Vaccines must be for all, or pandemic will persist

The success of clinical trials of COVID-19 vaccines has not only delivered desperately needed relief to a world teetering on the edge of a major catastrophe, it has also highlighted a major concern for global public health experts.

At least 10 vaccines will probably be approved by early 2021, but wealthier nations have already ordered up to 5 billion doses for their own people. The US alone has secured more than a billion doses of at least 6 vaccines in development, and the UK has signed agreements to supply as many as 5 doses per citizen.

A lack of transparency in the deals between pharmaceutical companies and powerful governments leaves little guarantee for the rest of the world, particular poorer nations. An inability to purchase the vaccines, let alone strike deals to manufacture them locally, will restrict low-income countries’ access to about 10 billion doses by the end of 2021. Only 4 of the 10 major vaccine manufacturers will be able to produce significant quantities this year, and most of these doses will be delivered to countries that ordered as early as August, while vaccines were still in development.

The nature of COVID-19 is such that, to effectively eradicate the virus across the planet, efforts must be applied everywhere and equitably. Unilateralism and vaccine nationalism will do more harm than good, prolonging the pandemic and even weakening any positive impact of intensive vaccine distribution programs.

The misallocation of vaccines is not new. It happened with H1N1 influenza in 2009, when wealthier nations hoarded vaccines, which prolonged the outbreak. H1N1 pales in comparison to the devastating impact of COVID-19, which makes the prospect of vaccine hoarding unconscionable. The hypocrisy of calling for equitable vaccine access and effective distribution adds insult to injury.

On the bright side, there are initiatives such as the Geneva-based COVAX facility and the ACT Accelerator Facilitation Council that not only fund the development of vaccines but also help poorer nations to secure doses and safely distribute them. After all, finding an effective vaccine is only the first step; distributing it effectively presents new challenges that require significant coordination at the highest level with organizations such as the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization.

Lack of infrastructure, already a problem forcing most poorer countries to resort to palliative rather than curative care, will again rear its head when it comes to delivering and storing vaccines. Some will require cold-chain facilities; the Pfizer-BioNTech vaccine must be stored at -70 degrees Celsius. This does not bode well for southern hemisphere countries, especially those without reliable power capacity. Relying on generators only leads to increased costs in terms of fuel and maintenance, since inconsistent storage temperatures are likely to render vaccines with short shelf lives useless.

It is therefore crucial that collaborative institutions are well funded and competently managed. However, ACT calculates that its efforts are underfunded by as much as $35 billion, while COVAX estimates vaccine manufacturers will need as much as $18 billion to produce and deliver at least 2 billion doses. So far, wealthier nations have only expressed interest in these initiatives; few have committed to them. With economies battered and domestic challenges mounting, it is unlikely that the world’s wealthiest countries will step up to ease the multibillion-dollar financial burden, despite the obvious benefits to all.

However, there are other viable solutions to address inequitable access to vaccines. Governments around the world could require vaccine developers to license their vaccines to domestic manufacturers. World Trade Organization rules allow for such licensing, which has worked with the development of generic antiretrovirals against HIV. However, compulsory licensing of vaccine patents does not cover proprietary information regarding the complicated development, testing and approval of vaccines. Pharmaceutical companies would probably reject such moves, and most governments have little leverage given rising COVID-19 numbers and the potential for economic disruption.

While forced licensing is one way to increase production and access, the real threat to equitable distribution of vaccines is the lack of collaboration between governments to raise the adequate funding and ensure dosage affordability worldwide.

Failure to apply the lessons of 2009 will only prolong the pandemic. Additionally, even if by some miracle the world’s poorer nations were able to secure adequate doses and distribute them, the same cannot be said of fragile states and conflict zones. This issue could be resolved by a coordinated and well funded international effort to secure doses and supervise their distribution as widely and as safely as possible. Unfortunately, with a global recession putting downward pressure on donor funds, it is likely that COVID-19 will not simply vanish.

After months of woeful news, it is certainly worthwhile to celebrate successful vaccine trials and inject a fair bit of optimism into these bleak times. However, the spread of COVID-19 was facilitated by how interconnected we have become, and no nationalistic, unilateral or protectionist actions can prevent the worst outcomes from inequitable access to vaccines. Only pluralistic, multilateral and well coordinated efforts will ensure a quick end to this pandemic. In our rush to bury COVID-19, we must not create new challenges before we even tend to the wounds wrought by the pandemic.

• Hafed Al-Ghwell is a non-resident senior fellow with the Foreign Policy Institute at the John Hopkins University School of Advanced International Studies. He is also senior adviser at the international economic consultancy Maxwell Stamp and at the geopolitical risk advisory firm Oxford Analytica, a member of the Strategic Advisory Solutions International Group in Washington DC and a former adviser to the board of the World Bank Group. Twitter: @HafedAlGhwell