In our struggle against the pandemic, we have come to a point where the emergence of COVID vaccines appears to be a tangible possibility. As of July, 170 vaccines have emerged of which 50 are potentially viable candidates. Many speculate that the end to this long-drawn nightmare may finally have arrived. While the double time development of vaccines across the globe is a definite silver lining (not without its own challenges, however), a series of concerning questions follow, more specifically: now that we have vaccines, who gets the shot?
“In a sense it’s an oxygen-mask-on-an-airplane analogy” says Peter Marks at a biotech industry conference. Representing the USA, Marks, the director of the Food and Drug administration compares vaccination deployment to the airplane oxygen mask mechanism, “you put yours on first, and then help others as quickly as possible.” Hence signaling an alarming rise of nationalist sentiments in regards to vaccine distribution. Countries, succumbing to mounting pressure, are engaging in tight domestic manufacturing, raw material procurement and distribution practices. Many wealthier countries have already begun investing in potential vaccines, demanding first access once (if) FDA approval comes through.
In July, the USA made a $1.95 billion deal with pharmaceutical company Pfizer Inc. and BioNTech, securing about 100 million pre-ordered doses of COVID vaccine exclusively for its citizens. As part of President Trump’s Operation Warp Speed, that promises a vaccine to US citizens by 2021, the Biomedical Advanced Research Development Authority has had multiple other investments in the works with companies like Senofi and GlaxoSmithKline, aspiring to attain 300 million doses on the whole. Similarly, the UK has invested $79 million in pharma company AstroZeneca as has the EU, investing in about 400 million doses. Countries like India and Germany have developed top contenders for vaccines, something that they, too, do not intend to share.
This will have dire consequences for poorer countries. If vaccines are distributed to the highest bidders first instead of those with the highest risk of infection like medical workers, certain age groups and other weighted demographics, if these few top-tier countries ensure that each of their citizens gets two doses each, the population of many countries will remain largely unvaccinated. With rising global demand, a possibility of ingredient export blockades by manufacturing countries and a general lack of global cooperation, prices of the left-over vaccines would be driven sky high. As of now, countries in the African region and Latin America are facing an acute shortage of ventilators, PPE kits and other medical equipment as more than 68 countries banned such exports; they are more prone to succumb to the disease. WHO and Bill Gates initiated COVID-19 Toolkit Accelerator to push for global access of COVID equipment, however, nations such as the US, India and Russia chose not to participate in it. This increasingly protectionist attitude is likely to lead to circular and multi-faceted problems.
The first aspect is the potential extension of the pandemic. Vaccines need to be distributed with an aim of protecting the groups most exposed to it or those presenting most fatal symptoms. If not, the pandemic may continue to rage globally barring some 30 countries that manage to get access. Many people would die without needing to. Grossly immoral implications aside, the pandemic would never be completely wiped out. Worst case scenario entails that if allowed to fester, the stronger virulent strains would potentially mutate, rendering many vaccines ineffective. This could add another two years along with more resources, man power and funds to eradicate the COVID pandemic.
Globalization is under considerable threat today, nations are re-thinking the global inter-connectivity fostered through the course of many centuries. Despite concerns, global chains are still strong today; this brings us to the second problem. Vaccine nationalism and the prolonged spread of the disease would continue to disrupt global supply chains that are very essential for every nation’s economic functioning. Fragile air travel, tourism, commerce and multi-lateral trade industries will buckle further. More importantly, cooperation is required to create the most effective vaccine possible. Different countries have advantages over different vaccine ingredients. If every nation tries working within the ambit of resources available only to them, there is a greater probability that the resultant fails or at least is not effective enough. This ties in to a more encompassing debate about globalization and the fallacy of composition.
Hoarding vaccine supplies can also backfire for countries. “The US is notorious for its high drug prices.” writes Ana Santos Rutchsman for The Conversation, “Does the US government deserve to obtain exclusive rights for a vaccine that may be priced too high?” The nationalistic approach of the US points to a problematic attitude: the hesitation to commit funds and resources to a non-profitable venture, even when the resource in question is a vaccine which extends a helping hand to poorer countries. This attitude can affect its own citizens’ well-being. If priced too high, vaccines would not be accessible to a significant portion of the country, this also has economic effects, as the same blog further discusses. A departure from equilibrium price and quantity by raising prices could create dead-weight loss or a gap between supply (associated costs) and demand (associated revenue); a loss of revenue for the home country and, in this case, a loss of lives for many others.
COVAX and the need for a sturdier global supply chain
“Everybody doing bilateral deals is not a way to optimize the situation,” said Seth Berkely, chief executive of GAVI, a Geneva based not-for-profit company. In a bid to induce global cooperation, GAVI and WHO have initiated an interesting operating mechanism called COVAX that, if implemented correctly, might just be the solution to the distribution problem. Under COVAX, wealthier governments and international organizations will be asked to invest in a whole range of potential vaccines, all of which they will then get access to. Once a viable vaccine is identified, these countries will also help produce enough doses for themselves and other nations. COVAX benefits both parties. Poorer countries get life saving support and wealthy countries, who also separately dealt with private manufacturers, get insurance. If all else fails, COVAX access is expected to cover at least 20% of their population.
Other collaborations such as CEPI (Coalition for Epidemic Preparedness Innovations) have put forth cooperative solutions. Countries such as Singapore, both Koreas and Germany have all shown enthusiastic interest in participating. “The COVID-19 pandemic demands a united and concerted response by all nations.” said Singaporean Prime Minister Lee Hsien Loong in a virtual COVID summit early June. With regard to COVAX, around 70 countries have submitted official expressions of interest. However, no nation has given confirmation. They have until the end of August to provide an advance of 15% on the whole amount. The lack of participation from leading countries and serious feasibility issues are still some major challenges that GAVI will have to get past.
Despite strides being made toward global vaccine cooperation, a significantly strong global supply and distribution chain is needed to carry out these initiatives. Many specifics still need to be sorted out. An extensive triage will be required to determine the order of vaccine provision from high to low risk. There also needs to be special accommodation and quantitative acknowledgement of donor countries and a system to identify what geo-political issues might hinder the process. Moreover, the fact that many backward countries lack the infrastructure and man-power to properly administer doses, despite being provided with vaccines, also needs to be taken into consideration.
Despite drawbacks, global cooperation is the direction in which we need to be steering global efforts for effective eradication of the pandemic as quickly as possible. Only once the pandemic is wiped out can we start laying the foundation stones for a more stable economy. It is time countries look at the bigger picture. Unlike the Starks’ dire warning – winter may be coming, but now is not the time to stock up.
References
1. The Danger Of Vaccine Nationalism; Rebecca Weintrub, Asaf Bitton and Mark L. Rosenburg for Harvard Business Review
2. The Economics of Vaccine Nationalism; Finshots
3. How ‘vaccine nationalism’ could block vulnerable populations’ access to COVID-19 vaccines; Ana Santos Rutschman for The Conversation
4. ‘America First’ VS ‘The People’s Vaccine’; Colum Lynch for Foreign Policy
5. Why We Should Avoid Vaccine Nationalism; Elaine Schwartz for econlife
