This post is provided by Jasmin Schmitz, Research Assistant at the Käte Hamburger Kolleg / Centre for Global Cooperation Research

When the then novel Covid-19-virus broke out in December 2019, it soon spread globally posing a challenge to health governance all across the globe. Internal containment measures were put in place to domestically stop the virus through lockdown or social distancing; internationally borders were closed, and travel restrictions were put in place to stop the ongoing spread at the borders. When first news broke that vaccine-trials were showing promising results, this seemed like the salvation from ever increasing new infections. Already during the first wave of Covid outbreaks trends of nation-focused policies could be observed. While there are certainly cases of cross-border cooperation, they tend to remain the exception. The WHO tried to install a global distribution mechanism through COVAX yet the initiative did not succeed in gaining global influence; Vaccine nationalism became is predominant mode of governance. The access to the shot has become highly dependent on where one lives. The inequality in access to vaccines has sparked discussion surrounding intellectual property as well as the involvement of public financing in the developmental stage of the pharmaceutical. So, more than half a year since the roll-out of the immunization campaign started, it is time to take a look at the distribution of vaccines globally and why they should not be viewed as the sole solution to the pandemic.

First, it is important to consider how the allocation of vaccines as it today came to be; I will briefly examine the development of agreements to argue why radical change is so crucial now more than ever. As early as March 2020 the US government made substantial investments in the development of a vaccine by Johnson & Johnson as well as the candidate of Moderna. Two months later in May 2020 the vaccine development undertaken by AstraZeneca received funding of $1.8 billion by the US  and of £84 million UK government. In June 2020, the vaccine development by BioNTech/Pfizer received €100 million in debt financing by the European Investment Bank. While this selection of investments in the development of vaccine candidates was not yet tied to the reception of vaccine shots, during the summer specific agreements over to-be-delivered vaccines were made. The orders solely placed between May and November 2020 by the UK, US and the European Commission accounted for millions more in vaccines than people living in these territories. The UK ordered 30 million doses of the Johnson&Johnson vaccine, 100 million from AstraZeneca, 30 million doses of the BioNTech/Pfizer candidate as well as 7 million vaccines from Moderna. The US ordered 100 million doses of Johnson&Johnson, 600 million vaccines of BioNTech/Pfizer, 100 million shots of the Moderna and 200 million doses of the AstraZeneca-vaccine candidate. The EU, though it lacked behind the UK and US in the race for vaccine deals for a while, ordered 200 million of Johnson&Johnson, 400 million doses of the AstraZeneca candidate, 300 million doses of BioNTech/Pfizer as well as 80 million doses of the Moderna-vaccine.

Of course, to achieve near 100 percent effectiveness of the vaccine in all but the Johnson&Johnson case, two doses are necessary. Nonetheless the amounts ordered before winter 2020 were large enough to cover not only population of the UK, UK and EU respectively but have millions in vaccines to spare, doses for 30 million people in the case of the UK, for 222 million people in the case of the US and vaccines for 144 million more people in the case of the EU. While we know today that these immense sums weren’t delivered to full amount or the delivery took longer than expected (see here for an outline of the supply chain at work to create the vaccines), this still meant that countries outside of the Global North were at a disadvantage in securing agreements with pharma companies. Even though COVAX (first launched in June 2020) has also received vaccines it is responsible for allocating them to 20% of the population of 92 countries for which it was able to ship 129 million vaccines (as of 19.07.2021).

But what does such a nation-centred vaccine allocation mean for the progression of the pandemic?

Development of mutations

We are currently seeing a vast increase in cases of the Delta mutation of the Covid-19 virus in Europe, the vaccines available thus far have all been found to provide some degree of protection against a serious infection. However, the Austrian molecular biologist Ulrich Elling estimates that with a higher virus count the likelihood of a mutation developing that is resistant to the vaccines increases. This means on the one hand that the spread needs to be addressed globally to drastically decrease the overall number of infected people in which the virus could mutate. Hence, global access to vaccines becomes crucial for the prevention of further outbreak waves. While scientists are not yet clear how likely a so-called ‘immune escape’ really is, there is still agreement that only overarching immunity offers protection from more severe mutations. But on the other hand, this also means that if a resistant mutation develops that already exciting vaccines will have to be adapted and the vaccine roll-out would have to start once more. With no global vaccine allocation scheme in place, this would take a considerable time and would leave people living in countries with weak health-care systems particularly vulnerable to be infected with an even more effective form of the virus.

Global responsibility

The virus won’t stop at borders, why should the care for others’ health? While the outbreak can be mitigated not merely through the roll-out of vaccines, lockdown and social distancing can be viewed as temporary viable measures. Bambra, Riodran, Ford and Matthews outline in their essay that during the Covid-19 pandemic as during previous ones existing inequalities in societies both domestic and internationally have played an overwhelming part. Thus, access to a certain quality of health care highly depends on where someone lives. The essay points to higher mortality rates during the H1N1 outbreak in low-income countries as opposed to high-income countries; such circumstances exasperate the need for lasting immunity. Further a person’s socio-economic circumstances, such as being unable to work from home, sharing a living space with several people but also living with a disability, can make them more vulnerable to Covid-19 but be also more effected by lockdown measures. However, with the development of mutations is driven by the amount of infected people globally, the reaction to this needs to therefore consider global inequalities. Thus, gaining control over the pandemic by continuing the vaccine roll-out based on a nation-first logic may not be a permanent solution, allocation needs to be restructured to consider where vaccines are needed the most while also making larger vaccine production possible.

Systemic Pandemic

The vaccine is not a fix-all cure; the vaccines give recipients immune systems the ability to react to Covid-19 but it is no cure to the issues that have arisen in the allocation of the vaccine. The need for re-thinking the distribution of the vaccine stems from the necessity to re-shape global cooperation, existing structures that hinder equal access to health care, are promoting the continuation of the pandemic. However, many see light at the end of the tunnel of seemingly never-ending bad news, the pandemic as a catalyst for radical change. The pandemic could become the gateway to understand health as a global public good.

(Jasmin)