COVAX and Global Vaccination

As soon as effective vaccines began to emerge from the laboratories of pharmaceutical companies, probably the most important issue facing the world became how to ensure that access to life-saving medicine was available to all and in direct proportion to need. Within countries a broad consensus rapidly emerged about who constituted the priority groups, and national programmes prioritised the elderly, those with comorbidities such as hypertension, diabetes and chronic heart disease and front-line workers in health and social care. Internationally, however, the procurement of viable vaccines immediately became a free-for-all, with individual nation-states using their economic muscle to buy up stocks for the benefit of their citizens alone. By January 2021 a small group of rich countries, comprising only 16% of the world’s population, had purchased 60% of the global vaccine supply. The consequences of this may be dire. The Economist Intelligent Unit estimates that on current trends the UK, US, Israel and the EU will receive ‘widespread vaccination coverage’ by late 2021, a group of other developed countries by mid-2022, but that most poor countries will not achieve mass Covid-19 immunisation until at least 2024 if at all. Even within the privileged club of affluent nations, distribution has become predated on contractural and economic grounds rather than need, as the unedifying dispute currently raging between Britain and the EU demonstrates. A global health emergency requiring a global solution, has been reduced to an economic and political battleground grounded in nationalism and self-interest. The picture is not, however, unremittingly gloomy. Early in the Pandemic the World Health Organisation (WHO), working with a wide range of partners (including governments, scientists, manufacturers and philanthropists), set up COVAX, with a mission to provide equal access to 19 vaccines under development irrespective of countries ability to pay. Its initial target was to make available 2 Billion doses, free of charge to the very poorest countries. This has subsequently been amended, with even the very poorest nations now obliged to take up World Bank loans and contribute up to 15% of the vaccine’s cost, which is likely to render them unaffordable for many of the poorest states. Nonetheless, it appears to represent a considerable achievement. Will COVAX succeed in its goals? What are the consequences if it fails? Will internationalism prevail over national self-interest? Will vaccines become a geo-political tool exercised by the wealthy and powerful to control the developing world? How will the logistical problems of production and supply be overcome? Will take-up of the vaccines be hindered by rational or irrational fears of their consequences? How will anti-vaxxer sentiment play out across the globe?

On 28 January 2021, the Pandemic Perspectives group debated these questions, guided by COVAX’s own pronouncements, an optimistic BBC report of January 2021, a more sceptical account from The Independent, and the alarm call raised by Oxfam. Historical context was provided by Holmberg et al (eds) excellent book ‘The Politics of Vaccination‘, and the simple but illuminating ‘Visual history of the global anti-vax movement‘ by Coda. The breadth of global anti-vax sentiment was given a statistical basis from Ritchie and Vanderslott’s report for Our World in Data, and another BBC report from back in June 2019.

David Christie began the discussion by outlining the work of COVAX so far. He noted that 78 countries had signed up with legally binding agreements to commit resources upfront, and that $6billion dollars had already been raised toward the COVAX target of raising $8billion to fund 2million doses. He also noted that one of Biden’s first acts as president had been to commit the USA to joining COVAX. He was divided in his feelings about the programme, on the one hand it seemed an extraordinary achievement of global co-operation, but on the other seemed a partial and inadequate response.

Liam Knight noted that even if it achieved its stated aims, the COVAX programme would not enable countries to reach the 70% threshold necessary to create effective communal immunity, and aired concerns about the recent announcement by Gavi (coordinating body) that even the poorest countries would now have to make a contribution. The price tag of between $1.2 and $1.5 per vaccine would appear out of reach of the very poorest states. David expressed concern that the requirement to access World Bank loans to fund the vaccine’s purchase would load up already highly indebted countries with yet greater unaffordable obligations.

Others were even more sceptical. Niall Gallen felt the programme did nothing to alter the status quo, maintained the business model of vaccine production and the profit motive, and was predominately an exercise in looking good rather than fundamentally addressing the problem. Ronan Love pointed out that although ostensibly large, the financial commitment was puny, noting that Astra-Zeneca had estimated the cost of their planned programme at $70.6 billion, and that $2 billion was both palpably insufficient and represented no more than 0.3% of the GDP of China alone. He also expressed the view that it was extraordinary that wealthy nations had committed so little, as the crisis would not be over until the whole world was adequately immunised, as the virus would continue to mutate and reinfect even vaccinated populations if left unchecked in the developing world. Liam argued that much more radical action was required, floating the idea that the global pharmaceutical industry could perhaps be reformulated as an international body presided over by the WHO, or at least a commitment by countries to match vaccine numbers for their own populations with equivalent donations to COVAX should be mandated.

David was highly doubtful that any such action was conceivable, arguing that while regrettable, populations elected governments to serve their citizens needs, and that some form of vaccine nationalism was inevitable as long as there was a limited source of supply. He argued that a properly resourced global programme would come (citing the examples of the eradication of smallpox by 1980, and the rollout of the Salk vaccine for polio that had eradicated the disease from most of the globe), but only after the affluent world had achieved collective immunity. Carmen Torres, whilst deeply supportive of internationalism, noted that in her native US, Biden had no choice but to ensure the supply of vaccines to American citizens first, and that given the polarised and febrile nature of the US at this time it was the only possible move. The dispute between the EU and Britain over supplies of the Astra-Zeneca vaccine was noted.

Ronan pointed out that, surprisingly, the use of vaccines as geo-political tools had not yet taken place, and that even China, with the pandemic largely under-control within its borders and a vaccine of its own development available, had chosen to make only commercial use of it, rather than as a means of enhancing its global soft-power. Niall noted, however, that Turkey was purchasing the Chinese vaccine, which could be interpreted as evidence of geo-political manoeuvring. Alastair Gardner cited a Der Spiegel article that had covered a Chinese dispute with Canada, originating in sanctions of Chinese companies in the Canadian 5G network which had been met by limiting supplies of vials and other paraphernalia necessary for vaccination.

The debate moved on to discussing the significance of global anti-vaxxer sentiment. Ronan pointed out that the BBC report had focussed on an eclectic group of nations (Romania, Russia, Nigeria, India and the Democratic Republic of Congo), and was suspicious that it neglected to mention the strong anti-vaxxer movement in the US and Britain. He also referenced a recent report on hostility to vaccination in the UK that focussed on the resistance of the British BAME population, one that lacked statistical verification and smacked of both victim-blaming and institutional racism. Niall concurred, arguing that such reports failed to acknowledge the issue as one of institutional failure, and therefore failure to examine why the British BAME population was often suspicious of health services, which he considered to be rooted in previous negative experiences. David suggested that there was evidence of greater anti-vax sentiment in these groups, siting the widely circulated fake news that the vaccines either contained pork or beef thereby alienating Muslims and Hindus respectively. He noted the parallel with the ‘Indian Mutiny’ of 1857. Carmen argued that under Trump, people of colour in the US had become deeply suspicious of any statements by their government, and vaccine uptake had been subsequently low. She noted, however, that the shift to a more transparent form of government, had already led to an abrupt change in outlook by African-Americans and many were now positive about vaccination. Alastair raised the issue of neo-colonialism in the history of resistance to vaccination programmes, noting historical health programmes conducted by the British colonial state that been viewed with suspicion by their recipients who were unsurprisingly sceptical of the benign intent of their colonial overseers. Sadegh Attari cited the impact on Iran of the export of blood from France that had been inadvertently contaminated by HIV in the 1980s, and how this had been built on by the Iranian state as evidence for deliberate malfeasance by the Western world. David noted the role of vaccination programmes as a tool to uncover Osama Bin Laden’s location by the US that had led to suspicions in Pakistan, and the fears fermented by Boko Haram in Nigeria that vaccination was a covert means of sterilising Muslims. He speculated about the long-term effects on vaccine acceptance of the sterilisation campaigns in India, funded in the 1970s by international institutions and reaching a grim crescendo in 1975 with Sangay Gandhi’s forced sterilisation of over 6 million poor Indian men. Liam noted the work of Julian Baggini on ‘the history of truth’, who argues that people of strong religious belief are commonly more susceptible to conspiracy theories, and drew attention to their prevalence among ‘new-age’ religious groups in the Western World.

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