The global risk of “vaccine nationalism” 

A Covid-19 outbreak in one country is a threat to all. What happens if the vaccine race is every nation for itself?

Russian hackers are at it again. This time, allegedly, to steal Covid-19 vaccine and treatment research.

The United Kingdom, along with its American and Canadian counterparts, said it was “95 percent sure” that hackers tied to Russian intelligence tried to probe their drug companies and research groups. US officials told the New York Times that Russia didn’t seem to be sabotaging efforts to find a vaccine. Instead, the Russians wanted to pilfer the research, to help themselves speed up their vaccine development.

Russian officials have denied the charges. Kirill Dmitriev, chief executive officer of the Russian Direct Investment Fund, said the hacking allegations represented a smear campaign because “because the Russian vaccine could potentially be the first to the market and it could potentially be the most effective vaccine out there.”

Russia is hardly alone in wanting an effective vaccine, or wanting to be among the first to get it. This is what every country wants: a way out of the coronavirus pandemic. After months of mass-gathering bans, of masks, of lockdowns and reopenings, and lockdowns again, a vaccine feels like the only real solution.

And so the global race for a vaccine is on.

That dash is one of desperation — to reopen economies, reduce the strain on health systems, and protect citizens from illness and death. It’s also all happening in a world where multilateral institutions are increasingly politicized, public trust is thinning, and tensions are rising between the world’s two superpowers, China and the United States — which also happen to be among the likeliest candidates to get first dibs on a vaccine.

The geopolitics are deeply intertwined with this competition for a cure. This is increasing fears of “vaccine nationalism,” where the race to discover and distribute a coronavirus vaccine pits countries against each other.

Vaccine nationalism would mean each nation prioritizes its own interests, inside its own borders, rather than cooperating and fighting against a pandemic that respects neither. It’s “America First,” but everybody’s doing it — or at least the countries with the means and resources to make sure they can get the first doses.

“The problem of vaccine nationalism could be stated simply: Let’s say the United States should get the vaccine before anyone else in any other country gets any — so that would be vaccine nationalism in its full colors,” Mark L. Rosenberg, president emeritus of the international nonprofit Task Force for Global Health, told me.

There’s no guarantee that the United States will get a vaccine first, though it is investing billions in many promising candidates, in the hopes that one or more will work out. It could be China, which currently has at least four vaccines in human trials. Another leading vaccine contender, being developed by Oxford University in the United Kingdom and the British-Swedish pharmaceutical company AstraZeneca, has multiple investors.

Governments in Europe and around the world are putting money into pharmaceutical companies and other vaccine developers in the hopes of securing doses for their populations.

But not every country has the resources to make those investments, which means the rest of the world could be left on the sidelines. And that will ultimately leave the whole world vulnerable, as outbreaks — and the spread — of the coronavirus will continue. “It’s convincing people that controlling the pandemic is the goal, and not just protecting your own citizens,” said Seth Berkley, the CEO of Gavi, the Vaccine Alliance, a public–private global health partnership that works to increase access to vaccines in lower-income countries.

There are global efforts to work together on a vaccine, including through a mechanism called the COVAX Facility (more on that in a bit), which seeks to make sure front-line workers and at-risk populations in all countries, rich and poor, get access to any vaccine.

These are the realities the world is already grappling with even before a vaccine has been proven safe and effective, mass-produced, and scaled up for distribution. A lot can still go wrong, and there’s still much we don’t know: How long would a vaccine last? How many doses would it require? What would its side effects be? Who gets a vaccine first if — as is almost certainly going to be the case — there isn’t enough for everybody? Should a healthy young person in the US get the vaccine before, say, a nurse in Bangladesh?

But the rush for a vaccine continues. It’s also unfolding against a global backdrop where countries — especially the United States — may be learning the wrong lessons from the pandemic, turning inward and eschewing global cooperation even more. And this, ultimately, might make the vaccine everyone in the world wants far from the salvation it is hoped to be.

“With the pandemic disease like this, you can’t actually protect your own country’s health if you’re not protecting global health. Without everyone in the world having access to this vaccine, no country is actually safe,” Alexandra Phelan, an assistant professor and member of the Center for Global Health Science and Security at Georgetown University, told me.

“This sort of self-interested, nationalistic approach,” she added, is “limited and shortsighted.”

“Vaccine nationalism” would have been hard to avoid in any geopolitical climate

There are more than 198 coronavirus vaccines in development, according to the Covid-19 Vaccine Tracker, 19 of which are in clinical trials. The best-case estimates stay a vaccine is possible by the end of the year, or early 2021. This 12- to 18-month timeline is ambitious, easily a record.

There have been some promising results: A vaccine from Chinese researchers, and another from the University of Oxford, working with AstraZeneca, produced an immune response in patients.

On Twitter, UK Prime Minister Boris Johnson called the development “very positive news.”

“A huge well done to our brilliant, world-leading scientists & researchers at @UniofOxford,” Johnson wrote. “There are no guarantees, we’re not there yet & further trials will be necessary – but this is an important step in the right direction.”

The UK has already purchased 100 million doses of this vaccine, a kind of future bet that it will get first dibs in case this vaccine is the one, or at least one of the ones that work. The UK is also making similar bets — buying millions of vaccine doses upfront — with a bunch of other vaccine manufacturers.

So are other countries, including the United States. After the UK, America will get 300 million doses of the AstraZeneca vaccine if it proves effective, paying $1.2 billion to the company as part of its “Operation Warp Speed” to accelerate and ramp up production of any coronavirus vaccine. At least four European Union countries have also signed a deal with AstraZeneca, for 400 million doses.

This is all very nice for the countries that have billions to spend on promising vaccines. Less wealthy countries may also be able to invest, but maybe just in one or two candidates — and if those vaccines don’t pan out, well, they’re out luck. And lower-income countries will likely have to wait, relying instead on the largesse of richer countries and international organizations.

Nobody is all that surprised the world ended up here. In 2009, during the swine flu pandemic, wealthy countries, including the US, pledged to donate doses of their H1N1 vaccine to low-income and developing countries — though countries made clear that those donations wouldn’t happen until those at risk at home got covered first.

A decade later, in a pandemic that has brought economies around the world to a standstill and killed more than 645,000 people worldwide in just about six months, governments face an even greater imperative to protect their populations.

“We live in a world with concepts such as sovereignty and clear borders,” Ana Santos Rutschman, assistant professor of law at the Saint Louis University School of Law, told me. “A more nation-centered discourse is inevitable.”

On one level, this national response makes sense: Governments should be accountable to those it represents, and if they’re pouring resources (read: taxpayer dollars) into vaccine development and distribution, it follows that its residents should get priority.

But this lends itself to vaccine nationalism, because the governments with the deepest pockets are shelling out money to get as close to the front of the line as possible, and making all the necessary investments to scale up production and manufacturing once it’s ready. America’s Operation Warp Speed, for example, is investing millions to ramp up its domestic capacity to produce syringes and vials.

Current geopolitical trends, some decades old, and some a bit more recent, also make it hard to avoid vaccine nationalism. A major one is how countries view public health: “Around the turn of the millennium people began to think of public health as a security issue,” S.S. Blume, emeritus professor in science and technology at the University of Amsterdam, told me. “There was a growing sense that protecting the public the health of a nation was also protecting its security.”

This has accompanied the decline of international institutions, such as the World Health Organization, which, even before President Donald Trump threatened to withdraw from, saw some of its clout diminish, especially as other global health initiatives entered the fray, and fragmented some of the authority of the United Nations body.

These trends predate the Trump administration, and even the Xi Jinping regime in China. But Trump’s rise came alongside a resurgence of nationalism worldwide, and his “America First” approach has championed sovereignty and national borders, and hastened the assault on the post-World War II global order that the United States helped build. (Though he’s not alone.)

Add to that an increasingly tenuous tit-for-tat between two superpowers, and the race for a vaccine becomes nearly impossible to divorce from the current geopolitical climate.

The US-China rivalry is front and center in the vaccine race

Last week, the US Department of Justice indicted two Chinese hackers with ties to the Chinese government, accusing them of more than a decade’s worth of hacking of tech, educational, software, and solar companies in the United States and around the world.

But one particular charge stood out: “Most recently, they researched vulnerabilities in the networks of biotech and other firms publicly known for work on Covid-19 vaccines, treatment, and testing technology,” the indictment reads.

The hackers, according to the indictment, have a record of trying to breach many different types of companies, stealing “hundreds of millions’ dollars worth of trade secrets, intellectual property,” and other business information.

This has long been China’s modus operandi, which means it’s a bit less clear if these hackers were after Covid-19 data, or just waging a more sustained campaign of poaching trade secrets that happened to include companies working on coronavirus research.

Still, the Covid-19 hacking allegations made headlines, becoming the latest example of how the global race to find a vaccine is playing out between China and the United States. The Washington Post previously called that competition the world’s “‘Sputnik’ moment,” a reprise of the space race between the US and the Soviet Union.

But the space race didn’t cause Cold War tensions, it was a symptom of it. And the competition to discover a vaccine isn’t what’s causing the increasing tensions between China and the United States. But it is an outlet for those tensions, and one that has serious implications for the rest of the world when it comes to the delivery of a safe, viable vaccine.

“What we’re living through is just a period of really sour relations between the great powers,” Joshua Rovner, an associate professor at American University’s School of International Service, told me. “And when you’re talking about an effort to coordinate the distribution of billions of vaccinations, that can’t help.”

It would be a lot easier if the world were in a period of harmony, he added, but it isn’t. “The intelligence stories that have come out in the last few days reflect an underlying diplomatic problem.” The same goes for Russia. To the extent this tells us anything, Rovner said, it’s about how deep the level of antipathy among major countries is right now.

China and the United States, though, are at the forefront of the vaccine competition.

The United States has, by pretty much any metric, handled the pandemic poorly — from testing backlogs to the ongoing lack of personal protective equipment to the hodgepodge of policies that put a misplaced emphasis on the economy, bred public distrust, and politicized public health.

A vaccine won’t make up for the US’s inadequate response. But discovering one, and soon, could help stop the catastrophe from growing even larger. (Assuming people aren’t apprehensive about taking it, which is another issue entirely.) If a vaccine is somehow delivered as early as this fall, it could also have domestic political implications.

China, too, has a lot at stake. Beijing wants to prove its scientific prowess. Yanzhong Huang, a China expert and senior fellow for global health at the Council on Foreign Relations, told me a vaccine would allow China to “showcase comprehensive strength, including research capacity.” President Xi Jinping wants to demonstrate that the Chinese system is the most effective, Huang said. China developing the first effective vaccine would certainly help that narrative.

Beijing is also eager to counter criticism that it gravely mishandled the coronavirus outbreak early on by trying to cover it up, allowing the coronavirus to morph from a local epidemic into a global pandemic.

China, like most other countries, has seen the virus resurge at times but, for the most part, it has brought the coronavirus under control (at least based on what we know). Beijing has since tried to rewrite its own coronavirus narrative, trying to frame China as a good global health partner, delivering PPE and medical expertise to other countries struggling to contain the virus.

In May, President Xi said that any vaccine China creates will be a “global public good.” “This will be China’s contribution to ensuring vaccine accessibility and affordability in developing countries,” Xi said at a virtual meeting of the World Health Assembly.

Huang said that initially, China may have wanted to be first to get the “trophy” of a vaccine, for national pride. It has already made a vaccine available to members of China’s military, and to some employees at state-owned enterprises, though there are still questions about its efficacy. But at least rhetorically, Huang said, China is now trying “to downplay the national competition and focus more [on what] China is going to contribute.”

The United States has been a lot less direct on whether it will share its vaccine with the rest of the world. Francis Collins, the head of the National Institutes for Health, has indicated that would be the case. “We have a great deal of responsibility,” he told the AFP in May. “We, as the richest nation in the world, need not to just take care of ourselves. That would be a terrible outcome.”

That’s a bit hard to square with the Trump administration’s “America First” agenda. Trump often complains that the world is taking advantage of the US; he has eschewed global cooperation, including withdrawing the US from the World Health Organization; and, according to some reports, has tried to negotiate exclusive access to vaccine doses for the United States.

Once there is an effective coronavirus vaccine, or even a few different ones, it will be an unprecedented undertaking to distribute and administer the vaccine around the world. And even if the US and China want to provide doses to the rest of the world, the animosity between the two countries also reduces the likelihood of any real cooperation to achieve this.

The Soviet Union and the US coordinated on public health during the Cold War, including a massive effort to eradicate smallpox. But Beijing or Washington working together sounds much more like a fantasy than a realistic prospect right now. “It would be great if the US and China could get together on this and coordinate efforts, especially if they could do it through the WHO. But that’s not going to happen,” Rovner said.

A global vaccine effort isn’t just nice. It’s in everyone’s self-interest.

There is a sort of mantra among public health experts: An outbreak in one country is a threat to all countries. “As long as there’s active disease, anywhere in the world, it is everywhere in the world. I know that’s trite, but it’s true,” Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics, told me.

International travel and tourism, though mostly halted for the past few months, can never be permanently or completely shut down. Completely containing an outbreak to just one country is already difficult, even with closed borders or quarantine measures in place. But such measures aren’t sustainable for economies long-term. And once that reopening happens, the risk of an imported infection increases again.

“Frankly, commerce, trade tourism, travel is not going to resume to normal if there are massive and raging outbreaks going on all over the place,” Berkley, of Gavi, told me. As he put it: “We fundamentally believe that nobody is safe unless everybody’s safe.”

Countries narrowly focused on protecting their own interests are missing the point — and working counter to them. Looking outward is exactly what has to happen in a pandemic, and that means global coordination on developing and delivering a vaccine.

“It’s in our self-interests, our survival as communities of nation on a planet, to be sure we’re tackling this using global solutions rather than national solutions,” Jon Andrus, former deputy director for the Pan American Health Organization in charge of emergency response and preparedness, told me.

“It makes no sense to manufacture a vaccine and only use it in the United States,” said Andrus, who is now an adjunct professor of global health at the Milken Institute School of Public Health at the George Washington University. “It makes absolutely no sense, because the next pandemic when a vaccine is [in] maybe China or Europe or some other country and they beat us to the punch, do you think they’re going to share that vaccine with us?”

And a vaccine isn’t just a vaccine. It requires additional additives to preserve the dosage and to manufacture it. Depending on how it’s delivered, 300 million coronavirus vaccine doses might require 300 million glass vials and 300 million syringes, and the health care infrastructure, personnel, and equipment to administer it all.

Rich countries have more flexibility in being able to invest and ramp up production for themselves. But the vaccine supply chain is complex. Components come from all over the world and different countries may specialize in a particular stage of vaccine production. The politicization of vaccines jeopardizes the efficient logistics, too.

“A vaccine is going to trigger people looking for ways through which they can get an upper hand in negotiating power to get supplies of a vaccine, especially countries which don’t have their own candidate or their own manufacturing capacity,” Prashant Yadav, an expert on health care systems and senior fellow at the Center for Global Development, told me.

Yadav said this can create a world where, unless a country has something to offer, they’re more vulnerable when it comes to securing supplies for their own populations. During the Covid-19 emergency, where every government wants and needs to try to protect their population, Yadav said this risks fragmentation of the supply chains for vaccines and medical supplies more broadly. “[It’s] almost my nightmare scenario,” Yadav said.

So what’s the alternative to vaccine nationalism?

It’s impossible to remove nationalism completely from the equation, experts say. But the best antidote is fairly obvious: international cooperation. Many of the world’s scientists are already doing this, even if their governments aren’t.

And there are hopeful signs that governments are still willing to cooperate. One of the most prominent efforts is COVID-19 Vaccine Global Access (COVAX) Facility, which is basically a financing instrument so that all countries, rich and poor, can have equitable access to a vaccine.

The COVAX Facility is led by Gavi, a public-private partnership that leads immunization efforts in developing countries; the World Health Organization; and the Coalition for Epidemic Preparedness Innovations (CEPI), which was formed after the Ebola epidemic in West Africa. (Both CEPI and Gavi began as Gates Foundation initiatives.)

Just as countries like the US are investing in a number of vaccine candidates, the COVAX Facility does the same, but on behalf of many countries. It works a bit like this: Higher-income countries contribute to the fund, pooling their resources to invest in a bunch of vaccine candidates. Lower-income countries don’t have to contribute, but if they participate, they’d also get access.

The perk for higher-income countries is that they increase their odds of landing on a successful vaccine. While richer countries can probably make a few deals with vaccine developers, if those fail, then they’re stuck. COVAX allows them to invest in far more candidates (and in multiple countries) than they could on their own. That goal is 12 to 15 vaccines, Berkely told me, though right now there are nine in the portfolio.

The idea is that all the countries involved, no matter their income status, get the vaccine at the same time. Dr. Mariângela Simão, assistant director-general for Access to Medicines and Health Products at the World Health Organization, told me that this was critical, as one of COVAX’s goals is to avoid what happened during the swine flu pandemic, when rich countries waited to distribute a vaccine to lower-income countries — at which point the pandemic had largely faded.

Given the pervasive nature of the virus, Simão said, this was seen as a priority. “It’s everywhere,” she said. “So if you have a vaccine it should be available in all countries.”

But, of course, there won’t actually be enough to give to everyone right away, so the COVAX Facility prioritizes the vaccination of health care workers, followed by high-risk groups and individuals.

“If you could do that and vaccinate that population, you would dramatically dampen the epidemic,” Berkley said. “You also would deal with the overwhelmed health systems that we’ve seen in so many countries.”

“The decision may be to vaccinate everybody in the world,” he continued, “but you can’t do that in the first 18 months, because there will be severe supply constraints. So the question is, what’s the best way to use doses in that period? So that’s the idea.”

So far, at least 165 countries have expressed interest in joining the mechanism; including 75 countries, like the United Kingdom and Canada. Expressing interest is not committing though, and a lot can change. Right now, neither the United States nor China is on the list.

The COVAX Facility is an experiment in real-time during an unprecedented global public health crisis. “But in terms of a global effort to try to ensure an approximation of equitable access to vaccines, COVAX is it,” Faden said. “This is the game in town, right? The COVAX facility is sort of our global best bet for something approximating a just allocation of vaccines globally.”

But experts told me that countries still need to make even stronger commitments to global cooperation during the pandemic. “There needs to be a meeting, the kinds of meetings that we had at the end of World War II,” Phelan told me, “of countries coming together in a moment of global solidarity around the equitable distribution of vaccines globally.”

Why thinking about equity in vaccines matters, no matter where you live

Maybe you’re not convinced. Maybe you’re stuck at home, have been for months, terrified and out of work, unable to visit your grandparents, or your grandkids — all of the things that are making everyone desperate for a vaccine. Global equity is great and all, but why shouldn’t the United States or France or Japan or anyone else take care of its own first?

The question then becomes who, exactly, is included as “its own,” especially in a world where a vaccine will still be scarce. It may be obvious to say frontline healthcare personnel, essential workers, and high-risk individuals. But even that’s not so simple.

Think of the United States: Who qualifies as essential — is it just doctors and health care workers, or do workers in grocery stores and meatpacking plants also count? What about undocumented immigrants who may be in those frontline jobs? What about inmates in prisons and jails, which have seen some of the worst outbreaks? What about the millions of people who are uninsured?

“I think that’s a discussion that has to take place in the US, but also in Europe: So who are our own? What about your undocumented migrants?” Blume said. “There’s a kind of core of those who are clearly at the heart of any definition of ‘us.’ But there’s a big gray zone.”

Here, a different kind of nationalism kicks in, and what’s good for the country — and good for containing the pandemic — might not match up with political realities.

The equitable distribution of vaccines isn’t just among rich and poor countries, but also within nations. Equitable access will be hard to enforce, experts told me, but establishing the global ground rules, with mass buy-in, might at least make it more likely that countries adhere to these principles domestically, too.

There’s also the very real possibility that an effective vaccine may not even be developed anytime soon. Places where the coronavirus is rapidly spreading, like the United States, can’t just wait it out until there’s a vaccine.

“It’s not too late to think about the response necessary to shorten or contain this outbreak, getting back to the public health infrastructure, getting back to very basic public health practice of testing, case identification, contact tracing — just really basic procedures,” Andrus said. “It’s not rocket science. That will have an extraordinary impact.”

The race to develop a vaccine shouldn’t overshadow what has to be done now. And even once a vaccine is discovered, in record time, even countries that will get doses will have a lot to contend with: fears about safety, public distrust of health experts, costs, the scaling-up of unprecedented mass immunization programs.

“There’s a problem about the extent to which we’re saying, ‘When there’s a vaccine, we’ll all get back to normal,’” Blume said. “We won’t. We won’t in a whole lot of ways: socially, economically, psychologically. Partly because the vaccine won’t be perfect, partly because, for at least a year, there won’t be enough.”

“I mean, we will be better off when there’s a vaccine,” he added. “But it won’t be like all the problems go away.”

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