global inoculation, thus making a multilateral effort to enhance vaccine access imperative.

ASSESSMENTS

  • Cooperation can still be attempted through existing enforcement mechanisms as the vaccine manufacture and trade already have several layers of interdependence. This has led to efforts towards a vaccine being referred to as a ‘global public good’ — a resource to be made available to all countries equitably.  While in the highly competitive “dog eat dog” world of pharmaceuticals it would be impractical to a expect a long-term sustainable enforcement mechanism, an effort to reach this goal would be a blessing for humankind
  • International scientists and health specialists are cooperating more than their governments. In a joint effort, the WHO, the Coalition for Epidemic Preparedness Innovations, which works to advance new vaccines, and Gavi, a global non-profit group focused on vaccine delivery, have set up a programme to distribute successful vaccines equitably around the world and increasing access in lower-income countries. Named the COVID-19 Vaccines Global Access Facility (Covax), it calls on higher-income countries to invest $18 billion in about 12 experimental vaccines, and ensures that all countries involved, no matter their income, get access to the vaccine at the same time.  These efforts deserve the strongest support.

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