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Abstract

The pursuit of ending the COVID-19 pandemic has shed light on the surfacing and rollout of vaccines to be utilized by people around the world. However, vaccine nationalism hinders the world’s poorest countries to have access to vaccines. This article puts into perspective the impact of vaccine nationalism on global health. It also underlines its repercussions on the universal rights to health standards and identifies avenues to be followed for equitable access to the COVID-19 vaccine, necessary to the containment of the pandemic. The study makes use of secondary data to gain a better understanding of problems associated with vaccine nationalism. We searched PubMed, CINAHL, and EMBASE databases, websites maintained by the United Nations (like the World Health Organization [WHO]), national and international newspapers, and grey literature using a predetermined search strategy to identify all relevant qualitative, quantitative, and mixed-methods studies related specifically to the aim of this study. Its findings prove that vaccine nationalism has a negative impact on global health by posing a predicament or a delay in ending the pandemic, and furthermore, it violates human rights to health standards of the global population. Therefore, to encourage the international sharing of the COVID-19 vaccine, enforceable frameworks for vaccine development and distribution are needed and should be managed by an established international platform like the WHO.

Keywords

COVID-19 human rights vaccine nationalism global health pandemic

Introduction

The novel coronavirus (COVID-19) disease outbreak was declared a public health emergency of international concern on January 30, 2020, and on March 11, 2020, it was declared a global pandemic (World Health Organization [WHO], 2021). The deadly COVID-19 disease affects the respiratory system which is caused by the coronavirus and spreads from person to person mainly via respiratory droplets produced by an infected person.

In less than a year, the COVID-19 pandemic affected almost every country on the planet. As of March 2021, more than 122.5 million people in 191 countries and territories had contracted the virus, which killed more than 2.7 million individuals (WHO, 2021). Countries around the world, pharmaceutical companies, intergovernmental organizations, and research institutes have set out to develop medical products capable of preventing, diagnosing, and treating COVID-19, starting an unprecedented race to produce vaccines in record time. Governments are estimated to have invested nearly $20 billion to accelerate vaccine research, manufacture, and distribution (Human Rights Watch, 2020b).

In May 2020, in response to this exceptional public investment, the World Health Assembly recognized the role of generalized vaccination against COVID-19 as a global public good. The Secretary-General of the United Nations publicly added that it should be accessible to all (United Nations, 2020). Since then, the World Health Organization (WHO) Secretariat has defined guiding principles to promote access to and allocation of essential health commodities related to COVID-19 based on justice and equity. These principles are based on the fundamental right of every human being to enjoy the highest attainable standard of health, regardless of race, religion, political opinion, economic, or social condition (WHO, 2020b). In order to ensure this basic right, vaccines, diagnostics, and other health products related to COVID-19 must be affordable, available, appropriate, and of guaranteed quality for all people who need them (WHO, 2020b).

However, since the discovery of the COVID-19 vaccine, the race to inoculate world populations against this pandemic has begun in earnest, and poor countries are losing it. According to The New York Times, as of 03/16/2021, a total of 107.3 million vaccine doses had been administered to individuals across the world. North America leads with 6% of its population having been vaccinated, Europe is on 3.6%, Asia is on 0.9%, South America is on 0.7%, and Africa lags far behind with fewer than 0.1%, whereas Oceania has none (Holder, 2021). In light of this, one has to understand how vaccine nationalism is affecting negatively the fight against the COVID-19 pandemic. Therefore, this article puts into perspective the impact of vaccine nationalism on global health, underlines its repercussions on the universal rights to health standards, and identifies avenues to be followed for equitable access to the COVID-19 vaccine, necessary to the containment of the pandemic.

To present the goal of this study in a logical format, first, this article starts by defining the concept of vaccine nationalism and how it can be understood. Second, it explains the research methodology used. This section briefly details the means by which secondary data were collected and analyzed. Third, the findings and discussion section outlines, analyzes, and discusses the themes that have been developed as a result of the secondary data. The main aim of this section is to examine the damaging impact of vaccine nationalism on global health and its insinuation of the violation of the human right to health standards. The last section presents the conclusion and recommendations.

Understanding Vaccine Nationalism

Vaccine nationalism is when a country manages to secure doses of vaccines for its own citizens or residents and prioritizes its own domestic markets before they are made available in other countries (De, 2020). In the case of COVID-19, as soon as many groups of scientists began to develop the vaccines, some wealthy countries around the world were engaged behind the scenes to make deals with pharmaceutical companies to ensure access to these vaccines for their own populations before any other country. This is done through pre-purchase agreements between a government and a vaccine manufacturer. For instance, according to a report published in the British Medical Journal, the United States of America (USA) has secured 800 million doses of at least six vaccines in development with an option to buy about one billion more (Callaway, 2020). The United Kingdom has purchased 340 million shots: approximately, five doses for each citizen (Callaway, 2020). Furthermore, Canada sparked outrage after purchasing vaccines doses to immunize nearly 10 times its population. Although on the surface it may seem these countries have ordered more doses than they need, the truth is many of these orders were put in during trial phases of the vaccines when they did not know for sure which vaccines would be successful (Callaway, 2020).

Vaccine nationalism is not a novel concept. Ruchtsman correctly noted that vaccine nationalism had not emerged but rather re-emerged in the COVID-19 pandemic, citing the earlier example of the 2009 H1N1 epidemic or swine flu pandemic (Rutschman, 2020a). During the early stages of the swine flu pandemic, certain wealthy countries signed pre-production agreements with potential manufacturers of H1N1 vaccines to advance the purchase of all doses that could be produced in their domestic markets (Rutschman, 2020b). Economically advanced countries used similar strategies in the case of drugs for HIV/AIDS (Dzodin, 2020) and vaccines for smallpox and polio (David, 2020). The history of political behavior during pandemics is repeating itself as countries with resources to obtain COVID-19 vaccines are showing even more enthusiasm in repeating the mistakes of the past without considering the catastrophic consequences for many of the world’s most vulnerable populations.

Research Methodology

The study draws on the literature to gain a better understanding of some of the risks and problems associated with vaccine nationalism. We searched PubMed, CINAHL, and EMBASE databases, websites maintained by the United Nations (like the WHO), national and international newspapers, and grey literature using a predetermined search strategy to identify all relevant qualitative, quantitative, and mixed-methods studies related to the universal right to health standards, public health, pandemics, COVID-19, virus, vaccine, and vaccine nationalism. Many of these terms relate specifically to the aim of this study. Overall, 42 studies were included based on the criteria mentioned previously to narrow the articles to those most relevant to the study. We used a three-stage thematic synthesis methodology to synthesize the qualitative evidence, and we used the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess confidence in the qualitative research. Quantitative data are presented by individual study characteristics and outcomes, and key findings are incorporated into the qualitative thematic framework.

Findings and Discussion

This section outlines and analyzes the themes that have been developed as a result of the secondary data collected. Two major themes were generated, and they are labeled as follows: (a) tragic consequences of COVID-19 vaccine nationalism on global health; and (b) the impact of COVID-19 vaccine nationalism on the human right to health standards.

The Tragic Consequences of COVID-19 Vaccine Nationalism on Global Health

The concern over less wealthy countries not having access to the COVID-19 vaccine is a serious one, and it is everyone’s problem. This pandemic is a global issue; one has already seen how quickly it can spread around the world, bringing some of the most powerful countries’ health facilities to their knees. Vaccine nationalism will ultimately impact everyone in both high- and low-income countries, as it hampers progress in tackling the COVID-19 pandemic. If some countries do not carry out enough vaccinations to build immunity within their populations, the pandemic will continue there and eventually impact everywhere else too.

Rich countries by engaging in vaccine nationalism pay for vaccines doses in quantities that cover more than their populations. If rich countries that bought up the majority of the supplies of the vaccine were to vaccinate only their citizens, it would mean the virus would continue to rage in other non-vaccinated countries. And the research on the mutation of the COVID-19 has already proved just how quickly and efficiently this virus can mutate and affect once again people who have been vaccinated against it.

The aforementioned statement is aligned with the research outcomes provided by Dr Khan, a National Health Service doctor and a Senior Lecturer at the University of Leeds in England who stated that

…the more people it [COVID-19] infects, the more likely it is that further mutations will occur, and it is inevitable that an escape mutation will eventually surface. The new mutation is then likely to become the dominant strain and will find its way back to our shores, setting off a whole new set of infections in those vaccinated against only the old variants. Vaccine nationalism, therefore, is incredibly short-sighted… (Khan, 2021)

Furthermore, according to WHO Director General, Dr Tedros Adhanom Ghebreyesus, vaccine nationalism would also lead to a prolonged pandemic as only a small number of countries would get most of the supply (Nebehay & Farge, 2020). To achieve global herd immunity against COVID-19, roughly 70% of the world population need to be immunized, an objective that remains unrealistic due to the vaccine nationalism approach used by wealthy countries (Nebehay & Farge, 2020). Therefore, vaccine nationalism only helps the virus. As long as there are ongoing outbreaks of the virus around the world, individuals will still get ill and have to stay off work, schools may have to close again, and travel, tourism, commerce, education, and other contact-intensive sectors will most likely continue to be depressingly affected. For this reason, it is keen to find a way to eradicate the COVID-19 pandemic in order to reduce its strain on global health systems and to protect citizens around the world from illness and death. Therefore, vaccine equity is significant in the fight to eradicate the impact of COVID-19 globally.

COVID-19 Vaccine Nationalism and Human Right to Health Standards

One of the most important rights to health questions unleashed by COVID-19 is the equitable access of the global population to COVID-19 treatments and vaccines, which invoke core state obligations to provide access to essential medicines. Here, one needs to consider fundamental right-to-health questions related to affordability, resource allocations, and accountability. The barrier to equitable access is the vaccine nationalism approach to the production and distribution of vaccines or other pharmaceutical treatments related to COVID-19 (Forman & Kohler, 2020). Such approaches undercut the promise of international declarations and conventions on the universal right to health because they undermine states’ willingness to engage in international cooperation, assistance, and equitable access to COVID-19 vaccines (International Covenant on Economic Social and Cultural Rights, 1976).

Several international declarations and conventions articulate the human right to health including Article 25 of the Universal Declaration of Human Rights, Article 24 of the Convention on the Rights of the Child, Article 25 of the Convention on the Rights of Persons with Disabilities, Articles 12 and 14 of the Convention on the Elimination of All Forms of Discrimination against Women, Article 5 of the Convention on the Elimination of All Forms of Racial Discrimination, and Article 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR).

In this section, the focus will be put on the ICESCR because it is central to the right to health. Although human rights are primarily owned by the country to its citizens, the wording used in the ICESCR recognizes these rights on behalf of “all members of the human family” (International Covenant on Economic Social and Cultural Rights, 1976). It has been observed that the wording in the ICESCR lacks any jurisdictional limitation, unlike other corresponding international covenants, indicating that it was intended to have extraterritorial scope.

The preamble of the ICESCR refers to the “obligations of States under the United Nations Charter,” which General Comment No. 14 (in paragraph 38) has clarified refers to “the essence in Article 56 of the United Nations Charter” (International Covenant on Economic Social and Cultural Rights, 1976). Article 56 of the United Nations Charter contains a pledge by its members “to take joint and separate action in co-operation with the Organization for the achievement of the purposes outlined in Article 55” which identifies the promotion of “international … health and related problems” as necessary for the “creation of conditions of stability and well-being … for peaceful and friendly relations among nations” (International Covenant on Economic Social and Cultural Rights, 1976).

Furthermore, under Article 2 of the ICESCR, States undertake to realize the rights granted by the Agreement through “international assistance and co-operation to the maximum of its available resources” (International Covenant on Economic Social and Cultural Rights, 1976). Ordinarily, this would be understood as an obligation by States to obtain necessary international assistance to ensure the realization of this right for their own people. Although State’s duties under the ICESCR are generally limited to taking steps to progressively realize rights to the maximum of available resources (International Covenant on Economic Social and Cultural Rights, 1976), States also hold core obligations to ensure the satisfaction of, “at the very least, minimum essential levels” of treaty rights. These core obligations include non-discriminatory access to health facilities, goods, and services; essential drugs, as defined by the WHO; and adopting and implementing a national public health strategy and plan of action addressing the health concerns of the whole population, with particular attention to vulnerable or marginalized groups (UN Committee on Economic Social and Cultural Rights, 2000). However, some of the wealthiest countries, primarily the USA, have failed to implement these obligations for their own populations. This can be proved by the fact that the COVID-19 pandemic exposed the reality of the health-care system in the USA which is a microcosm of American society in which power and resources are not allocated fairly among races. Black, Latina, and Indigenous Americans are dying from COVID-19 at disproportionately high rates, and this increased lethality is coupled with the disparate prevalence of hypertension, diabetes, and obesity (Evans, 2020). The increased COVID-19 risk is most likely conferred not only by the prevalence of these chronic diseases and disparate chronic disease severity but also by the health-care system’s failure to provide minority patients (Black, Latina, and Indigenous Americans) with preventive and therapeutic care of quality equal to that provided to White patients (Dawes, 2020).

When it comes to the distribution of the COVID-19 vaccines, poor countries as well have been left behind. The global roll-out of COVID-19 vaccines to date is neither inclusive nor adequately planned. The majority of wealthy countries are already administering boosters while the rest of the world is being left far behind. For instance, despite the urgent need to increase vaccination, Africa has received too few vaccines from the global supply. As of this writing, of more than 9 billion vaccines doses produced, Africa has only received approximately 540 million (about 6% of all COVID-19 vaccines despite having 17% of the world’s population) and administered 309 million doses (Sidibe, 2022). Less than 10% of Africans are fully vaccinated. In other words, approximately, 1.2 billion Africans have not received a single dose of vaccine and, at the current rate, much of Africa may not be vaccinated until 2023 (Sidibe, 2022). The global failure to share vaccines equitably is taking its toll on some of the world’s poorest and most vulnerable people.

According to Article 27 of the Universal Declaration of Human Rights and Article 15 of the ICESCR, everyone also has a right to enjoy the benefits of scientific progress. This places obligations on states to ensure that vaccine nationalism does not adversely impact the right to health (Human Rights Watch, 2020). Countries blocking or limiting broader access to vaccines are acting in contravention of these rights, and in effect, interfering with other countries’ abilities to fulfill their human rights obligations. United Nations human rights experts have repeatedly pointed this out by reminding countries that under international human rights law, access to any COVID-19 vaccine and treatment must be made available to all who need them, within and across countries, especially those in vulnerable situations or living in poverty (Human Rights Watch, 2020). Therefore, to achieve global equity for COVID-19 vaccines under the international human rights law, stronger international partnerships under the COVID-19 vaccines global access (COVAX) facility are needed. The COVAX facility is currently the only mechanism that aims to secure access to successful vaccine candidates multilaterally and proposes a rational allocation sequence among countries (OECD, 2021). It promotes fair and equitable access to the COVID-19 vaccines for every country in the world, protecting and acknowledging the right to life and health for everyone, and preserving human dignity everywhere. This recognition underscores the recognition of the WHO (2020a) and the Council of Europe for Human Rights (Council of Europe for Human Rights, 2020), among others, that a human rights approach is crucial to an effective public health response to COVID-19.

Conclusion

Countries around the world, international agencies, and health systems have an obligation to ensure, to the best of their ability, adequate provision of health care for all. However, this may not be possible during a pandemic like the COVID-19, when, due to the vaccine nationalism approach, wealthy countries purchased the majority of the vaccines in quantities that cover more than their populations. Thus, vaccine nationalism prevents the COVID-19 vaccines from reaching vulnerable people in poor countries, leading to preventable deaths. Furthermore, vaccine nationalism will prolong the duration of the pandemic because only some people will have access to the treatment. To encourage the international sharing of vaccines, enforceable frameworks for vaccine development and distribution are needed and should be managed by an established international platform like the WHO. The international effort to support vaccination distribution needs to be sustained over time. Moreover, it must be extended beyond most political cycles. As such, global cooperation could help to take short-term thinking out of decision-making and focus on the long-term aspirations for the human rights to health standards of the global population. The preamble of the ICESCR and other international declarations and conventions offer human rights standards, principles, and rules that could center equity and vulnerable populations in pandemic control-related law, policy, and practice, and offer key protections to challenge inequities in global health.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Patrick Bashizi Bashige Murhula

Shanta Balgobind Singh

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