Thursday, June 20, 2024

Coronavirus & Vaccine Nationalism: Tragedy or Deja Vu?

Public opinion, misinformation and disinformation on Covid-19 vaccine acquisition and roll out relate to the propagation of false or misleading content. In the case of Botswana, this information epidemic (Infodemics increased exponentially recently on social media.

Leading to one commentator recently writing:

“We never said go buy a vaccine that won’t work properly, we want you to go buy a vaccine whose efficacy is high enough BW Govt.”. “That’s what we want”. “RSA having tested some of the vaccine and finding what they found is no excuse for your slow and inept….”

The drumbeat clearly demonstrates a clear lack of understanding on the process of procuring the Covid-19 vaccine and allocation.

“Vaccine allocation among countries raises complex and controversial issues involving public opinion, diplomacy, economics, public health, and other considerations”.

Scholars have argued that Covid-19 has triggered a first vaccine fully immersed in far reaching globalised misinformation and disinformation. Vaccines have long played a crucial role in the prevention, mitigation and eradication of infectious diseases. More than any other recent outbreak, the COVID-19 pandemic has brought the phenomenon of the vaccine race to the forefront of personal, national and global preoccupations.

This piece begins by situating the ongoing vaccine race, firstly, by assessing the role(s) played by the World Health Organization, as well as public-private partnerships like CEPI (the Coalition for Epidemic Preparedness Innovations) and Gavi Alliance, a Geneva-based vaccine procurement organization.

Moreover, it offers a case study on COVAX, a quasi-global push and pull mechanism designed during the early stages of the COVID-19 pandemic to promote vaccine affordability and equity.

A few months after the World Health Organization declared COVID-19 a pandemic, there were well over 100 different vaccine development projects across the world. By July 2020, the number had risen to 150, of which 23 had moved to clinical trials. As one commentator put it:

“The speed with which this vaccine has been developed is remarkable—from publication of the first SARS-CoV-2 sequences through phase 1 [clinical trials] in 6 months, as compared with a typical timeline of 3 to 9 years. (…) The world has now witnessed the compression of 6 years of work” (Rutschman A,2018).

The study of how diseases spread, and why, has loomed large in the struggle to understand, contain and respond to COVID-19. imposing quarantines and mandating social distancing and mask-wearing; Washing hands frequently with soap and water, educational institutions were closed, gatherings limited, and essential businesses closed…. All these, in combination contributed to a considerable drop in transmission.

To stem the tide of havoc unleashed by Covid-19 as noted by Batool et al., 2020; Ashford et al., 2020, frantic efforts were made around the world during 2020 to develop and distribute a viable vaccine that would help immunize the world population against coronavirus (Chohan 2020).

By December 2020, good news had come from various pharma companies including BioNTech (Pfizer), Gamaleya, Sinopharm, and Moderna. In January 2021 almost 300 vaccines were being tracked by the London School of Hygiene and Tropical Medicine as going through various stages of development (Caddy, 2021). As of mid-January 2021, more than 35 million doses have been administered in 49 countries, and inoculation programs continued, at least in the “developed” world, (Gupta, 21). The aim was to develop an effective and safe vaccine in minimal time and distribute it around the world.

During the policy making and development of vaccines to curb the pandemic, “Vaccine Nationalism” became prominent and made it to popular press headlines. The expression “Vaccine Nationalism” made it to during the Covid-19 pandemic, (Myre G, 20).

Vaccine Nationalism is, however, not new. It refers to the management of secure doses of vaccines by a country, for its own citizens or residents and prioritises its own domestic markets before being made available in other countries. This is done through pre-purchase agreements between a government and a vaccine manufacturer. Several developed countries placed pre-production orders directly with different Pharmaceutical companies working on leading vaccine candidates, (Ruchtsman,20). For example, the United States, the United Kingdom, Japan, and the European Union have invested tens of billions of dollars on Research and development (R & D) deals with vaccine front runners.

The present race to hoard Covid-19 vaccines harks back to a similar situation that happened during HIV/AIDS with ARVs. Numerous scholars identified the risks pertaining to vaccine nationalism early on, and they warned of the true crisis emerging only after a vaccine’s discovery (Ruchtsman, 2020a; Hafner et al., 2020; Chohan 2020). Bollyky and Bown used the explicit term “vaccine nationalism” to draw attention to the tragic consequences that might befall the world in the absence of cooperation (2020).

During the Covid-19 pandemic GAVI, a Switzerland based public-private partnership entered into procurement agreements reserving vaccine doses to populations in both developing and developed countries, setting up what might become the largest vaccine procurement scheme in history. It did so through the formation of the Covid-19 Vaccine Global Across Facility (COVAX), which in addition to procurement mechanisms functions as a, risk sharing and push financing mechanisms on a global level, (Disease Control & Prevention, 2019).

COVAX offers participants the possibility to place advance commitment orders for pre-established doses of Covid-19 vaccine in exchange for a financial contribution. COVAX procures predefined qualities of vaccine doses from pharmaceutical companies which in turn have incentive to engage in at risk manufacturing of vaccines reserving sufficient doses to meet COVAX Commitment.

Writing in Science, Fidler remarked that “vaccine nationalism is more evidence that efforts to elevate health cooperation and the sciences that inform it have produced more rhetoric than political roots within countries and the international community” (2020).

The rhetorical ploy that pandemic preparedness and global health cooperation would “enhance national security, support economic wealth, protect human rights, and facilitate humanitarian assistance around the world” was not commensurate with the politics of vaccine nationalism, Fidler argued (2020). Abbas argued “that this self-centred political behaviour of leaving others behind is short-sighted, potentially risky, morally indefensible, and practically inefficient in containing the pandemic” (2020).

Ruchtsman correctly noted that vaccine nationalism had not emerged but rather re-emerged (2020a) during the Covid-19 pandemic, citing the earlier example of the 2009 H1N1 epidemic. This observation is shared by Hafner et al., who attempted to quantify the damage of vaccine nationalism in terms of the exclusion of developing countries from an inoculation drive (2020).

Other scholars have stated that Vaccine Nationalism is a tragic obstacle to justice in the global distribution of coronavirus vaccines. There are moral reasons to allocate vaccines in nationally self-interested way, reasons that too often are dismissed out of hand. Vaccines are the best chance of bringing this pandemic under control unless leaders succumb to vaccine nationalism.

International collaboration among scientists was critical to vaccine development, but now weak cooperation between nations is a major barrier to achieving worldwide vaccination at the scale needed to end the pandemic. Vaccine equity is not just a slogan; it is meant to protect people everywhere, protects the existing shots from new vaccine-resistant variants, and strengthens the international community’s ability to stop COVID-19, it has been argued by scholars.

At present, rich countries with just 16 percent of the world’s population have bought up 60 percent of the world’s vaccine supply. Many of these countries aim to vaccinate 70 percent of their adult population in pursuit of herd immunity. However, COVAX, offers participants the possibility to place advance commitment orders for pre-established doses of Covid-19 vaccine in exchange for a financial contribution.

COVAX procures predefined quantities of vaccine doses from pharmaceutical companies which in turn have an incentive to engage in at risk manufacturing of vaccine reserving sufficient doses to meet COVAX commitment. 

Most troublingly, new mutations could lead to vaccine resistance. There is already evidence that some vaccines are less effective against the variants first identified in Brazil and South Africa. Vaccines were based on version 1.0 of the virus but new viruses, like software, are constantly evolving/mutating, (Gupta G,21). The new variants may infect people who have already survived an earlier version of the virus. Vaccine manufacturing, distribution, pricing and equitable access frameworks are intertwined contractually from a policy perspective.

Meanwhile China factories in China are currently in on overdrive, producing large amounts of untested and un-reliable vaccines, with a plan to ship them out to other countries to deflect some of the blame from its mishandling of the VIRUS, Gupta GD, 21 observed. China has intentionally also decided to prey on vulnerable developing countries by giving them priority access to untested vaccines (Gupta, 21).

As noted above, the Covid-19 Accelerator was conceived as a time limited endeavour. Many of its components including COVAX were not designed as permanent structures. From a policy perspective the response to future outbreaks should rely predominantly on permanent mechanisms that adjust to specific crises rather than hastily crafted remedies to problems that abruptly erupt as a public health crisis unfolds.

The recent growth of vaccine misinformation and disinformation illustrate how internet policy, or the regulation of social media may bear indirect fruit on the successful deployment of vaccines as tools for the promotion of public health. A growing strand of commentators with a specific aim of casting doubts on government’s response contribute to infodemics.

Thabo Lucas Seleke is a Researcher & Scholar, Global Health Policy Analysis (LSHTM) contributed to this article.

Iris Penny Mosweu is Research Fellow, Health Economist, London School of Economics (LSE)

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