MILWAUKEE, Wisconsin — As of May 30, 2021, there have been more than 169 million cases of COVID-19 and more than 3.5 million deaths worldwide. As of May 31, 2021, more than 1.5 billion vaccine doses have reached people across the globe. However, just as we have seen inequities in the impacts of COVID-19, we are likely to see a disproportionate number of people living in poverty remain unprotected long after wealthier people are fully vaccinated. Out of 29 low-income countries, just four had begun vaccinating as of March 4, 2021, highlighting the likelihood of even larger challenges in COVID-19 vaccine distribution.
Vaccine Nationalism Versus Vaccine Multilateralism
An important part of preventing this vaccine inequity, and thereby, fighting general COVID-19 inequities, is global diplomacy and cooperation. This approach, known as vaccine multilateralism, is the opposite of or an “antidote” to vaccine nationalism, which is characterized by wealthy nations prioritizing the entirety of their own populations over those most at risk in other areas of the world.
Global Vaccine Distribution in History
To better understand the case for vaccine multilateralism, we need not look far back in history. Gavi, the Vaccine Alliance promotes fair vaccine production and access for all nations. Gavi has done so for many diseases and vaccines throughout its existence. Recognizing the value of equitable and expansive vaccination, Gavi was formed in 2000 as a public-private partnership thanks to a $750 million five-year pledge from the Bill and Melinda Gates Foundation.
These partners collaborate to negotiate for affordable vaccines by providing manufacturers with demand they can rely on predictably and long-term. If demand is low or just too unpredictable, manufacturers are not incentivized to continue to supply vaccines. Plus, if certain manufacturers monopolize certain vaccines, they are able to charge outrageous prices, thereby preventing equitable access.
Today, COVAX, the global initiative working for equitable access in COVID-19 vaccine distribution, is co-led by Gavi. Without specific efforts toward global cooperation, many people would remain without access to vaccines, extending the number of people who will remain at higher risk of contracting and spreading the virus.
Though far less widespread and much less deadly than COVID-19, both the avian flu (H5N1) in 2006 and the swine flu (H1N1) in 2009 demonstrated the self-interest of nations amid global health crises. Indonesia, facing the highest H5N1 death toll of all countries, temporarily refrained from sharing virus samples with the WHO. Though motivated by concern for its own citizens, this step represented a notable contradiction to global cooperation and a drastic step that affected people worldwide.
In the case of H1N1, the world saw many of its high-income countries quickly claim vaccines even before they were manufactured. The United States, for instance, ordered what would have been 30 to 60% of the total doses likely to be available worldwide. Though the disease thankfully dwindled and the pandemic was declared over in 2010, it was only after notable declines in the spread of the virus that high-income countries were willing to reallocate supplies to other countries.
Benefits of a Cooperative Approach
Beyond the obvious altruistic nature of multilateralism, there are many compelling reasons for nations to prioritize the vaccination of those most vulnerable worldwide above their citizenry as a whole.
First, there is still a lack of evidence as to the long-term effectiveness of the vaccines currently available, leading to the potential demand for more effective vaccines from elsewhere in the world. To demonstrate this point, and as the CEO of Gavi, Seth Berkley puts it, signing up to the COVAX facility specifically “represents a win-win” in that participating countries are assured access to as many vaccines as available and countries are simultaneously taking part in negotiations that expand global access by lowering prices.
Second, vaccine manufacturers may find themselves in need of materials available in other countries. Maintaining cooperation in COVID-19 vaccine distribution, and international relations in general, avoids difficult negotiations for such materials down the line.
Third, ignoring the need for vaccination elsewhere is to ignore the effects of borders that remain closed and economic effects that will continue to ripple across those borders should the virus continue to spread and kill unimpeded. Additionally, even with COVID-19 under control within a country’s own border, the continued spread elsewhere could bear further variants for which vaccines available in a given nation are not designed.
The Promise of Cooperation
Despite the myriad of challenges posed by the pandemic and COVID-19 vaccine distribution, promising efforts are already underway. An encouraging 600,000 doses developed in Britain and manufactured in India are being administered in Ghana, Beijing is donating 50,000 doses to Lebanon and the U.S. has pledged $4 billion to COVAX. The Chinese government has reportedly pledged donations to 53 countries. Nonetheless, there remains much to be done to ensure vaccine equity and vaccine multilateralism will continue to play an important role in overcoming the COVID-19 pandemic.
– Amy Perkins