Vaccine nationalism will persist: global public goods need effective engagement of global citizens

Corruption risks in COVID-19 vaccine deployment: lessons learned for future pandemic preparedness

BACKGROUND

During the COVID-19 pandemic corruption risks were amplified in health systems globally, increasing health inequities within and between countries. During the pandemic, the deployment of COVID-19 vaccines, particularly concerning their procurement and distribution, had corruption risks given the large amounts of public and private funding allocated to them, the need for speed, the involvement of a high number of stakeholders, and often insufficient oversight. To explore this issue further, we conducted a descriptive, qualitative study of corruption risks in the COVID-19 vaccine deployment process.

METHODS

We conducted a descriptive, qualitative study triangulating two data sources between May and August 2022: (1) published academic and grey literature and (2) key informant interviews with representatives from organizations involved with the COVAX Facility, representatives from COVAX donor and recipient countries, and individuals with expert knowledge of the COVID-19 vaccine deployment process (e.g., consultants for international organizations involved in COVID-19 vaccine deployment, members of non-governmental organizations, etc.).

RESULTS

We identified 44 academic articles and policy documents and triangulated. Documentary data with 16 key informant interviews. A review of the literature identified several corruption risks in the international COVID-19 vaccine procurement and distribution process such as a lack of transparency in the vaccine procurement process; a lack of transparency in the operation of the COVAX Facility; a risk of bribery; and a risk of vaccine theft or the introduction of substandard and falsified vaccines at the point of distribution. Key informants further articulated concerns about a lack of transparency in vaccine pricing and contracts and the exclusion of civil society organizations from the vaccine deployment process. Reported anti-corruption, transparency, and accountability (ACTA) mechanisms implemented across the many levels of the vaccine procurement and distribution deployment included institutional oversight processes, blockchain-based supply-chain solutions, and civil society engagements.

CONCLUSION

Public health emergencies require nimble and quick actions on the part of governments, international organizations and other actors Our study on the COVID-19 vaccine deployment process highlights the pressing need for more robust ACTA mechanisms to reduce corruption risks and ensure fair and equitable access to lifesaving vaccines for populations.

Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models

BACKGROUND

Unequal and inequitable access to Covid-19 vaccines in low- and middle-income countries (L&MICs) was a major political, ethical and public health failure in the pandemic. However, vaccine developers' practices were not monolithic, but rather, took diverse approaches to supplying different countries, with important implications for global access.

RESULTS

Using data on R&D investments, regulatory approvals, manufacturing and purchase agreements, and vaccine deliveries, we identified six distinct innovation models that apply across the 14 COVID-19 vaccines with more international presence from 2020-2022. "Western Early Arrivers" Pfizer/BioNTech and Moderna supplied the largest volumes quickly and prioritized high-income countries (HICs) from registration to vaccine delivery. "Western Latecomers" Janssen and Novavax supplied intermediate volumes later, also prioritizing HICs but with a greater proportion to L&MICs. "Major Chinese Developers" Sinopharm and Sinovac supplied intermediate volumes early, primarily to middle-income countries (MICs). "Russian Developer" Gamaleya completed development early but ultimately supplied small volumes, primarily to middle-income countries (MICs). "Cosmopolitan Developer" Oxford/AstraZeneca supplied large volumes early to HICs and MICs at the lowest prices. Finally, "Small MIC Developers" CanSino, Bharat Biotech, Medigen, Finlay Institute and the Center for Genetic Engineering and Biotechnology (CGEB), exported relatively small volumes to a few MICs. Low-income countries (LICs) were not targeted by any developer, and received far fewer doses, later, than any other income group. Almost all developers received public funding and other forms of support, but we found little evidence that such support was leveraged to expand global access.

CONCLUSIONS

Each of the six innovation models has different implications for which countries get access to which vaccines, how quickly, and at which prices. Each offers different strengths and weaknesses for achieving equitable access. Our findings also suggest that Western firms had the greatest capacity to develop and deliver vaccines quickly during the pandemic, but such capacity is rapidly becoming more globally distributed with MICs playing a significant role, especially in supplying other MICs. Given the critical role of public support in enabling pandemic vaccine development and supply, governments have both the capacity and responsibility to craft international rules that will make responses to future pandemics more equitable and effective.

Public opinion on global COVID-19 vaccine procurement and distribution policies: A nationally representative survey in Aotearoa New Zealand 2022

The World Health Organisation and many health experts have regarded vaccine nationalism, a "my country first" approach to vaccines procurement, as a critical pandemic response failure. However, few studies have considered public opinion in this regard. This study gauged public support for vaccine nationalism and vaccine internationalism in a representative survey in New Zealand (N = 1,135). Support for vaccine internationalism (M (mean rating) = 3.64 on 5-point scales) was significantly stronger than for vaccine nationalism (M = 3.24). Additionally, support for openly sharing COVID-19 vaccine manufacturing knowledge and technology (M = 4.17 on 5-point scales) was significantly stronger than support for safeguarding vaccine manufacturers' intellectual property (M = 2.66). The public also supported a utilitarian approach that would see distributions based on need (M = 3.76 on 5-point scales) over an equal proportional international distribution (M = 3.16). Akin to the few preceding studies, the present observations suggest that the public is likely to be more supportive of pandemic responses that are globally equitable and long-term orientated. Our findings have substantial implications for pandemic preparedness as the congruence or lack thereof of public vaccine-related values with government policies can affect public trust, which, in turn, can affect public cooperation. It may pay for governments to invest in proactive public engagement efforts before and during a pandemic to discuss critical ethical issues and inequities in global vaccine procurement and distributions.

Adolescents' Opinions on COVID-19 Vaccine Hesitancy: Hints toward Enhancing Pandemic Preparedness in the Future

To understand and assess vaccine reluctance, it is necessary to evaluate people's perceptions and grasp potential reasons for generic apprehension. In our analysis, we focus on adolescents' impressions towards anti-vaxxer behavior. The aim of the study is to figure out students' opinions about vaccine reluctance, connecting possible explanations that motivate anti-vaxxer decisions with common specific personality traits. We further investigate people's forecasts concerning the evolution of the pandemic. Between 2021 and 2022, we conducted a randomized survey experiment on a sample of high school individuals (N=395) living in different Italian regions. At that time, the vaccination campaign had already been promoted for nearly one year. From the analysis, it emerges that vaccinated people (92%), especially males, tend to be more pessimistic and attribute a higher level of generic distrust in science to anti-vaxxers. The results show that family background (mother's education) represents the most influential regressor: individuals coming from less educated families are less prone to attribute generic distrust and distrust of vaccines as principal reasons for vaccine reluctance. Similarly, those who rarely use social media develop a minor tendency to believe in a generic pessimism of anti-vaxxers. However, concerning the future of the pandemic, they are less likely to be optimistic toward vaccines. Overall, our findings shed light on adolescents' perceptions regarding the factors that influence vaccine hesitancy and highlight the need for targeted communication strategies to improve vaccination rates.

Business as Usual? Centering Human Rights to Advance Global COVID-19 Vaccine Equity Through COVAX

This essay examines the extent to which COVID-19 Vaccines Global Access (COVAX) has been a successful mechanism for global COVID-19 vaccine equity as a component of the human right to health. First, I provide background on COVID-19 vaccine equity and COVAX as part of the Access to COVID-19 Tools ACT-Accelerator. Second, I situate access to COVID-19 vaccines within the context of human rights to exemplify how the international community intended COVAX to advance both health equity and the human right to health. Third, I assess how those intentions have played out in practice due to challenges of vaccine nationalism, lack of transparency, funding shortfalls, unreliable donations, inadequate civil society participation, and inequitable resource allocation. Fourth, I suggest how COVAX might function differently if human rights were centered within its purpose, strategy, and operations. Ultimately, I argue that COVAX is upholding a largely market-oriented approach to making essential medicines accessible and that COVAX would be a more effective mechanism for vaccine equity and global health if it were grounded in human rights.