Image Source: Ian Hutchinson/Unsplash
The Big Idea: Defining Vaccine Nationalism and Privatization
At the beginning of the pandemic, many speculated that COVID-19 vaccines would be hoarded by the rich and powerful while the poor suffered unimaginably, and the data shows that this fear is coming true. This is the result of vaccine nationalism, which applies the nation-first approach to the medical field. Wealthy nations have prioritized the vaccination of their own population. While that itself is not an issue - these nations have begun to hoard vaccines that are up to [9 times](https://globalhealth.duke.edu/news/ensuring-everyone-world-gets-covid-vaccine.) the amount needed to vaccinate their entire population twice over. High-income countries (HICs), or the global north, contain only [16% of the global population, yet they hold over 60% of the world's COVID-19](https://globalhealth.duke.edu/news/ensuring-everyone-world-gets-covid-vaccine.) vaccinations. However, it is important to note that though not all HIC’s are geographically northern nations, they are often classified as part of the global north because the north-south divide is actually a socio-economic divide, not a geographic divide.
The problem doesn't lie in a nation's wish to aid its own population first; if they didn’t, the nation's government would likely fall due to immense backlash from its own suffering people. The problem is the privatization of vaccines, and, more broadly, private healthcare. These national industries are controlled by private enterprise, which has its benefits and its shortcomings- one of which being that this privatization leads to a disparity of necessary items such as the COVID-19 vaccine. The ability of these countries to hoard vaccines is due to the fact that they are HIC’s. Vaccine companies sell the vaccine for a price ranging between $2 and $5 per dose. To put this in perspective, [Canada has committed $220 million](https://www.canada.ca/en/public-services-procurement/services/procuring-vaccines-covid19.html#:~:text=The Government of Canada is,for everyone in Canada.) for the vaccine. While this price is already extremely expensive for low-income nations (LICs), it becomes increasingly difficult for many HIC’s to actually receive a lower price for the vaccine. In South Africa, a single dose goes for $5.25 USD whereas in the EU the price falls to $2.15 USD. When asked about the disparity in pricing South Africa’s deputy director-general of health, Anban Pillay stated,“...the explanation we were given for why other high-income countries have a lower price is that they have invested in the [research and development], hence the discount." Thus many LICs cannot afford to buy mass amounts of vaccines at one time. While many low-income nations have attempted to get around this by trading or selling PPE to high-income nations in return for donated doses, it hasn’t been enough to sustain them and they must rely on donated doses.
The donation paradigm has long been used in the public health field because philanthropy is often used by economically capitalistic society to make up for its shortcomings. Due to the privatization of production, necessities such as food, shelter, healthcare, and water, are all private industries. As a result, the price increases because wealthy individuals can keep up with price changes whilst companies earn a profit, though it leaves behind those who can't keep up with changing prices. These people rely on philanthropy, donation, and social welfare to sustain themselves yet the philanthropic amount is far displaced from the need as seen with the vaccine. 49 million vaccines have been donated through the COVAX program, though an estimated 45 billion more are needed. The solution would then seem to be that LICs should invest money into creating their own vaccines, but this is currently inviable. The patents that protect pharmaceutical companies from copyright infringement are a huge reason why COVID-19 is quickly becoming a developing world problem. Dr. Maria Guevara, an international medical secretary at Medecins Sans Frontieres argues, "...we are once again faced with issues of scarcity, which can be addressed through diversification of manufacturing and supply capacity and ensuring the temporary waiver of relevant intellectual property." However, scarcity is not the issue. When we talk about a similar situation regarding world hunger, a prominent claim is that food is scarce due to overpopulation, whereas in reality, we produce more food than necessary to feed the entire human population; the cause is actually distribution. Guevara goes on to state, “It is about saving lives at the end, not protecting systems."
What Is (Or Isn't) Being Done?
On October 2, 2020, a proposal was submitted to the World Trade Organization’s (WTO) Council for Trade-Related Aspects of Intellectual Property Rights by India and South Africa. The proposal was backed by over 100 nations and aims to remove the patents of the COVID-19 vaccines and temporarily end the privatization of pharmaceuticals. This proposal was brought forward in order to increase global vaccine rollout. However, it has been blocked by many wealthy nations, most notably the U.K and Canada, because of the nations’ fear of the consequence that would come from patent removals.
Local production of vaccines would help to combat the effects of vaccine nationalism and save millions of lives across the globe. However, some argue that it would have more negative effects than positive. Dr Jerome Kim of the International Vaccine Institute (IVI) made a statement regarding patent protection. While the IVI supports global vaccination Kim asserts, “It's easy to say we should open patents to everybody. But the real question, I think, is: Are we going to be able to get as much high-quality vaccine out as needs to get out as quickly as possible if we were to just open the books on all the patents?” Questions about vaccine quality aren’t asked when selling the vaccines, nor are they asked when the pharmaceutical companies set up their own for-profit clinics in developing countries because the quality is tested before being sent out. The notion that those developing the vaccines in the global south are less qualified and produce poor quality vaccines is coated with racist and colonial ideas of intelligence and quality. The removal of patents won’t change the testing requirements of the World Health Organization. While Kim's concern lies with the quality of vaccines, the Director of the International Federation of Pharmaceutical Manufacturers & Associations is more concerned with “unravelling the system of [scientific] innovation." While patents and privatization do breed innovation; they also breed poverty, medical inequity, and class divide. Furthermore, innovation shouldn't belong to the private sector, many nations with socialized healthcare and other socialized sectors produce innovative ideas.
The Moral, Economic, and Health Consequences
It is morally reprehensible to continue to engage in vaccine nationalism and the privatization of COVAX. The health consequences are clear: if Canada, the U.K, and other wealthy nations continue to block patent removal and contribute to vaccine nationalism, countless people will suffer. Additionally, the economic and sociopolitical dimensions must be considered as well. The global economy will suffer as LICs are unable to participate fully in the economy, which has dire implications for the wellbeing of the international community. Dr Angela K. Shen confirms, "In order for a vaccine to work [effectively], you need most of society to be protected — and that protection happens when you get everyone vaccinated. So you want to roll this out to everyone because, inherently, that’s how you protect everyone collectively." It is likely that uneven vaccination will cause mutant strains of COVID-19, such as the South African Variant, to develop in the global south and eventually work back to the global north, restarting the pandemic.
It’s also not the first time the global community has faced a similar issue regarding vaccines. In 2009 the H1N1 pandemic swept across the globe and resulted in a similar situation in which HICs had more than enough vaccines, and LICs were left with almost none, leaving them reliant on the aforementioned donation paradigm. While H1N1, Ebola, and AIDS were all crises in the global north when they first surfaced, they have become in recent years, problems of the underdeveloped world. Though it is a concern of many that removing COVAX patents will cripple the economy due to its impact on pharmaceutical companies, the Organization for Economic Cooperation and Development (OECD) made a clear statement that the global economy would suffer a loss of 9.2 trillion dollars if the global south is left behind. So while these nations advocate for privatization and innovation, they will cripple themselves if something doesn’t change in the vaccine rollout.
A Solution for the Future
It is morally clear that our duty as global citizens is to our brothers and sisters of the world, and not to the systems that aid some of us in the short run. Economically, the world will suffer if the patents for COVAX aren't waived, we continue to rely on philanthropy, and LICs are unable to participate in the global economy. We are at a crossroads as to what decision to make in order to prevent global suffering, medical inequity, and economic destruction.