We need an equitable and coordinated global approach to covid-19 vaccination

Vaccine nationalism will hinder our ability to effectively combat covid-19

This month, Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), repeated his concerns about the ugly face of vaccine nationalism.Vaccine nationalism hurts us all and is self-defeating…. Remember, ending this pandemic is one of humanities great races, and whether we like it or not, we will win or lose this race together.” Last week he added that the world is on the brink of a catastrophic moral failure.  

Failure to address structural and systemic inequalities in the acquisition and delivery of vaccinations is an ethical and moral issue of fairness, between and within all countries. But beyond the profound ethical dimension, no region or nation can truly be free of the pandemic until all nations are free of it. With this in mind, equity is a practical and pragmatic concern for all. Until there is an international consensus and coordinated operational strategy, the virus will find new vulnerable populations and continue to spread. It will neither respect international boundaries, nor be limited or eradicated by sporadic vaccination coverage across different populations and countries. It will continue to replicate and mutate to new and as yet unpredictable forms of the virus. These potentially limit the effectiveness of current and future vaccines, further threatening the world’s health and economic prosperity. Efforts within countries to use their vaccine programmes to generate local herd immunity will be unlikely to succeed. As a result, there will remain a continued need for lockdown restrictions within countries and for restrictions on international travel—variably and inadequately implemented by individual countries. 

The potential for chaotic differences in vaccination policies between countries will threaten our collective ability to control and suppress the virus worldwide. Given the potential for further virus mutations, some of which may be vaccine-resistant, the need for a coordinated global approach to vaccination through the lens of equity has never been more evident. Governments must commit to overcoming the ugly face of “vaccine nationalism” and replace it with “vaccine internationalism.” 

The COVAX programme has overcome scientific, legal barriers, logistical and regulatory barriers and grows in its capacity to deliver. International partners with the WHO have secured 2 billion doses sufficient for one fifth of the world’s population and planned to be delivered by the end of 2021. It is insufficient to suppress the spread of SARS-COV-2 and to prevent further mutations arising where the virus continues to proliferate. Wealthy countries like Canada, UK, USA, and the European Union, have purchased vaccines greatly in excess of their per capita needs. Forty four countries signed bilateral deals in 2020 and 12 more have signed this year already. This is driving up the prices of vaccines and placing poorer countries at an even worse disadvantage. The WHO says 95% of Covid-19 vaccine doses administered globally so far limited to 10 countries.

Tedros recognises that wealthy countries are right to want their vulnerable and elderly populations vaccinated, but questions why they should move on to lower priority groups at a time when many countries worldwide cannot vaccinate even these priority groups. He pleads for wealthy countries to be willing to share their stocks to enable fairer coverage of high risk groups around the globe. 

National governments must commit to international leadership of the vaccination effort through the WHO, supported by other key international agencies. They should adopt an international consensus with a clear strategy on moving towards the reduction of the virus spread. It is not merely a question of obtaining funding to support poorer countries in access to vaccines. Co-ordinated international effort is needed to ensure that vaccine deployment programmes are comprehensive and fit for purpose, with considerations made regarding the circumstances within countries in which they are administered (e.g. the Pfizer vaccine is unsuitable without expensive refrigeration below -70 celsius for transportation). 

The WHO needs to lead efforts to secure global collaboration and capacity in immunology, virology, public health, and vaccinology to anticipate potential antigenic drift or shift in the SARS-COV-2 virus. This is necessary to bolster efforts to maintain and develop comprehensive vaccine responses to the virus, as well as adapt them to combat potential new strains, similar to existing collaborations on anticipating the antigenic drift of influenza viruses

The creation of a range of vaccines to combat SARS-COV-2 is a major scientific achievement brought about through truly international efforts. The willingness of scientists to collaborate must now be matched by politicians from all nations. Without coordinated global capacity and collaboration to anticipate new strains of the virus and new modifications of vaccines, we may find ourselves faced with a perpetual covid pandemic. There is legitimate vaccine nationalism in the obligations and duties of the public servants in all countries; but there must be no continuation of the “ugly vaccine nationalism” we have seen thus far.

Politicians of all nations must commit to a global strategy for the control and eventual elimination of the SARS-COV-2 virus, the root cause of the covid-19 pandemic. There must be a genuine commitment to ensuring equitable access to vaccines both between and within countries. This is more than just a fundamental question of fairness and the right of all global citizens to health. The virus will not be eliminated anywhere, (except potentially in island populations) if it is not eliminated everywhere. Restoration of the pursuit of health and a better socioeconomic future for our global citizens requires global commitment to the largest vaccination programme ever undertaken to date. To make this happen, nations will need to pool their resources and sovereignty and put their weight behind the leadership of the WHO.

At the time of writing, a dispute has started between the EU and the UK on the distribution of vaccines. This can only damage confidence in the vaccine rollout, and serves no-one except anti-vaxxers and covid-19 deniers. Politicians have raised expectations among their citizens of a rapid vaccine rollout and peoples’ hopes are high that this will be delivered. Technical production limitations exist with all vaccine production efforts and it is an extraordinary success that we have got so far, so quickly. There will always be disinformation, commercial, and political factors in play. Vaccine internationalism requires measured calm heads, diplomacy, and generous visionary leadership. We need to put our aim of defeating the virus first.  

John Middleton, President, Association of Schools of Public Health in the European Region.

Brian Li Han Wong, Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London.

Manfred S Green, Professor of epidemiology and public health. School of Public Health, University of Haifa, Israel.

John Reid, Honorary Professor of Public Health  Chester University. 

Jose M Martin-Moreno, Professor of preventive medicine and public health at the Medical School and INCLIVA-Clinical Hospital, University of Valencia, Spain.

Competing interests: none declared

On behalf of the Association of Schools of Public Health in the European Region (ASPHER) COVID_19 task force Vaccination group: Brian Li Han Wong, Manfred Green, Jose M Martin-Moreno, Nadav Davidovitch, John Reid, Laurent Chambaud, Mohamud Sheek-Hussein, Ranjeet Dhonkal, Robert Otok, John Middleton.