Vaccine nationalism: the concern over COVAX

 With international concern over the potential rise of vaccine nationalism, countries are increasingly signing onto COVAX. But what critique does the project face?

Source: Unsplash

The story feels too familiar. In November 2002, a viral disease made its way through Guangdong, a province in South-Eastern China. Within months, the pathogen spread throughout various Asian countries, as well as to Canada and the United States, taking 774 lives and infecting 8,098 in the process. However, in spite of the initially intimidating scale of SARS, actions by the World Health Organization (WHO) and governments to contain the virus were successful. Fortunately, we no longer have to worry about SARS today.

Eighteen years later, the world has again been cast into the throes of another coronavirus, but this time without a comparatively simple solution. In contrast to the SARS outbreak of the early 2000s, Covid-19 has killed 1.09 million people worldwide at the time of writing, and leaves few regions of the world untouched. At this point, containing the pathogen looks near impossible, prompting reliance on a vaccine. As such, numerous candidates are currently working to formulate such a solution, raising hopes of a vaccine ready in 12 to 18 months. 

With development progressing, governments and international organizations are discussing the prevention of vaccine nationalism. Now, one project poses a solution - COVAX (the Covid-19 Vaccines Global Access Facility), a global collaboration led by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the WHO.

According to GAVI’s chief executive, Dr Seth Berkely, “COVAX will achieve [equitable access to vaccines] by acting as a platform that will support the research, development and manufacturing of a wide range of Covid-19 vaccine candidates, and negotiate their pricing.” As part of the greater Access to Covid-19 Tools (ACT) Accelerator, the project is supported by a cast of well-known public and private sector institutions, including the Bill and Melinda Gates Foundation, Wellcome, as well as the World Bank.

As of the October 14 , 80 countries have signed commitment agreements to COVAX, with 78 more confirming their intent to participate. One of the most recent signatories, China, is the biggest economy to back the initiative. This move brings much needed funding for the project. However, some also see it as a means of asserting global leadership during the pandemic. 

In contrast, the U.S. has chosen to abstain from the project. According to White House spokesman Judd Deere, the country refuses to be “constrained by multilateral organizations influenced by the corrupt World Health Organization and China.” The U.S. rejection and criticism of COVAX is unsurprising, especially considering President Donald Trump’s earlier decision to leave the WHO and his rejection of multinational institutions in general.

Criticism, however, has not only come from the Trump administration. Whilst COVAX was arguably formed on noble grounds, Vice Provost of Global Initiatives Ezekiel Emanuel argues that the organization’s promises for “fair and equitable” distribution remain ambiguous. In particular, he argues that the two prevailing suggestions for COVAX’s vaccine distribution are flawed. Currently, one proposal suggests issuing vaccines to an equal percentage of participating countries’ populations, whilst another proposes prioritising vaccine access to elderly and frontline medical workers. 

In an article for Science Magazine, Emanuel and other scientists explain that distributing vaccines based on population, rather than being fair, fails to acknowledge differing rates of infection across countries. Likewise, prioritising elderly and frontline healthcare workers may disproportionately emphasise middle- and high-income countries. 

Instead, Emanuel urges countries and international organizations involved in COVAX to consider the Fair Priority Model, which is based on three phases. During the first phase, those adopting the Fair Priority model should use the Standard Expected Years of Life Lost (SEYLL) to consider which countries experience the most severe harm as a result of the coronavirus, whilst phase two calls for considering the projected reduction in poverty per dose of vaccine. Phase three urges the initial prioritisation of countries with higher rates of transmission. Put together, the article claims the Fair Priority Model is “is the best embodiment of the ethical values of limiting harms, benefiting the disadvantaged, and recognising equal concern.” However, it is worth noting that Emanuel still urges countries, international organizations, and vaccine producers to “use the cooperative mechanisms that have been created to deal with the pandemic, such as the COVAX facility” in spite of his own critiques.

In addition to Emanuel and his team, Doctors Without Borders (MSF) have also been sceptical of the COVAX project. For one, the organization believes that COVAX lacks transparency, noting that “details of any decisions taken on what the COVAX facility will ultimately entail have hardly been shared.” Moreover, MSF has publicly questioned GAVI’s decision to lead the initiative. Whilst the organization has experience in negotiating prices and finance, “GAVI has no experience working with most [middle income countries] or high-income countries on procuring for the countries’ vaccine needs.”

Vaccine nationalism needs to be prevented at all costs. However, whilst global political collaboration is encouraging, our longing for fairly distributed vaccines should not blind us from downfalls in COVAX’ leadership and eventual action. Abstaining from the program, like Trump has done, is not the solution. But now that countries are increasingly recognising the harm of protectionist coronavirus policies, we also need to recognise the harm of failing to critically assess the organizations involved in potential solutions. Participation in COVAX does not exempt ignorance.

Pi Opinion content does not necessarily reflect the views of the editorial team, Pi Media society, Students’ Union UCL or University College London. We aim to publish opinions from across the student body — if you read anything you would like to respond to, get in touch via email.