Vaccinating the world is a test of our ability to co-operate

Is it possible to tackle a global pandemic in a world marked by huge inequalities of wealth and power? The answer might tell us how the world will address the far more complex challenge of climate change. What we have learnt from Covid-19, so far, is that the world has shown more co-operation than many might have expected. Even so, given that we are all in this together, it has not been enough.

The effort to vaccinate the world is not the only test of our ability to co-operate. Another is assistance to badly-hit developing countries, given that between 88m and 115m people fell back into extreme poverty last year, according to the World Bank. Still, the vaccine programme is a test of our capacity for self-interested co-operation, because the world cannot return to normal if the pandemic is not controlled everywhere.

So far, the countries with the financial resources and technological capacity have won. According to the Financial Times’s vaccine tracker, more than 178m doses have been administered worldwide so far. Some 30 per cent of them have gone to the US, 23 per cent to China, 12 per cent to the EU and 9 per cent to the UK. India has administered only half as many doses as the UK. Many developing countries have administered none.

This outcome was inevitable, whatever one’s hopes for a more co-operative world. All governments are accountable to (and responsible for) their citizens first. Equally, companies engaged in the risky venture of creating vaccines will pay most attention to the demands of those with deepest purses. Such realities cannot be ignored. But can they be transcended?

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Now that several vaccines have been developed and won regulatory approval in record time, the aim must be to vaccinate as much of the adult population as possible, as quickly as possible. Because of viral mutations, modified vaccines are already being developed, though it is not yet certain how many people will need to be revaccinated and how often.

Thus, the fight against Covid might turn out to be the beginning of a multiyear vaccination programme of unprecedented scale. Or it may be more of a one-off. If the latter, some of the new capacity may prove useful in other, future vaccination campaigns. In either case, the needed scaling up of global production capacity is complex, expensive and risky; as, too, is the scaling up of logistics and global vaccine deployment. Realistically, much of those risks and costs will have to be borne by governments, particularly those with the broadest financial shoulders.

Happily, the organisational structures for a global effort also exist. Thus, Gavi (the Global Vaccine Alliance), Cepi (the Coalition for Epidemic Preparedness Innovations) and the World Health Organization, together with other groups, have created the Act (Access to COVID-19 Tools) Accelerator, one of whose pillars is Covax, a co-operative effort to vaccinate the world.

What are the main obstacles to a global effort? From discussions with people involved, the answers seem to be chiefly the scale and complexity of the task, and shortages of money, time, organisational capacity and technical ability — particularly around the new mRNA-based vaccines. Note that not only have developing countries been pushed to the back of the queue, supplies are also constrained even for those at the front (the EU being perhaps the most prominent example.)

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Despite all these difficulties, Covax currently hopes to deliver more than 2bn doses this year. Nobody can be sure that this will actually happen, given the complexity of the effort. Even if it does, it will still leave a huge challenge for 2022, if all the world’s adults are to be vaccinated. Regulatory processes have to be managed; new production capacity has to be built; supply chains must be created; and vaccine producers need indemnification against risk. Then, the vaccines actually need to be delivered. This is a more demanding task in developing countries, especially with the new mRNA vaccines which need to be stored in ultra-cold conditions.

There are many risks and uncertainties to this vast endeavour. All of them need to be managed. That will take time, effort and money. This is even before considering the best way to finance vaccine supplies to poor countries. Should scarce development aid be used or new funds provided? Given the cost of the pandemic to their economies, the answer should be the latter. But who will provide these extra funds?

How important an impediment to rapidly increasing the vaccine supply are the intellectual property rights of companies? The answer seems to be: not much. There are well known objections to the patent system as a means of motivating innovation: it creates temporary monopolies, which are costly and can be an obstacle to innovation rather than a spur. There are good arguments for alternative methods of motivating innovation. There are also arguments for compulsory licensing and control over the price at which licensing occurs, notably when governments have funded much of the innovation.

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Yet, under current law (including trade law), intellectual property is not a binding constraint to creating, producing and deploying vaccines. After the crisis is over, it may make sense to reconsider these rules. Now is not the time.

It is hard to manage so global a challenge. But it cannot be impossible, especially as worldwide action is necessary. It is also an opportunity for Joe Biden. The new US president could reshape the world’s view of his country by galvanising G20 countries into making a decisive effort. Its leading members must provide the resources needed to accelerate the production of global vaccine supplies.

The effort only needs several tens of billions more dollars. The cost is dwarfed by the lost economic output from Covid-19, which I calculate at $6tn in 2020 and another $4.4tn in 2021, relative to the IMF’s pre-pandemic forecasts. Ending this haemorrhage of livelihoods and lives is the priority. That can only happen if all adult humans are vaccinated. The G20 must now ensure the means.

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