The prospects of “vaccine nationalism” are an alarming development for COVID-19. They are aggravated by the looming US-China divide but also by the lack of global leadership from the US for any alternative to it. These aggravations are hurting the potential for the emergence of “vaccine multilateralism”, whether through the World Health Organization (WHO), the G-20 or some other global forum. But one can still identify some countervailing signs from an initiative known as the ACT-Accelerator initiative and its vaccine development pillar. More public awareness needs to be mobilized in support of this initiative – and in support of vaccine multilateralism generally. The message has to be – and can be – that “We’re only safe if we’re all safe”.
Vaccine Nationalism versus Vaccine Multilateralism
What is “vaccine nationalism”? It is exhibited when a country chooses to control the distribution of a vaccine for its own citizens even though the vaccine is needed globally for a pandemic like COVID-19. “Vaccine multilateralism”, on the other hand, is when the distribution of the vaccine is prioritized on the basis of need, regardless of geographic location.
The pandemic crisis is suffering from the “go-it-alone” mentality of vaccine nationalism, especially aggravated by the countries that are able to control the research and development – and manufacturing – of potential COVID-19 vaccines – India, Russia, the US and China. One can argue that the worst culprit of the “go-it-alone” mentality is the US, but this is because we have all looked up to the US for its global leadership in past pandemics. Not only is the absence of the US on the global level today leaving a leadership vacuum; it is also disrupting the capacity of international organizations like the United Nations or the World Health Organization to mobilize a global response. Even the G20, which has had a sympathetic leader in this year’s presidency, none other than Saudi Arabia, has been hobbled by the US.
Media attention has understandably been directed at these inadequacies. This series of articles has highlighted the weaknesses of the WHO and the UN and even the G20 in dealing with the pandemic. The prognosis for the world order after the pandemic is indeed bleak. And yet, one should look beyond these limitations in the current environment for encouraging signs of global collaboration. This is well illustrated by the remarkable but not yet widely appreciated show of support for something called the ACT-Accelerator initiative. I am hopeful that we can mobilize a “Friends of Global COVID-19 Relief” to advocate for this initiative – and for the whole idea of vaccine multilateralism that it represents.
While the UN is spearheading a humanitarian effort to raise $10.3 billion for COVID-19 relief, and the G20 is working on far-reaching debt-relief (or at least debt-delay) for the hardest hit and poorest economies of the world, the WHO is where the spotlight needs to be directed in terms of delivering a global response to the coronavirus crisis itself. In spite of the US withdrawal from the WHO that President Trump triggered in early July, the WHO continues to be the pivotal agency for mobilizing resources and commitments for a globally focused distribution of whatever is needed to bring an end to the pandemic. This has taken the form of the Access to COVID-19 Tools (ACT) Accelerator, a massive undertaking to accelerate development, production and equitable access around the three pillars of COVID-19 tests, treatments and vaccines.
The ACT-Accelerator Solution
As reported in my previous commentaries, the WHO was not alone in launching this initiative. In fact, it has benefited from fund-raising efforts that have essentially operated outside of the WHO framework. Co-hosts for the April 2020 launch included the President of France, the President of the European Commission, and the Bill and Melinda Gates Foundation. Since then, and following a number of pledging summits in May and June, some 40 countries and organizations have joined the initiative – plus lots of individuals and private sector entities. This is a truly Global Coronavirus Response in support of the ACT-Accelerator initiative. The latest financial tally (available here) is that pledges have reached €15.9 billion!
The ACT-Accelerator initiative is specifically dedicated to ensuring global and equitable access in three priority areas – (1) vaccines (our primary concern), (2) treatments and (3) testing. It has nine governmental partners (the European Commission, Canada, France, Germany, Italy, Japan, Norway, Saudi Arabia, Spain and the UK) working with the WHO, the Bill & Melinda Gates Foundation, the World Economic Forum and the Wellcome Trust. Their oversight provides the political guidance, while a Delivery Partners Group will concentrate on implementation. See the chart below (available here):
The focus in this commentary is on the first of the three priority areas – the Vaccine Partnership. While the WHO has a supporting and coordinating role for the overall initiative, each pillar has its own set of co-convenors; and this vaccine pillar is co-convened by the Coalition for Epidemic Preparedness, founded in 2017, and GAVI, the Vaccine Alliance, founded in 2000. CEPI is a relatively new partnership concentrating on vaccine development, while GAVI, the Vaccine Alliance has proven its value over 20 years in leading vaccine distribution to the poorest economies of the world. Both are global multi-stakeholder initiatives; and both work closely with the WHO but also with the Bill and Melinda Gates Foundation, the World Economic Forum and the Wellcome Trust. (Both, by the way, are headed by prominent American scientists/public health experts – Seth Berkley at GAVI and Richard Hatchett at CEPI.)
A New COVAX Facility
Together, CEPI and the Vaccine Alliance have launched a new “COVAX Facility”. (See the latest announcement on the COVAX Facility here.) The purpose of this Facility is to guarantee participating countries a share of doses whether they are in a position to pay for it or not. For starters, there are 92 developing and emerging economies with whom the Facility will have a burden-sharing arrangement, with a graduated scale for a local budgetary share based on the country’s level of development. But, most importantly for its potential role for vaccine multilateralism, the Facility is also open to all other countries, of which 75 have already conveyed an “expression of interest”.
The COVAX Facility aims to purchase 2 billion doses of COVID19 vaccines by the end of 2021. For its existing network of low-income countries, it has a new COVAX Advanced Market Commitment (AMC) component for negotiating a pooled and lower purchase price with specific manufacturers. As the head of GAVI, Dr. Seth Berkeley has observed, manufacturers need these advance purchase agreements to speed up the availability of vaccines, even before they have been proven effective. The goal is to have this AMC component financed initially by $2 billion in contributions, of which some $600 million has already been committed.
The first advance purchase commitment to the COVAX AMC, for the pre-purchase of 300 million doses, was announced in June with AstraZeneca in collaboration with Oxford University. This particular collaboration appears to be the farthest along of Western-based potential vaccines, but there now appear to be several others entering what are known as Phase 3 trials. The prospects are encouraging for this COVAX AMC to mobilize the equitable distribution of COVID-19 vaccines. One can hope that more vaccine developers and manufacturers than the AstraZeneca vaccine will participate in this approach to vaccine multilateralism.
But it is also appealing that a second mechanism has been proposed for pooling among upper-income and middle-income countries. Several G20 countries have actually expressed interest in this – including Brazil, Canada, Japan, Mexico, Saudi Arabia (the current President of the G20) and the United Kingdom. CEPI has reported on the impressive turnout of interest here. The EU has shown interest, along with a few other European countries – Norway, Portugal, Monaco, Switzerland and some others.
These countries are encouraged to negotiate how they would participate, with the aim of having legally binding agreements in place by the end of August. Many of them are already doing their own advance purchase agreements but are still being encouraged to participate. The pool would be used for advance purchase commitments with some 12 or 15 eligible vaccines, so that any country could at least get a share of whatever ends up working. In this mechanism, the participating country could get up to 20 percent of what it might need. The CEPI/GAVI distribution priorities, however, would apply to all participating countries in both mechanisms. That is to say, vaccine doses will be allocated in proportion to population, with priority to health care workers, the elderly, other higher-risk population before any broader distribution in each country and then on a needs basis more broadly.
Mixed Signals from the World
The EU, it should be noted, has been the main political entity behind the ACT-Accelerator. With the US, China, Russia and India all doing their own development of vaccines – and staying out of the collaborative effort, does this make the effort more of a European initiative than a truly global one? (China, by the way, is a token member of the ACT-Accelerator – listed as having pledged €45 million.) After all, the bulk of the €15.9 billion for this initiative is coming from the EU, the European Investment Bank and EU countries.
One could hope that the COVAX Facility under the ACT-Accelerator initiative is the answer for a truly global distribution of COVID-19 vaccines. But unfortunately, it seems that a form of vaccine nationalism has even crept into the EU setting. Thus, the Commission launched its proposal for an EU Vaccine Strategy in June, emphasizing the importance of getting commitments from EU-based vaccine manufacturers – for vaccine distribution within the EU. This may well have been necessary in the light of the US making it clear that US-based manufacturing would not be available outside the US. And certainly, the Russian, Indian and Chinese sources are not likely to be forthcoming.
To be fair, the European approach does emphasize the desirability of both “fair access” for all countries and “a fair price”. This suggests, then, that any vaccine multilateralism here is European first – but then (and only then) supportive of global distribution. The ramifications of this are daunting. It would seem that no country is prepared to give up the priority of taking care of its own citizens first. Regrettably, for now, it may be that the best one can hope for is this European approach – emphasizing a fair price for everyone while ensuring access to EU citizens first and pooling as much remaining negotiating strength as possible to achieve truly global access. But in this setting, “vaccine nationalism” still prevails.
Stick with Multilateralism, please!
That said, it is still important to highlight the multi-stakeholder nature and global focus of the ACT-Accelerator initiative and its implementation of access to vaccines through a proposed COVAX Facility for both developing and developed countries. The EU, at least, has expressed interest in participating in the pooling approach for everyone – but only if, as its June strategy document stated, “a significant number of countries would agree to pool resources for jointly reserving future vaccines from companies for themselves as well as for low and middle-income countries at the same time.” And it’s good, as already noted above, that Canada and Mexico have shown interest in this, as well as the UK, Japan and Korea and even the G20 President Saudi Arabia. The potential is there for this alternative to start attracting more widespread attention and support. And perhaps a G20 initiative in the future?
We live in a highly frightened environment. The US and China are big players who are essentially outside this multilateral effort; Russia and India are also operating on their own; and the rest of the world has to manage a multilateral vaccine policy without them. The major European powers may display their own form of vaccine nationalism, and I can understand why even strong advocates of vaccine multilateralism can’t afford to lose their base of support. But we all need to be more vociferous in our support of the multilateral effort. This pandemic is clearly a situation where “We’re only safe if we’re all safe”. So let’s speak up for vaccine multilateralism!
NOTE on the Series
This series of commentaries has been promoting a political lens on the COVID-19 pandemic – in parallel to the scientific lens. The understanding is that science should drive our behavior because of the unexpected spread and severity of the pandemic across the world. We need to know what this virus is doing to us and how we can protect ourselves from it. But here, in this series of commentaries, the argument has been that we need more than science to guide our global policy deliberations. We need a rational political lens, too. This political perspective is even more urgent now that we are seeing the disruptive signs of vaccine nationalism at the expense of vaccine multilateralism.
There are, to be sure, deleterious effects when the application of a political lens ignores the scientific one. When the political lens is used with an anti-science mindset, it reinforces the bravado and fear of nationalistic populists. Nonetheless, even with the appropriate deference to a pro-science mindset, the policy-making process needs the perspectives of the political scientists, the philosophers, the ethicists, the humanists, if not also the globalists, the multilateralists and even the transcendentalists to guide us along with the scientists.