The Danger of Vaccine Nationalism

The Danger of Vaccine Nationalism

by Rebecca Weintraub , Asaf Bitton and Mark L. Rosenberg - May 22, 2020

For those who believe that a vaccine for Covid-19 will end or largely contain this pandemic or who hope that new drugs will be discovered to combat its effects, there is plenty cause for concern. Instead of working together to craft and implement a global strategy, a growing number of countries are taking a “my nation first” approach to developing and distributing potential vaccines or other pharmaceutical treatments.

This “vaccine nationalism” is not only morally reprehensible, it is the wrong way to reduce transmission globally. And global transmission matters: If countries with a large number of cases lag in obtaining the vaccine and other medicines, the disease will continue to disrupt global supply chains and, as a result, economies around the world.

In the midst of this global pandemic, we must leverage our global governance bodies to allocate, distribute, and verify the delivery of the Covid 19 vaccine. We need the science - not politics - to inform the global strategy.

If there were any doubts that countries are moving away from a collective, equitable global strategy for combating the pandemic, consider these recent developments:

• European nations, the Bill and Melinda Gates Foundation and Wellcome Trust committed over $8 billion to finance Access to Covid-19 Tools (ACT) dedicated to rapid deployment of new Covid-19-related health technologies. Yet the United States, Russia, and India have chosen not to participate in this initiative.
• Paul Hudson, the CEO of Sanofi, said that the United States “has the right to the largest pre-order” of a vaccine due to the investment agreement the company signed in February with the U.S. Biomedical Advanced Research and Development Authority (BARDA). Protests from European Union officials forced Sanofi to backtrack.
• The chief executive of the Serum Institute of India, the world’s largest producer of vaccine doses, said most of its vaccine “would have to go to our countrymen before it goes abroad.”
• AstraZeneca reported that due to the U.K.’s $79 million investment, the first 30 million doses of the vaccine it’s developing with the University of Oxford would be allocated to that country. Then, on May 21, the United States pledged as much as $1.2 billion to the company in order to obtain at least 300 million doses, with the first to be delivered as early as October. The pledge to AstraZeneca is part of the Trump administration’s Operation Warp Speed for securing vaccines for Americans as early as possible.
• After announcing he was ending U.S. funding for the World Health Organization (WHO), the international body leading global health responses, President Trump has been equivocating about whether or to what degree he might restore it.

We’ve seen such nationalistic behavior and its problematic effects before. In 2009, the H1N1 virus, also known as Swine Flu, killed as many as 284,000 people worldwide. A vaccine was developed within seven months, but most high-income countries turned to pharmaceutical companies within their own borders for production. High-income countries directly negotiated large advance orders for the vaccine, crowding out poor countries. Although several of those rich countries, including the United States, agreed to make vaccine donations to low- and middle-income countries, they only carried out these donations after ensuring they could cover their own populations first. As a result, the distribution of the H1N1 vaccine was based on high-income countries’ purchasing power, not the risk of transmission.

Experts in epidemiology, virology, and the social sciences - not politicians - should take the lead in devising and implementing science-based strategies to reduce the risks that Covid-19 poses to the most vulnerable across the globe and to reduce transmission of this novel virus for all of us. To avoid ineffective nationalistic responses, we need a centralized, trusted governance system to ensure the appropriate flow of capital, information, and supplies. Thankfully, we have precedents.

One innovative financing mechanism is the advanced market commitment (AMC) model: Donors make a commitment to subsidize the purchase of a yet-to-be-developed vaccine for developing countries, providing vaccine manufacturers with an incentive to invest in what’s needed to bring a vaccine to the developing world market. In 2007, five countries and the Bill and Melinda Gates Foundation committed $1.5 billion to launch the first AMC, which led to the development and delivery of the pneumococcal vaccines to low- and middle-income countries. Another innovative finance mechanism that has been successful in raising funds for vaccines is the International Finance Facility for Immunisation, which secures funds via bonds.

Beyond financing, we need a global coordinated effort to estimate and account for the available global workforce of vaccinators, operationalize mass vaccination programs, implement plans for equitably allocating vaccines on a prioritized basis, and verify the delivery of vaccines. Customized strategies for using the available vaccine may be deployed in different countries when the vaccine first becomes available in limited quantities. These strategies may depend on the prevalence of the virus, the degree to which testing can identify all infected persons, and how the infected persons are geographically distributed. Public health leaders can integrate key lessons on allocation and distribution from previous experiences with polio and smallpox vaccination efforts.

We must leverage our global governance bodies to aid in doing all this and planning and strengthening health systems to operationalize national vaccine campaigns. They include the WHO, the Global Fund, CEPI, and GAVI, and a wide array of country partners within health ministries, regional health systems, and the private sector. These organizations will be essential in supporting governments’ communication efforts to explain to their populations why evidence-based approaches are essential to ending the pandemic.

We have the organizations, institutions, and tools to distribute a Covid-19 vaccine effectively and efficiently. All countries have to remember that it is the virus, not each other, that is their foe. A nationalistic stance toward the pandemic will prolong this global health and economic crisis. A vaccine must be allocated on the basis of the best evidence of what will stop transmission and protect the most vulnerable groups - no matter in which nation they reside. A vaccine can end the pandemic but only if all countries ensure timely, equitable, global access to it. Selling vaccines to the highest bidders is not the way to go.

Rebecca Weintraub, MD, is a member of the faculties of Harvard Medical School and Ariadne Labs and is managing director of the Draper Richards Kaplan Foundation.

Asaf Bitton, M.D., is executive director of Ariadne Labs, a joint health system innovation center at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health.

Mark L. Rosenberg, MD, is an epidemiologist, infectious disease physician, and psychiatrist. He is president emeritus of the Task Force for Global Health and a former U.S. assistant surgeon general.