A grim resource inequality in poor nations and glimpsing the road to worldwide COVID-19 vaccination
On April 27, 2021, Center for Disease Control and Prevention (CDC) director Rochelle Walensky announced to all Americans that if vaccinated, they could freely walk outside without a mask. With half the population vaccinated, they even eased the mask mandate for those who weren’t. Soon enough, there were Americans on social media feeds everywhere whooping and cheering on the end of the pandemic. Everyone was ready to enjoy a mask-less summer, because when the United States fixes problems, the rest of the world is expected to cheer them on as well.
To people living in other countries however, swallowing the news was strenuous. In India alone, most people haven’t received quick access to a vaccine despite a raging second-wave and threats of a third-wave in the second half of the year. Economies in the Global South remain in a tumultuous state of chaos as they rush to supply vaccines. Terms like “vaccine apartheid”, “vaccine race”, and “vaccine nationalism” started entering lexicons. Vaccine or not, COVID-19 has ravaged the world in ways that cannot be recovered from until many years. In just one and a half years, income inequality has widened within and between states, leaving the globe in an economic crisis. No matter how much wealthy countries clean up their local epidemics, COVID-19 won’t go away until they lend a hand and reject the vaccine nationalism they’ve stayed faithful to up to this point.
What is vaccine nationalism?
Nation-states, when securing themselves against COVID-19, may choose to understandably prioritize their own domestic market above international ones. This prioritization began in the form of vaccine agreements that were pre-purchased between the Government and medical manufacturers. By August 2020, major economies such as the United States, Japan, and the United Kingdom had spent billions of dollars on agreements with vaccine frontrunners such as Pfizer and AstraZeneca Plc. Tabulated data from Airfinity, a science analysis service, on August 21, 2020, suggested that the US had secured about 800 million doses of six developing vaccines. By this point, no one was even sure if every pharmaceutical company’s vaccine was effective. They took their chances, which later proved to be the right decision.
In contrast, low to middle-income countries could not secure the same deals. The aforementioned wealthier nations left few resources for others. Treatment prices soared exponentially in poorer nations due to vaccine hoarding, according to a United Nations News article in August 2020. Nations couldn’t fend for the livelihoods of people as medical expenses became unaffordable. The policy think tank RAND Europe published a study mentioning the cost of the global pandemic would continue to be as high as $1.2 trillion per year due to the inaccessibility of immunization.
In short, the US, UK and European Union might have secured vaccines for themselves, but the resulting slowed global recovery will still cost them billions per year until every country is provided for, since states depend on each other for trade, development and employment. On June 9, 2021, following a three-month review of vulnerabilities in the US supply chain, the Biden administration had to specifically promote domestic materials of critical materials. The supply chain security report acknowledges that the shift of drug manufacturing overseas has left the American health care system vulnerable to shortages of essential medicines. Underlying factors of the shift include the necessity for a large factory site and a low-cost labour force, easily accessible economic factors of production in the Global South.
The US Food and Drug Administration (FDA) in October 2019 noted that both China and India enjoy a labor cost advantage and that Active Pharmaceutical Ingredient (API) manufacturing in India can reduce costs for U.S. and European companies by an estimated 30 to 40 percent, saving trillions in the process. The US healthcare manufacturing sector has therefore reduced in strength over time leading to reliance on others. Despite first-world countries thinking they can sustain themselves, their livelihood is dependent on the exports and imports of products, which won’t be manufactured sufficiently if the Global South continues to suffer. Slowed global economic recovery from the effects of coronavirus will additionally lead to weakened trade, less exports of products, and declining sales.
The pharmaceutical rat race of COVID-19 could easily be considered unique, but similar situations have happened before. Take the case of the 2009 H1N1 influenza outbreak. The seasonal flu vaccine seemingly offered no protection, leading to the same wealthy states pre-ordering vaccines before the World Health Organization (WHO) had even declared a pandemic. 60% of the world’s vaccines belonged to the US, according to a H1N1 research article in the University of California press in January 2021. That is a grotesquely colossal amount. The Harvard Business Review in May 2020 explained that the swine flu ended up killing more than 284,000 people worldwide, which was later discovered to be just a fraction of the real mortality rate, resulting from the vaccine shortage. Even when the situation hit rock bottom, the US only supplied a miniscule fraction of stockpiled vaccines internationally to stop the swine flu, only after they had supplied enough for themselves. History repeats itself; the world still hasn't learned a lesson today and the coronavirus rages on.
Vaccine inequality in India
Fast forward to summer 2021. In countries such as the United States, the virus is fairly controlled. Immunization is widely distributed among all age groups and the population works back to a normal life where masks aren’t mandatory. All is well, until one steps foot into the developing world. Tedros Adhanom Ghebreyesus, the director of the WHO, has expressed concern over self-serving behaviour stating “We need to prevent vaccine nationalism. Whilst there is a wish among leaders to protect their own people first, the response to this pandemic has to be collective.”
India is one of the biggest victims of initial vaccine nationalism. By the second week of April, news of India’s massive second wave of the pandemic spread throughout the world. The abysmal state of healthcare in urban areas shone in the limelight. An alarming amount of cases rose from urban hotspots, similar to a year ago. Data given by the Hindustan Times in April 2021 suggests that in the first four days of April, a majority (51.9%) of new cases were reported from these urban areas. The numbers are even more worrying when disaggregated at the city level. For instance, Mumbai, Pune, Thane and Nagpur together accounted for 59% of Maharashtra’s cases in the first four days of April. Meanwhile, the effect of the pandemic on rural India remained more silent, but grew frightening over time. In rural India, six districts accounted for 52% of deaths due to COVID-19 -- according to an India Today article on June 7, 2021. Beyond the lack of oxygen beds and life-saving drugs, doctors and nurses have had to battle fear, misinformation, and despair. Hospitals aren’t available for long distances. Families stay waiting for healthcare only to receive grief. In part, India’s poor healthcare, awareness, and government programs are to blame for the current issue.
The hoarding habits of the world’s developed economies came into question. In India, only people aged 18 and over are permitted to be immunized. Despite leaving a large number of people unprotected, vaccines still aren’t being distributed in efficient ways. A severe vaccine shortage has occurred. The public recognized the crisis and the United States in particular, was criticized for resource domination. Recently, India requested the US to lift the embargo against exporting raw materials for vaccines, an embargo introduced under the Defense Production Act. In April 2021, Business Standard reported in an article that the US would be sending an aid package filled with items needed to manufacture vaccines, a jab that never actually happened. European nations such as the United Kingdom also planned to help by sending concentrators and ventilators, but these ad hoc efforts weren’t reaching enough of the populace in time. The situation only got worse.
In a nation of over 1.3 billion people, the world should have realized the potential for more dangerous variants of the virus. India’s strain, B.1.617 has two critical mutations that make it more likely to transmit and escape prior immunity that has been built up, Anurag Agrawal, the director of India’s Council of Scientific and Industrial Research’s genomics institute, told Bloomberg in April. Soon enough, current vaccines won’t be enough. With the threat of new variants, the world might have stepped in too little, too late. Scenarios may inexorably occur where new variants would emerge and there would be no time to tweak the vaccine enough to save the world again. At that point, everyone would be left with regrets about nationalist hoarding and not distributing the hitherto scarce vaccines widely enough to bring about a change in time.
The COVAX situation
Back in late 2020, governments announced the debut of the COVAX initiative. Two-thirds of the world is engaged in guaranteeing a swift and rapid response to equitable vaccines. Coordinated by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and the WHO, the “global collaboration” COVAX (abbreviated from WHO’s COVID-19 Vaccines Global Access) planned to achieve this by acting as a platform that would support the research, development and manufacturing of a wide range of COVID-19 vaccine candidates, and negotiate their pricing. Poor countries were supposed to receive 2 billion doses of the vaccine via the initiative, but many of them are unable to even sign procurement contracts on their own. Public procurement is a fundamental, crucial component of democratic governance, poverty reduction and sustainable development. The World Bank estimates that governments around the world spend US$9.5 trillion in public contracts every year, but poorer states necessitate assistance to implement contracts, mostly due to poor implementation, illiteracy, and financial weakness. Seeing as the pandemic’s worldwide impact has not subdued even in the middle of 2021, COVAX’s and many such plans have become questionable.
India’s Serum Institute was a key supplier to the COVAX initiative. Although India was unable to effectively handle its own internal epidemic, India was a mass producer for the world. By the rise of the second wave however, India changed its mind. Soon, shipments were pared back and India began mirroring the actions of Western countries, becoming somewhat of a vaccine nationalist. Serum Institute’s emergency license requires approval from Indian capital New Delhi's central government to export vaccines, and the caveat lies there. Due to concern for the domestic outbreak, exports were no longer approved. In March 2021 as reported by Bloomberg, the UK faced a supply cut of AstraZeneca Plc vaccines due to India’s new decisions. Nations like Kenya and Brazil, with deaths surging past 300,000 are left begging for doses in the shadows of more developed nations. The healthcare systems do not have the capacity to support as many patients as needed, due to an acute lack of funding -- lower income and greater poverty are directly linked with higher mortality rates.
The Indian republic might have stopped helping others, but in doing so cut off a large bit of assistance weaker as well as wealthier nations were relying on. As of 2015, $6 billion of US pharmaceutical imports originated from India, according to the US Council on Foreign Relations. India is also a frequent provider of finished medications. In the 1990s, the first finished medications made in India began arriving in the United States. The trend has only risen since then. The Indian government started to encourage the growth of drug manufacturing by Indian companies in the early 1960s and then with the Patents Act in 1970. A large raw material base and the availability of skilled workforce gives the industry a definite competitive advantage. Domestic pressures and a lagging immunization campaign in India have created a ripple effect, and more states will continue to give in to vaccine nationalism like India did, copying the examples first-world countries set.
As the situation has prolonged, wealthy economies have shifted into a state of disquietude and offered more help. US trade representative Katherine Tai on June 11, 2021, reported that the Biden administration promised to donate half a billion doses of the vaccine and during negotiations at the World Trade Organization (WTO), secure a limited waiver of intellectual property rights of vaccines. Whether these promises will end up improving conditions is a much-awaited mystery the public will witness in the near future. A “what-if” situation comes to mind: the current urgency for vaccines and aid being offered could’ve been executed in the past. As mentioned, the US purchased a vaccine surplus. Despite the new agreement, nations can never forget that first-world countries only decided to help after they were done expelling the virus themselves. The first priority is the self, therefore echoing a nationalist and realist mindset.
In the midst of the chaos of poverty and famine brought by the pandemic, worldwide cooperation to eradicate COVID-19 is difficult to imagine. After all, nation-states are struggling to fend for their own citizens. Reaching out to others seems like a fantasy. Countries made mistakes in the handling of COVID-19, and now many believe we are doomed for a virus-induced apocalypse. However, this is not true and it is still possible to improve the situation. Nations need to act, and they need to act fast. Everyone with mass vaccine supplies can celebrate, but must stay conscious of the fact that coronavirus needs a lot more effort to be considered controlled. End the spread in areas that need it most-- cease variants from spreading. COVID-19 will continue to be a lurking monster until vaccine nationalism reaches death.
Western and industrialized countries often neglect impoverished states. This is common knowledge societies have normalized. Though developed nations such as the US are finally starting to contribute globally, aid is not reaching vulnerable populations soon enough, worsening the global situation. COVID-19 extends beyond borders and finances, beyond caring for just one’s own nation. Vaccines dozing off in cold storage rooms must be donated to the Global South in order to accelerate the slowed global recovery. In a global health crisis, excessive self-preservation is bound to backfire. Manufacturing facilities are under limited capacity and the importance of vaccine equity is at its peak. Variants are likely to spread and disastrously increase the amount of deaths. Economies would crumble, including economies that wealthy economies rely on, such as those of Mexico or India. A slowed economy in the Global South would lead to lackluster exports from trade agreements for other nations. The world is a macroeconomy where everyone depends on each other for imported and exported products, so at one point not even the healthy will remain wealthy. Wealth should not equal health as all countries must step in and do their part to end the pandemic. As the saying goes, “No one is safe until everyone is safe.”
Image credits: Africa CDC / Peninsula Daily News / Statista / Healthcare IT News / ABC News / The Guardian / Gavi / The Economist / France 24 / NPR
Written by Eshal Zahur
Edited by Thenthamizh SS and Veda Rodewald
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