USA TODAY International Edition
Vaccine nationalism threatens global effort
Coronavirus pandemic: ‘ No one is safe until everyone is safe’
A deadly virus causes a pandemic. A wealthy country signs a more than $ 100 million contract for vaccine with a manufacturer in a small nation. When the vaccine becomes available, the small nation’s government balks, demanding enough for its entire population before any can be exported.
That’s what happened in 2009, when Australia demanded biotech manufacturer CSL fulfill domestic needs for H1N1 vaccine before any could be sent to the USA.
And it’s the scenario public health experts fear as the world enters a scientifically turbo- charged but chaotic race to create, then produce coronavirus vaccines. Rather than widespread coordination and sharing, “me first” vaccine nationalism pits nation against nation to get and keep enough doses for their citizens.
Countries focus on their own vaccine development programs rather than collaborating to pool resources. Agreements are scarce to share vaccines when they’re available so health workers and those in international COVID- 19 hot spots can have first access.
As what happened in Australia shows, no matter what contracts may be in place, the country where a vaccine is manufactured could slap export restrictions on it to ensure its own population gets first dibs.
When it comes to creating vaccine, the United States has largely chosen to go it alone. It declined to join international development efforts and instead cut advance deals worth billions of dollars with pharmaceutical and manufacturing companies for control of hundreds of millions of doses.
“Many people naively assume it’s the United States that’s going to have ( a vaccine) first, because we have several candidates. But that may not be how it goes,”
said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
Through the White House coronavirus effort, dubbed Operation Warp Speed, the United States plans to invest in seven candidate vaccines. That’s out of 21 vaccine candidates in clinical trials globally and 139 in preclinical evaluation, according to the World Health Organization.
Any sharing efforts will come only after America’s needs are fulfilled, according to Operation Warp Speed officials.
During the H1N1 influenza pandemic in 2009, the United States pledged to share up to 10% of its vaccine supply with low- and middle- income countries as supplies became available. It was one of nine nations that did so.
The presidential election looming in November could bring policy changes should the White House change hands. Presumed Democratic presidential nominee Joe Biden told a health care activist Wednesday he “absolutely positively” would commit to sharing technology and access to a coronavirus vaccine if the United States is the first across the finish line.
There is no certainty one of the U. S. candidate vaccines will make it there. Vaccines that reach human clinical trials have a 17% chance of success, said Kate Elder, senior vaccine policy adviser with the humanitarian group Doctors Without Borders, which advocates for making vaccines affordable and accessible to all. “That’s a huge failure rate,” she said. Other nations at least contemplate more collaborative approaches. The European Union is creating a European vaccines strategy in which members pool funding, research and manufacturing resources. Any resulting vaccines would be allocated to all members.
France, Germany, Italy and the
Netherlands created an “inclusive vaccine alliance” to pool vaccine development resources and secure vaccine supplies for Europe while allowing fair access to the vaccine for all countries.
Another effort is the COVID- 19 Global Vaccine Access Facility ( Covax) launched by an international nonprofit group called Gavi, the Vaccine Alliance. Focused on low- and middle- income countries, it allows nations to pool resources for research, production and advanced purchase agreements, and each would get a share of vaccines.
A work in progress, it launched in June and is meant to counteract vaccine nationalism and give poorer nations a seat at the table.
Taking part in global vaccine partnerships would be a kind of insurance, said David Fidler, a senior fellow on global health at the Council on Foreign Relations.
“( It’s) buying into multiple candidate vaccines, so you’d at least get part of the production if one or more of them works out,” he said.
Global health means sharing
As public health experts see it, nations in an ideal world would collaborate to create vaccines. As soon as one proved safe and effective, the formula would be licensed to every facility with the capability of manufacturing it. The resulting doses would go first to health care workers in virus hot spots around the world, then to health workers globally, then to the rest of the world’s population.
That is the best way to protect everyone, said Robbie Silverman, a senior adviser to Oxfam, an international antipoverty organization based in the United Kingdom.
“This is a global pandemic. If the disease is located anywhere in the world, it will come back to the United States,” said Silverman, who works on health and inequity issues.
Public health experts acknowledge we do not live in an ideal world.
“It’s hard to see a politician saying, ‘ Yup, let’s give 30% of our vaccine to countries in sub- Saharan Africa,’ ” Fidler said.
Few countries outside vaccine consortia have committed to sharing with less fortunate nations. It’s a tough sell, conceded Jason Schwartz, a professor of health policy at the Yale University School of Public Health.
“But that’s what global health is. It’s not just the right thing to do to help countries without resources. It also helps us,” he said.
The United States is not embracing that approach.
The United States bought more than 90% of the world’s supply of remdesivir for the next three months. It’s one of the few proven treatments for COVID- 19, and the purchase, announced July 1, left little for the rest of the world.
The United States isn’t the only country putting itself first. In the past six months, more than 46 nations put export restrictions on medical supplies, including masks, gloves, disinfectants and ventilators, according to Simon Evenett, a professor of international trade at the University of St. Gallen in Switzerland and creator of the Global Trade Alert initiative, which tracks trade protectionism.
Such behavior isn’t a good recipe for stopping COVID- 19, public health experts said. As the World Health Organization puts it, “No one is safe until everyone is safe.”
Geopolitics of securing a vaccine
Countries where vaccine is manufactured may not let it out, no matter what contracts the manufacturers have with other nations.
Under international law, any nation has the sovereign right to seize private property for the public good. In the middle of a health emergency, seizing vaccine can be seen as exactly that, Fidler said.
“That’s not something any country can or would sign away in connection with vaccine development,” he said.
Even if a country signed a contract to get a certain amount of vaccine produced in another country, the originating country could seize it – in legal terms, “expropriate” it.
“It’s not just a fear. It will happen,” said Sam Halabi, a law professor at the University of Missouri and expert on global health law. Not even the best- written contract can “blunt the geopolitics of the vaccine.”
The hope is that those contracts will be honored, said Thomas Bollyky, director of the global health program at the Council on Foreign Relations.
Countries jockey for position to get as much vaccine as possible as quickly as possible when it becomes available.
Any attempts to make vaccine distribution more equitable – and likely to stop the pandemic – need to happen now, Bollyky said.
“We’re running out of time,” he said. “Anything that focuses on allocating according to public health needs instead of the public purse will require some time to put together, and we’re running out of it.”