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Vaccine nationalism, vaccine diplomacy, and India

pandemic preparation waving colorful national flag of india on a gray background with text coronavirus covid-19 . concept.. COVID-19 cases in India illustration. Indian COVID-19 cases concept. Cases of COVID-19 crisis in India concept. Image credit: luzitanija / 123rf. Used to illustrate one million deaths due to the pandemic. covid-19 vaccine supplies in india
Image credit: luzitanija / 123rf

Ngozi Okonjo-Iweala, who will assume the role of director-general of the World Trade Organization (WTO) next month, has cast a spotlight on vaccine nationalism and warned that progress in combating COVID-19 will be hindered without equitable access to vaccines.

Okonjo-Iweala, a Nigerian-American development economist, said “both on a human health basis, as well as an economic basis, being nationalistic at this time is very costly to the international community.” She asserted that “no one is safe until everyone is safe. Vaccine nationalism at this time just will not pay, because the variants are coming. If other countries are not immunised, it will just be a blow back.”

The incoming WTO chief’s remarks come amidst a global debate over vaccine nationalism. The term, RAND explains, commonly refers to “a situation in which countries push to get first access to a supply of vaccines, potentially hoarding key components for vaccine production.” It warns that “vaccine nationalism could lead to the unequal allocation of COVID-19 vaccines and cost the global economy up to $1.2 trillion a year in GDP terms. Even if some countries manage to immunise their populations against the virus, as long as the virus is not under control in all regions of the world, there will continue to be a global economic cost associated with COVID-19.” 

“Vaccine nationalism will not pay,” warns Incoming WTO chief Ngozi Okonjo-Iweala (pictured). Image credit: the International Monetary Fund, Public domain, via Wikimedia Commons

Research published in The Lancet last week underscored this message. “Having licensed vaccines is not enough to achieve global control of COVID-19: they also need to be produced at scale, priced affordably, allocated globally so that they are available where needed, and widely deployed in local communities,” reads the introduction in part. Lead author Dr Oliver Wouters of the London School of Economics and Political Science said “several manufacturers have successfully developed COVID-19 vaccines in under 12 months, an extraordinary achievement. But the stark reality is that the world now needs more doses of COVID-19 vaccines than any other vaccine in history in order to immunise enough people to achieve global vaccine immunity. 

“Unless vaccines are distributed more equitably, it could be years before the coronavirus is brought under control at a global level. The questions now are when these vaccines will become available, and at what price.”

Co-author Professor Mark Jit from the London School of Hygiene & Tropical Medicine highlighted the discrepancy, outlining that “based on known deals, governments in high-income countries representing sixteen percent of the global population have secured at least seventy of doses available in 2021 from five leading vaccine candidates.” 

The largest bulwark against vaccine nationalism and seeking to ensure equitable global access to vaccines against COVID-19 is COVAX, an initiative jointly led by the Coalition for Epidemic Preparedness Innovations (CPEI), GAVI, and the World Health Organization (WHO). As the WHO explains, COVAX “is supporting the building of manufacturing capabilities, and buying supply, ahead of time so that two billion doses can be fairly distributed by the end of 2021.” However, the Lancet research notes a further US$6.8 billion in funding is required for COVAX to meet this target. Wouters notes, “with additional funding, COVAX could compete better in the global scramble for vaccines.

“Vaccines developed by Chinese, Indian, and Russian manufacturers may also offer a lifeline for the lowest-income nations if they show good results in phase 3 trials, allowing them to procure abundant doses of vaccines that have not yet been authorised in most high-income countries. Once authorised by WHO, these vaccines could also potentially contribute to the COVAX portfolio.”

Covid-19. Red liquid vaccine in glass tubes.. Cases of COVID-19 illustration. Image credit: Ivan Uralsky. vaccine hesitancy concept. Also to illustrate article re: emergency use authorisation. Oxford/AstraZeneca vaccine. Also used in coverage of vaccine hoarding. Vaccination campaign concept. Cost of COVID-19 vaccine concept. vaccine shipments concept. Sputnik V illustration.
Image credit: Ivan Uralsky / 123rf

India has long been anticipated to assume a centre stage in the global vaccination campaign against COVID-19, being home to the world’s largest manufacturer of vaccines – the Serum Institute of India (SII). It has earned the title ‘pharmacy of the world’ owing to its voluminous exports of pharmaceutical products. Last month, the country commenced exports of COVID-19 vaccines. 

As of the second week of February, the country had exported more than 1.6 crore vaccine doses to twenty countries of which 37 percent were grants. The remaining 63 percent of doses shipped overseas were sales. The countries to have received vaccine exports from India include Afghanistan, Algeria, Bahrain, Bangladesh, Barbados, Bhutan, Brazil, Dominica, Egypt, Kuwait, Maldives, Mauritius, Morocco, Myanmar, Nepal, Oman, Seychelles, Sri Lanka, South Africa, and the United Arab Emirates. 

The news of the WHO granting emergency approval to the Oxford University / AstraZeneca vaccine for distribution through COVAX is likely to further push India into the centre of the global vaccination campaign, as the SII manufactures the vaccine in India. “We have been waiting for this final milestone,” said SII chief executive officer Adar Poonawalla. “I am happy and relieved that with the WHO’s EUL [Emergency Use Listing] we will be able to start the deliveries to African and other low and middle-income countries immediately. Countries with a large population must be protected as soon as possible.”

India does indeed have a huge role to play in the global fight against this pandemic – and its role in combating global vaccine nationalism will be of enormous significance. This has lent rise to vaccine diplomacy, reminiscent of India’s “medicine diplomacy” seen in earlier stages of the pandemic such as when it came to hydroxychloroquine (one far from free of controversy).

As noted in The New York Times earlier this month, India and other countries are embracing vaccine diplomacy. China and India are in the spotlight of the international conversation. Writing for The New York Times, Mujib Mashal and Vivian Yee state that “for India, its soft-power vaccine drive has given it a rejoinder to China, after years of watching the Chinese make political gains in its own backyard — in Sri Lanka, the Maldives, Nepal and elsewhere.” They quote Constantino Xavier of the Centre for Social and Economic Progress, who said “the vaccine push bolsters India’s credibility as a reliable crisis-responder and solutions provider to these neighboring countries.” 

This is not a strategy without risk. “India and China, both of which are making vaccines for the rest of the world, have vast populations of their own that they need to inoculate,” write Mujib Mashal and Vivian Yee. “Though there are few signs of grumbling in either country, that could change as the public watches doses get sold or donated abroad.” 

In India’s case, the report elaborates, “for now, the…government has room to donate abroad, even after months when cases soared and the economy was hobbled, and even as it has vaccinated just a tiny percent of its 1.3 billion people. Part of the reason for a lack of backlash: the Serum Institute is producing at a faster rate than Indias’s [sic] inoculation program can currently handle, leaving extras for donations and exports.” 

In terms of the use of vaccines within the context of international relations, as well as the context of potential domestic ‘grumbling’, it is important that the fundamental be noted. Vaccine nationalism is a threat to public health everywhere, in countries rich and poor. Our lived experience as a species of diseases quashed such as smallpox to ongoing battles such as HIV/AIDS and malaria illustrate clearly the importance of international cooperation and an approach oriented around equity. In COVID-19, this is not the case. 

The New York Times report explains that “rich nations are scooping up the world’s supplies. Poorer countries are frantically trying to get their own, a disparity that the World Health Organization…warned has put the world “on the brink of a catastrophic moral failure.”” Indeed, WHO Director-General Dr Tedros Adhanom Ghebreyesus has said “these actions will only prolong the pandemic” and “create exactly the scenario COVAX was designed to avoid, with hoarding, a chaotic market, an uncoordinated response and continued social and economic disruption.” 

How India’s role in the global vaccination campaign plays out going forward remains to be seen. As with virtually all aspects of this pandemic, the only certainty is uncertainty. But what is clear is that vaccine nationalism is among the most pressing hurdles to overcome – and that India’s role in the world overcoming this hurdle is sizeable to say the very least.

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