The power of vaccine nationalism is so strong that it apparently managed to seduce even Canada, an avatar of multilateralism. That’s the charge leveled against Ottawa following reports that it had pre-purchased tens of millions of COVID-19 vaccine doses from private companies. The Canadian government has repeatedly said that it is committed to ensuring that poorer countries have access to a vaccine and has pledged hundreds of millions of dollars to multinational initiatives to do that. Still, Ottawa’s planning exposes the profound moral dilemmas posed by the COVID-19 pandemic.
Fortunately, the case for unilateral restraint and multilateral engagement makes economic, strategic and ethical sense. International programs are underway to ensure that any COVID-19 vaccine is available to those around the world who need it most. Sadly, the nationalist impulse remains strong and there is little inclination to think about the problem before acting — especially as the death toll mounts.
Canada isn’t the only country hoping to jump the queue when a vaccine is delivered. Wealthy countries — the United States, Britain and some countries in the European Union among them — are estimated to have pre-ordered more than 2 billion doses (The Wall Street Journal reckons it’s 4 billion doses), which is pretty much everything likely to be produced until late 2021.
The Japanese government is in the hunt as well. Tokyo has said that it wants to secure enough doses by the first half of 2021 to immunize all its residents, and has reportedly signed deals with pharmaceutical manufacturers — AstraZeneca and Pfizer among them — to do so.
Medecins Sans Frontieres, the humanitarian medical nonprofit organization, warns that “the global scramble to hoard vaccines by rich countries” will feed “a dangerous trend of vaccine nationalism.” But the temptation to take care of one’s own is understandable; it’s also standard procedure. During the 2009 H1N1 swine flu outbreak, rich countries bought up the world’s supply of vaccines, leaving practically nothing for poorer nations. Eventually, nine wealthy governments agreed to share 10 percent of their vaccines — after they determined that they had enough to meet their domestic needs. Fortunately, that outbreak was weak: “Only” 284,000 people died around the world.
That nationalist logic has been at work throughout the COVID-19 outbreak. More than 70 countries and the European Union imposed export controls on local supplies of personal protective equipment, prohibiting them from being sent to other countries in need. There were reports of purchasing agents on airport tarmacs greeting flights transporting personal protective equipment and offering multiples of the contract price to redirect the shipments. The United States bought almost all the supplies of remdesivir, one of the first drugs proven to work against COVID-19, leaving none for most of the rest of the world for three months.
Succumbing to the nationalist temptation is the wrong decision. It doesn’t make strategic, economic or medical sense. It is projected that COVID-19 could kill as many as 40 million people worldwide and reduce global economic output by $12.5 trillion by the end of next year. In a world in which national economies are deeply intertwined, and in which global supply chains are the bedrock of economic activity, the idea that countries can isolate themselves from a pandemic that size is laughable. If governments think that protecting their own people is enough to end the economic pain, then they should think again. Those who claim that the main point is saving lives should look more closely at national debates over lockdowns: Those who favor ending them insist that “the cure can’t be worse than the disease,” which is another way of saying that economic recovery should take precedence over health.
Vaccine supply chains are global as well. No country has everything it needs to create, produce and provide drugs. For example, several vaccine candidates use a compound that comes from the soapbark tree, which is found in Chile and is processed in Sweden; yet neither country has a pharmaceutical industry. World Health Organization Director-General Tedros Adhanom Ghebreyesus adds that “a vaccine developed in one country may need to be filled in vials with stoppers that are produced in another, using materials for the high-grade glass that is only available from yet another country.” In each case, a supplier country would be reluctant to let materials go if it could not be assured access to the final product. Typical is a statement by the chief executive of the Serum Institute of India, who declared that “at least initially,” any vaccine it produces will go to India’s 1.3 billion people.
Or a country could bet on the wrong vaccine. In mid-summer, 160 candidate COVID-19 vaccines were in development. If a government committed to buying a vaccine that didn’t work, it would be locked out in a dog-eat-dog world of vaccine nationalism. Even if the bet is correct, unrestrained governments would bid up prices, reducing the number of people who can be vaccinated even among the wealthiest nations.
Then there are strategic considerations. Buying up vaccines, driving up prices and denying others the opportunity to enjoy good health (or life itself) is bad diplomacy. It will isolate that government — literally, if it has to live in a bubble to avoid infection by those beyond its borders who either have not been vaccinated or cannot be inoculated, and, figuratively, as it battles the resentment its selfishness will create. That will imperil cooperation on other vital issues and will certainly shape responses to future health crises — and rest assured that there will be many more.
Countries that share will be recognized for their generosity. Not surprisingly, Chinese officials, including President Xi Jinping, Premier Li Keqiang and Foreign Minister Wang Yi, have repeatedly promised to share their country’s vaccine — which is already being distributed to groups in China — with governments around the world.
Finally, and perhaps most fundamentally, vaccine nationalism is profoundly immoral. The notion that a person’s health should be a function of their net worth is soulless and wrong. This proposition is so painfully self-evident that it almost doesn’t need to be argued.
Fortunately, there are alternatives. The World Health Organization, the Coalition for Epidemic Preparedness Innovations and nongovernmental vaccine alliance Gavi have created a facility called the COVID-19 Vaccines Global Access (COVAX) to develop a vaccine and secure 2 billion doses for the most high-risk groups around the world by the end of 2021. More than 170 countries and territories are in discussions to join COVAX; 78 of them are wealthy nations. Canada and Japan are in the group, but the U.S., China and Russia are not; the European Commission reportedly advised member countries not to buy COVID-19 vaccines through COVAX (although the EU has said it will contribute to the COVAX fund).
COVAX’s difficulties are reported to have forced the World Health Organization to change its plans. The program is being adjusted to make it more appealing.
The easiest way to undercut vaccine nationalism is to show that national immunization programs that don’t discriminate among populations are not effective. Researchers must identify the most vulnerable groups and show how to differentiate among vaccine recipients to stop the spread of the disease. It makes no sense to vaccinate individuals who don’t need it, especially when others who are more vulnerable or more likely to transmit the disease are denied treatment as a result. When those opportunity costs are exposed, government positions should shift. That research does not yet exist, however, and only international efforts are likely to provide it — one more reason to promote multinational, rather than unilateral, programs.
Figuring out the best way to distribute vaccines once transmission vectors are identified is another matter. The world won’t have enough vaccines to help all high-risk populations and a rollout will take time. Health professionals, philosophers, ethicists and government officials are hard at work on this problem. One solution is a “fair priority” model proposed by Ezekiel Emanuel and colleagues, a richly textured and deeply informed assessment that deserves attention.
Vaccine nationalism is wrongheaded and dangerous. The COVID-19 outbreak is an evolving crisis, in which today’s answers might soon become irrelevant or wrong. Amid that uncertainty, rest assured that another similar crisis will erupt and behavior in this case will shape perceptions and responses. Vaccine nationalism will be a blot that endures.
Brad Glosserman is deputy director of and visiting professor at the Center for Rule Making Strategies at Tama University as well as senior adviser (nonresident) at Pacific Forum. He is the author of “Peak Japan: The End of Great Ambitions” (Georgetown University Press, 2019).
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