To achieve global immunity, we need at least 60% of the world's population to be vaccinated, and thus governments must realize that the fight against Covid-19 can only be successful by ensuring equal access to the vaccine. Giving priority to selling vaccines to countries that pay the highest price is not the right approach.

Usually, it takes years, or even decades, to develop a vaccine, but with Covid-19, an effective vaccine does not seem too far-fetched. More than 200 vaccines are under development, of which at least 24 have been tested in humans and six are now in phase 3 of clinical research - the final step before approval for distribution in the market. A safe, effective vaccine is widely believed to be the best medicine to bring the world back to the way it was.

Russia's vaccine on trial

When we look at the incredibly fast spread of the coronavirus from China to almost every country on Earth, we know that this virus has no borders in its global infection crusade. Today's phenomenal globalization requires a vaccine strategy that adapts to that reality - a global strategy of scope, and one that can guarantee inclusiveness: all who need a vaccine should have a vaccine. One sensible strategy would be one in which health-care workers, people at higher risk of catching the virus, and people in areas where the virus is rapidly spreading, should be given priority to be injected with the first doses.

However, such an approach continues to be looked down upon in a world dominated by money and national interests.

Instead of working together to formulate and implement this global strategy, more and more countries, including the United States, have chosen the "my country first" approach to grow and secure large numbers of potential vaccine candidates. This vaccine nationalism is not only morally objectionable; it is also the wrong strategy to reduce viral spread globally.

With a virus capable of spreading rapidly from country to country, vaccinating each country will only exacerbate and prolong the pandemic. It could also lead to a spike in vaccine prices, and if a country with a large number of infections, such as India, is left behind in vaccination and other forms of treatment, the virus will continue to disrupt global supply chains, and as a result continue to disrupt economies around the world.

Concerns increase

As health professionals sound the alarm, wealthy nations have invested heavily in ensuring that their citizens are vaccinated first.

In the US, the Trump administration has launched the Warp Speed campaign - a billion-dollar government-funded effort to speed vaccine development, production and ensure the delivery of the vaccine for the American people. The US has pledged billions of dollars to pharmaceutical companies and nearly $ 10 billion has been allocated by the US Congress to produce more than 300 million doses of medicine exclusively for US citizens by January 2021.

This is a similar strategy to an earlier government policy that bought 500,000 doses of remdesivir - one of the only drugs certified as an effective treatment against corona virus - equivalent to almost all output of the manufacturer in July, August and September.

Meanwhile, there is the Inclusive Vaccine Alliance between France, Germany, Italy, and the Netherlands in Europe, where the four countries have joint discussions with several pharmaceutical companies to secure promising vaccine initiatives. They have ordered 400 million doses of the vaccine from AstraZeneca, which is being co-developed with Oxford University.

The UK also reached an agreement with AstraZeneca and hired India-based pharmaceutical company Wockhardt to help secure and distribute 30 million doses of the vaccine by September and will eventually push for 100 million doses by the end of the year 2021. When an Indian pharmaceutical company is responsible for vaccine delivery in the UK, rather than within its own country, we know something wrong is going on.

Vaccine research in Vietnam

Can vaccine nationalists fully secure the # 1 spot for their population on the global vaccine waiting list? What could be more important once we have an effective vaccine rather than the country that has bought it all and where the vaccine is made?

Pharmaceutical companies have prepared for the possibility that governments of countries where these companies have manufacturing plants will require sufficient doses for their populations before allowing exports. Similar restrictions have been put in place worldwide - more than 90 countries have restricted drug exports, including between countries within the European Union, to ensure this resource is for themselves. So it wouldn't be surprising if this approach is applied to vaccines.

Global division

Unequal access to vaccines will create cracks between countries with higher immunization rates and those with lower rates. People of the lower classes, and the poorer, less developed countries may be denied entry and may face additional stigma from the global community.

This happened to Chinese citizens in the early stages of the pandemic, or similar to Europeans with the US-enacted travel ban - all before the world reached a standstill. This is not unprecedented, as the same thing happened during the 2014-2016 Ebola outbreak to the people from African countries.

From here it may not be difficult to imagine the potential emergence of a global two-class system: the clean people, those who are immune and non-infectious, and those who are not immune, who are infectious and are still feared as a source of infection.

The inequality of rights and freedoms will inevitably stem from such a system, where unvaccinated people can lose their privacy and are subject to constant government supervision and subject to travel restrictions, and restriction to access to public areas and health care facilities.

Career opportunities, particularly international employment opportunities, may also be closed to people from “not vaccinated” countries, as employers can prioritize hiring people from countries certified as “immune” or who can demonstrate evidence of immunity to Covid-19. Such an injustice system sounds far-fetched, but it can, and has happened before: a striking example is people living with HIV/AIDS.

If governments in poorer countries do not have equal access to an effective vaccine, the economic and social disadvantages of not being vaccinated will ultimately motivate everyone to try and obtain vaccines, or obtain immunity through illegal means. Then one can expect a surge in the black market for fake vaccines, which could have serious long-term consequences for public health.

Pham Vu Thieu Quang (Leiden University, the Netherlands)

To be continued....

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