Vaccine diplomacy

The COVID-19 crisis has forcefully revived the field of vaccine diplomacy by re-opening the debate on how to ensure affordable and equitable access to vaccines of global public interest.

At the time of publication of this guide and as vaccines begin to be rolled-out, significant gaps exist between countries in the level of access to vaccines, diagnostics and essential supplies. It is antic- ipated that most upper-income countries will see coronavirus vaccines widely available between September 2021 and March 2022, large middle-income countries and emerging economies – be- tween September 2021 and summer of 2022; a number of other middle-income countries in 2022 and low-income countries between spring of 2022 and 2023.

Vaccine diplomacy refers to all aspects of global health diplomacy pertaining to the development, manufacture and delivery of vaccines as public health goods. Among the key features of vaccine diplomacy are its potential as a humanitarian intervention and its proven role in helping to mediate the cessation of hostilities and ceasefires during vaccination campaigns.

Modern vaccine diplomacy starts with the creation of Gavi, the Vaccine Alliance in 2000 after it was recognized in the late 1990s that coverage of the six basic vaccines under the WHO Expanded Programme on Immunization had been stagnating or declining, and that other vaccines, including new potentially life-saving ones, were too expensive for developing countries.

The Gavi Alliance was established to bring UN agencies, governments, the vaccine industry and other branches of the private sector, and civil society together with a view to improving childhood

immunization coverage in poor countries and providing future purchase guarantees for new vac- cines. By 2018, Gavi-funded programmes had reached over 700 million children. Many countries gained access to vaccines against rotavirus and Haemophilus influenzae type B. The Gavi Alliance also facilitated the development of a new vaccine against Streptococcus pneumoniae.

The outbreaks of SARS, H1N1 influenza, Ebola, MERS and Zika, along with the growing problem of antimicrobial resistance, have made the production, financing and availability of adequate and ef- fective vaccines an even more sensitive political issue. Geopolitical and national interests have hampered negotiations on vaccination. A “securitization” of the public health agenda made itself felt in these negotiations, as did lobbying by health and pharmaceutical industries. Increasing in- sistence on national sovereignty has slowed down global talks. Notably, during the long process of the WHO-convened Intergovernmental Meeting on Pandemic Influenza Preparedness: Sharing of Influenza Viruses and Access to Vaccines and Other Benefits (2007–2010), Member States failed to come to an understanding for years because they could not agree on the assets to be provided to developing countries. Indonesia, for example, was reluctant to share viral sequences. A compro- mise was eventually reached whereby pharmaceutical manufacturers were no longer permitted to access data on and samples of circulating viral strains for the development of influenza vaccines unless they committed to benefit-sharing arrangements, including the provision of a certain per- centage of influenza vaccines at heavily discounted prices. Other benefits included such measures as technology transfers and improved access to diagnostic reagents and influenza test kits – re- sources that many low-income countries had previously been struggling to obtain.

The COVID-19 pandemic has abruptly brought back the question of how a vaccine – if an effective one can ultimately be developed – will reach everyone who needs it.

Political and global leaders have called for a COVID-19 vaccine to be treated as a global public good that should be available to all.²³ The full potential of vaccines cannot be realized if national interests and economic power determine who gets access, instead of basic principles of fairness and ensur- ing that allocation will optimize their public health impact. Nevertheless, rich countries have rushed to place advance orders in order to ensure vaccine access for their citizens, since it is expected that supply will be limited. This raises important questions concerning vaccine access for people in de- veloping countries, particularly in middle-income countries that are not eligible for support from the Gavi Alliance or other international aid mechanisms.

The task of addressing the key questions of how to develop effective global cooperation and who should be given priority access has been pushed aside by the current disarray of multilateral health governance and by the nationalistic and free-market-driven, competitive approaches taken by some countries.

On the other hand, there are several vaccine diplomacy initiatives that point in the right direction.

The alliance between several EU countries for pooled advanced purchase of vaccines, for example, requires the pharmaceutical companies with which the EU contracts to make a portion of vaccine supplies available to low-income countries. The COVAX Facility – which brings together WHO, the Gavi Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and industry – allows the participating countries to pool their resources so that they can back the development of a larger number of candidate vaccines than any single country could do on its own. This initiative further uses “push” investments in manufacturing facilities and “pull” mechanisms (advance purchase commitments) to encourage manufacturers to invest in scaling up vaccine production and help share the risks. If a vaccine is successful, doses as they become available will be distributed equi- tably through the COVAX Facility between self-financing countries (there are currently 75), which will pay for their doses, and developing countries (currently 90) that would otherwise be unable to afford the vaccine.

Massive resources have been channelled into R&D work on a COVID-19 vaccine. Ensuring equitable access to such a vaccine will require strong global governance and the use of vaccine diplomacy.

23 UNAIDS. Uniting behind a people’s vaccine against COVID-19. Geneva: Joint United Nations Programme on HIV/AIDS; 14 May 2020 (https://www.unaids.org/en/resources/presscentre/featurestories/2020/may/20200514_covid19-vaccine-open-letter, accessed 16 November 2020).