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An International Journal for Research, Policy and Practice
Volume 16, 2021 - Issue 3
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Articles

COVID-19 vaccines and treatments nationalism: Challenges for low-income countries and the attainment of the SDGs

Godwell Nhamoa Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South AfricaCorrespondencenhamog@unisa.ac.za
ORCID Iconhttps://orcid.org/0000-0001-5465-2168
ORCID Icon,
David Chikodzia Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South Africa
,
Hlengiwe Precious Kuneneb Junior Researcher: Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South AfricaORCID Iconhttps://orcid.org/0000-0002-1410-8376
ORCID Icon &
Nthivhiseni Mashulab Junior Researcher: Exxaro Chair in Business and Climate Change, Institute for Corporate Citizenship, Unisa, South Africa
Pages 319-339
Received 08 Aug 2020
Accepted 26 Nov 2020
Published online: 15 Dec 2020

Articles

COVID-19 vaccines and treatments nationalism: Challenges for low-income countries and the attainment of the SDGs

ABSTRACT

ABSTRACT

The 2030 Agenda for Sustainable Development (AfSD) has the vision to leave no one behind, particularly low-income countries. Yet COVID-19 seems to have brought up new rules and approaches. Through document and critical discourse analysis, it emerges that there has been a surge in COVID-19 vaccines and treatments nationalism. Global solidarity is threatened, with the USA, United Kingdom, European Union and Japan having secured 1.3 billion doses of potential vaccines as of August 2020. Vaccines ran out even before their approval with three candidates from Pfizer-BioNTech, Moderna and AstraZeneca having shown good Phase III results in November 2020. Rich countries have gone years ahead in advance vaccines and treatments purchases. This is a testimony that the 2030 AfSD, especially SDG 3 focusing on health will be difficult to achieve. Low-income countries are left gasping for survival as the COVID-19 pandemic relegates them further into extreme poverty and deeper inequality. The paper recommends the continued mobilisation by the World Health Organisation and other key stakeholders in supporting the GAVI vaccine alliance and the Coalition for Epidemic Preparedness Innovations (COVAX) global vaccines initiative that seeks to make two billion vaccine doses available to 92 low and middle-income countries by December 2021.

Introduction

Given the focus of this paper, and the philosophy of ‘leaving no one behind’ as embedded in the 2030 AfSD (Feeny, 2020), it is inevitable that the entry point highlights key provisions from the third Sustainable Development Goal (SDG 3). This SDG focuses on ensuring healthy lives, as well as promoting wellbeing for all (United Nations, 2015) and is a harmonisation and merging of several health Millennium Development Goals (MDGs) that were in place from the year 2000–2015 (Feeny, 2020). With the risk of COVID-19 infections still a major threat globally, and just three vaccines requiring two doses per person having just shown promising Phase III results in Novembers 2020, governments and global leaders remained worried. Drastic non-pharmaceutical strategies to deal with the pandemic (flattening the curve) that included hard lockdowns, staying at home, working-from-home, isolations and quarantines, have added to the great depression (Hein & Paschke, 2020). This is likely to collapse many health care systems that were already stressed in developing countries, derailing plans to attain universal health by 2030 (Lone & Ahmad, 2020). The United Nations and global leaders committed to 13 targets under SDG3. Those that directly address the focus of this paper are included in Box 1.

Box 1. SDG 3 targets of relevance to the COVID-19 pandemic

  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

  • Target 3b: Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries; provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all.

  • Target 3c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and Small Island Developing States (SIDS).

  • Target 3d: Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.

Source: Authors, based on United Nations (2015, pp. 16–17)

As this paper was being finalised, on the 27th November 2020 the John Hopkins University reported about 61.15 million global confirmed cases of COVID-19 (John Hopkins University, 2020). In addition, about 1.435 million deaths had been reported globally, with numbers still rising! Although there is a general agreement that ‘COVID-19 does not discriminate … knows no racial, ethnic, gender, or national borders’ (Ho & Dascalu, 2020, p. 65), its impacts are not evenly spread across races, and later, countries and geographical regions. The levels of vulnerability differ depending on the speed at which countries react, financial availability, technical and social safety nets, and other resources. In 2014, the cost of attaining the SDGs (before COVID-19) was estimated by the United Nations Conference on Trade and Development to range between US$3.3 and US$4.5 trillion annually for developing countries. This left a funding gap of approximately US$2.5 trillion (Feeny, 2020). Therefore, low-income nations are likely to suffer the most from COVID-19 as such resources are not readily available.

Access to health care remains a critical pillar in dealing with the COVID-19 pandemic (Ho & Dascalu, 2020). Already, low-income countries have suffered from a secondary shortage of already approved drugs for malaria such as hydroxychloroquine and chloroquine that were, at one point, thought to be effective in treating COVID-19. The World Health Organisation (WHO) estimated that up to 769,000 people in sub-Saharan Africa (SSA) could succumb to malaria as a result of the shortage, thus, double the number estimated under normal supplies of the drugs. The USA, France, Italy and Israel all granted emergency approvals for use of these drugs for COVID-19 use and clinical trials as appropriate. The USA later revoked the approval on 15 June 2020 (USA Food and Drug Administration, 2020), yet it had stockpiled about 29 million doses of hydroxychloroquine, with Australia reported to having bought 30 million doses (Ho & Dascalu, 2020).

Concerning matters on fair and equitable access to COVID-19 treatments and vaccines, the Nuffield Council on Bioethics (2020) is of the view that several factors need to be addressed upfront. These include research funding and priorities, the distribution of burdens and benefits, commercial confidentiality, patents and licensing, pricing, manufacturing and distribution infrastructure, limited supplies and purchasing monopolies, public trust, and distributive justice. One issue that needs to be highlighted herein is the challenge that developing countries have faced in procuring supplies even where budgets were available. Brazil and South Africa, for example, had to wait up to two months to procure chemical reagents crucial for testing for COVID-19. Wealthier countries had already purchased these supplies blocking out months of production for their benefit. Furthermore, the prohibitive prices of personal protective equipment (PPE) and testing kits meant many developing nations could not afford them, reducing them to relying on well-wishers to come by with donations.

Given the foregoing, this paper raises the question: What is the nature and extent of COVID-19 vaccines and treatments nationalism? Which countries are driving the agenda and which countries could be left behind? Furthermore, the following two research objectives are spelt out: (1) to determine the nature and extent of COVID-19 vaccines and treatments nationalism document countries driving the COVID-19 vaccines and treatment agenda, and (2) to document efforts being made by the World Health Organisation (WHO) and partners to promote the Gavi COVAX global vaccines initiative promoting access by low-income countries. It is anticipated that this work will assist in reminding the world that there is an agenda on the table to 2030 and a global legacy of inequality that should be eliminated in light of COVID-19.

A literature survey

Since the outbreak of the novel coronavirus in December 2019, which was ultimately named SARS-CoV-2 (COVID-19) and declared a pandemic on 11 March 2020 by the WHO (Lone & Ahmad, 2020), there has been visible growth in new nationalism and protectionism across the world (Bieber, 2020). This subject, as it pertains to pandemics and other natural hazards, however, has received limited attention in the literature, with national political pressure and opposition fuelling the nationalism agenda (Heisbourg, 2020). Zarhloule (2020) sees the new emphasis on nationalism as a genuine pathway to fight COVID-19 and mobilise domestic resources to fight the pandemic. However, when things are ramped up to the extent of having China accusing USA soldiers of importing COVID-19 to China (Heisbourg, 2020), and the USA government labelling COVID-19 as the Chinese virus (Bieber, 2020) and seeking to buy vaccines and treatments exclusively for the USA, this becomes a worrisome development (Dyer, 2020). Yet the weaknesses in health systems from countries from the global south – including weak health systems, vulnerable economies, and extreme inequalities that threaten the livelihoods, peace and stability – are well known (Hein & Paschke, 2020). Ultimately, stopping the spread of COVID-19 and facilitating rapid global economic recovery rests upon ‘the development of, and universal access to, effective drugs and vaccines’ that must be considered as global public goods (Hein & Paschke, 2020, p. 1). The growing COVID-19 vaccines and treatments regionalism and nationalism favour the SDGs set-up, which Nhamo et al. (2020) highlight as having been agreed on because it presented a leeway for protecting national interests and manipulation from stronger nations.

The United Nations Secretary-General, António Guterres, gave a sobering assessment regarding the state of nationalism, regionalism and the United Nations in the era of COVID-19 during his virtual Nelson Mandela Annual Lecture held on 18 July 2020. In the speech, Guterres highlighted that Nelson Mandela spent 27 years ‘fighting the inequality that has reached crisis proportions around the world in recent decades – and that poses a growing threat to our future’, yet ‘COVID-19 is shining a spotlight on this injustice’ (Guterres, 2020 online). To this end, layers of inequality in the global economy that required urgent attention before they destroy societies were put under the ‘COVID-19 X-ray’. Nothing could be hidden. COVID-19 re-ignited fault lines in global solidarity and laid in the open past centuries of inadequate health systems, huge gaps in social protection, as well as systematic and structural inequalities. As such, many regions and countries that had registered significant progress in eradicating extreme poverty under the MDGs era were taken back many, many years in just a few months and rebuilding will not be easy. Given that the least developed and vulnerable economies will be most affected, and in the context of the Black Lives Matter (BLM) global movement following George Floyd’s brutal murder at the hands of police in the USA (Sobo et al., 2020; Bhala et al., 2020), one can safely indicate that the lives in developing countries matter (LDCM) under COVID-19. Guterres (2020), views the BLM movement as an additional genuine sign that people are tyred and have had enough of oppression and inequality, including Africa’s under-representation in international institutions such as the Bretton Woods and the United Nations Security Council. This is why as authors we believe LDCM.

While acknowledging the fact that the world was facing the deepest recession since World War II, and the widest collapse in incomes since 1870, Guterres (2020) estimated that more than 100 million people were likely to be pushed into extreme poverty. This kind of insight remain relevant to contextualise the ills of COVID-19 nationalism and regionalism, as the majority of the poor will not be from the rich nations. From Guterres’ perspective, COVID-19 exposed many falsehoods everywhere, including: ‘The lie that free markets can deliver healthcare for all; The fiction that unpaid care work is not work; The delusion that we live in a post-racist world; The myth that we are all in the same boat. … The 26 richest people in the world hold as much wealth as half the global population’ (Guterres, 2020 online). Thirty-four times, the United Nations Chief mentions ‘inequality’ (SDG 10) in his speech. He goes further, reminding the world that the vision and promise of the United Nations is that, among others, basic needs and human rights matters, healthcare (SDG 3), food (SDG 2), water and sanitation (SDG 6), education (SDG 8) and decent work (SDG 8) should not be commodities for sale to those who can afford such or, in our view as authors, go to the highest bidder.

Guterres further presented what he thought would be an amicable way of resolving the inequality impulse in addressing COVID-19 between the developed global north, and the battling and underdeveloped global south. He proposed a ‘New Social Contract and a New Global Deal that create equal opportunities for all, and respect the rights and freedoms of all’ (Guterres, 2020 online). From his view, this will be the only way for the world to attain the targets under SDG 3 and many other targets from the 2030 AfSD. The global political system was put under the spotlight for its failure to deliver critical public goods like public health. Hence, COVID-19 ‘brought home the tragic disconnect between self-interest and the common interest; and the huge gaps in governance structures and ethical frameworks’ between and among nations (Guterres, 2020 online). The proposed New Global Deal would focus on the redistribution of power, opportunities and wealth. Without such, the evidence presented by fragmented global responses to the COVID-19 pandemic would be even more in the future. Indeed, there are huge gaps in COVID-19 solidarity (Ho & Dascalu, 2020) and there is no doubt that the development of COVID-19 vaccines will be expensive. Yamey et al. (2020) refer to the Coalition for Epidemic Preparedness Innovations (CEPI) putting up a figure of at least US$2 billion to develop only three vaccines for a period of a year to a year and a half.

Bollyky et al. (2020) observe that the worry regarding rich nations hoarding and/or purchasing all available pandemic vaccines is not new. The authors recall that during the 2009 influenza A(H1N1) pandemic, all vaccines on the market were sold out, having been channelled to wealthy nations. This went against the advice and appeal from the WHO for donations and ring-fencing of some supplies for low-income countries. However, the tug-of-war between the WHO and its members over the unfair distribution of benefits over pandemics vaccines and therapeutic has a long history. Australia is reported to have delayed the export of the H1N1 vaccine to other countries before its domestic needs were met (Ho & Dascalu, 2020) and it was the first country to have such capacity (Khamsi, 2020). Canada and the USA completely withheld the vaccine for domestic use, allowing developing countries to suffer. In earlier instances, in 2007, Indonesia withheld influenza A(H5N1) virus samples from WHO, indicating its worry over the benefits that were likely to leave others behind as the benefits would not be fairly shared. This resulted in the 2011 WHO Pandemic Influenza Preparedness (PIP) Framework, including a clause granting researchers access to biological samples in exchange for financial or in-kind donation of products (Bollyky et al., 2020). The key challenge is that most countries have laws in place enforcing companies to manufacture and prioritise domestic consumption. Furthermore, there is no global entity with the responsibility to order the production of vaccines on a global scale and pay for it.

There are also existing bottlenecks in life-saving supplies for COVID-19 such as PPE and ventilators. For example, there have been restrictions on the export of these from European and some rich Asian countries (Bollyky et al., 2020). Up to 50 countries were known to have imposed these restrictions (Nuffield Council on Bioethics, 2020). The Asian Development Bank (ADB) identifies a high geographical and regional concentration in the PPE supply chain. There are three regional clusters, namely: Asia, Europe and the USA (ADB, 2020). The main producing countries are China, Germany and the USA. However, China is central in exports to Asia and the entire world. China is strong in producing masks, gowns, protective suits and goggles, with Malaysia being a top exporter of surgical gloves globally, followed by Thailand and China. From Europe, Belgium, France, Germany, Italy, the Netherlands, and Poland are major suppliers of PPE. The USA is also a major importer of PPE from China and gloves from Malaysia. The next section draws the readers’ attention to the materials and methods used.

Materials and methods

To address the objectives highlighted earlier, the work utilised the qualitative approach in data gathering (Wood et al., 2020) as this came across as the most appropriate. The main methods included document and critical discourse analysis (Linton et al., 2019) and elements of event study (Bimha & Nhamo, 2017). The events that were tracked included key announcements from global institutions such as the John Hopkins University, which provides daily data on COVID-19 cases in terms of infections, deaths and recoveries, as well as vaccines and treatments development from key pharmaceutical companies, philanthropic organisations and the WHO. Policy announcements and documents from main proponents of COVID-19 nationalism and regionalism, as well as the United Nations, particularly the 2030 AfSD and its intertwined 17 SDGs, the Secretary-General’s Annual Nelson Mandela Public Lecture of 18 July 2020, were also retrieved for analysis. The announcements of COVID-19 vaccines and treatments advance contracts and their values were also traced.

Following some preliminary analysis of proclamations and announcements by political heads and their country positions on COVID-19 vaccines and treatments procurements and distribution, a picture was emerging that resulted in the authors classifying certain countries based on their WHO-driven GAVI COVAX vaccine global access facility orientation and support. Initially, the GAVI COVAX vaccine global access facility identified 92 low-income countries (herein referred to as the G92) to benefit from subsidised vaccines (Figure 1). To this end, it became inevitable that the researchers determine the extent of COVID-19 vaccines and treatment nationalism and regionalism drawing from the G20, which included the European Union 27 and some Nordic countries through an evaluation matrix that included investments aspects such as: forward vaccines and treatments orders, public proclamations, financial and other in-kind donations and/or support, and the nature of commitment to the COVAX facility. Three nationalism categories emerged as follows: (1) Strong (Limited COVAX Support), (2) Moderate (Meaningful COVAX Support), and (3) Weak (Full COVAX Support). Needless to indicate that many countries both within and outside the G92 remain at the mercy of two global and most powerful opposing forces of the USA and China.

Figure 1. G92 identified for COVAX vaccine global access facility. Source: Authors, Data from GAVI (2020a)

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In addition, recent academic and other authentic literature was retrieved. This included drawing from writing on the BLM movement as this had relevance in terms of documenting inequalities being experienced from the distribution of COVID-19 PPE and life-saving ventilators. The BLM movement also remained relevant to the ongoing fights on vaccines and treatment development and financing, and forward contracts from affording countries leading to the exclusion of low-income countries in the race. The analysis teased out why none of the Chinese COVID-19 vaccine candidate developers that were at advanced stages, such as CanSino Biologicals and Shenzhen Geno-Immune Medical Institute, did not make it to the USA sponsored list. It further sought to understand the visible breakdown in the BRICS (Brazil, Russia, India, China and South Africa) political and trading block that many expect to stand firm against possible COVID-19 vaccines and treatment injustices from the global north. The next section is dedicated to presenting the research findings and discussing them.

Presentation and discussion of findings

This part comes in five sub-sections. The first and second sub-sections present some updates on COVID-19 treatments and vaccines. The third sub-section is dedicated to addressing matters pertaining to the huge sums of money being poured into COVID-19 vaccines and treatments development and advance purchase. The fourth sub-section focuses on the rise of COVID-19 vaccines and treatments nationalism and regionalism, with the last sub-section addressing global cooperation towards universal COVID-19 vaccines and treatments access and equity through the GAVI COVAX facility.

COVID-19 treatments: an overview

After COVID-19 was declared a pandemic (Vanden, 2020), researches around the world kicked into action to try and get either a cure or vaccine as soon as practical. However, Hill et al. (2020) see COVID-19 treatment only likely to be available globally by late 2021. With this rush, the WHO director-general proposed and coordinated the four COVID-19 treatment strategy (Sayburn, 2020) that witnessed treatment trials to determine which treatment would be effective among: (1) the novel drug remdesivir that was developed by Gilead in response to Ebola, (2) lopinavir and ritonavir, some antiretroviral drugs used against HIV/AIDS, (3) lopinavir and ritonavir, in combination with the immune system regulator, interferon β, and (4) the antimalarial drug chloroquine. Combinations of different therapies were also put on the table and these included: lopinavir and ritonavir, lopinavir/ritonavir plus arbidol, as well as ribavirin and interferon. The use of anti-inflammatory drugs such as glucocorticoids, 1L-6antagonist, Janus kinase inhibitors, and chloroquine/hydroxychloroquine were also thrown into the hat. Table 1 shows the summary of drugs and/or treatments registered for clinical trials against SARS-CoV-2.

Table 1. The summary of drugs/treatments registered for clinical trials against SARS-CoV-2.

On 22 October 2020, the USA Food Drug Administration (FDA) announced that it had approved the antiviral drug, Veklury (remdesivir) as the inaugural drug for COVID-19 treatment (FDA, 2020). The drug was to be used in adult and pediatric patients that were 12 years and older. Earlier, the FDA had granted emergency use authorisation to a few including in vitro diagnostic products, high complexity-based laboratory developed tests, SARS-CoV-2 antibody tests, PPE and related medical devices, ventilators and other medical devices and drug products (Yosra et al., 2020). Remdesivir was also the first drug that received emergency authorisation from the FDA in April 2020 as it was among the promising treatments for COVID-19. Two clinical trials had been initiated in China and clinical trials were registered at Capital Medical University to test if the remdesivir is safe and effective (Eastman et al., 2020). Lopinavir and ritonavir is the other drugs combination that was approved by the FDA, as well as hydroxychloroquine (Lythgoe & Middleton, 2020). Following the move by the FDA, there was a shortage of this drug for the treatment of other diseases. The drug was later retracted as it was found to be harmful and the FDA revoked its emergency approval because it was found to have negative side effects on the human heart (Vanden, 2020).

COVID-19 vaccines pipeline

As of 15 July 2020, a total of 24 COVID-19 candidate vaccines were undergoing human testing (clinical evaluation) and were at different phases of clinical trials, while 140 candidate vaccines were in pre-clinical evaluation (WHO, 2020a). Of the active clinical vaccine candidates, 12 (52%) were led by public entities such as research institutes and academic institutions with the remaining 11 (48%) being led and developed by private or industry developers. Along with a suite of institutions, vaccination platforms such as mRNA have been utilised to treat past coronavirus pandemics. The mRNA is said to instruct human cells to build a wall of protein to trigger an immune response to COVID-19 (Pardi et al., 2018). Findings from Herper and Garde (2020) support further development of this vaccine as it has reported no side effects. Other platforms include DNA vaccines where protein, as a foreign cell, is introduced into the body to increase immunity against the pathogen (Callaway, 2020). Some biotech companies such as Inovio pharmaceuticals have opted to use nanoparticles (virus-like particles) to deliver proteins into the immune system, which can then fight the virus. Live attenuated, inactivated viruses, recombinant protein, peptide and viral vectors are among other approaches in exploration (WHO, 2020a). Table 2 presents the COVID-19 vaccines research and development pipeline.

Table 2. COVID-19 vaccines pipeline.

The results also depict that although leading clinical trials for COVID-19 vaccine candidates are distributed across the world, most COVID-19 vaccine development activity is concentrated in Asia, with 12 (52%) vaccine development programmes, followed by Europe (17%) and North America with four programmes each (17%). According to Mullard (2020), the first vaccine was developed by the USA company called Moderna and was funded by the US National Institutes of Health (NIH). Given the urgency of the pandemic, Moderna could skip the animal testing step and head straight for clinical trials. Australia with two (9%) through the partnership between Clover Biopharmaceuticals and GlaxoSmithKline, and financial assistance from CEPI. Russia currently has one active programme, which accounts for 4%. Additional vaccine development efforts have been reported for Africa and Latin America. South Africa was also involved with the first COVID-19 Phase III vaccine trial in Africa developed by Oxford University/AstraZeneca. The vaccine being used in South Africa is the same as that being explored in the UK and Brazil.

Wong and Qui (2018) state that it is essential for vaccine studies to be performed in both developed and developing countries, concurrently. This allows evaluation of the effectiveness and safety of candidate vaccines to be evaluated globally, failing which the introduction of certain vaccines into immunisation programmes for developing countries frequently lags behind developed countries. This is clearly shown by the geographical distribution of COVID-19 vaccine development activity that is almost non-existent in developing countries. As this is the case, should the COVID-19 vaccine becomes available, developing countries are likely to face a host of challenges in accessing it, which could have further devastating human and economic impacts. Experience with past pandemics has indicated the risk of hoarding, in the sense of vaccine doses being nationalised and secured before being developed by wealthier countries, which could jeopardise equitable distribution. During the 2009 swine flu pandemic, this was the case when developed countries made the vaccine available only after being satisfied they had enough vaccine to meet their own needs (Enserink, 2009).

Branswell (2020) extends that conventional vaccine developments undergo various stages and have typically taken 12 or more months in the past. Hence, finding one for COVID-19 soon is unlikely. Even if one or more vaccine candidates prove to be effective, the chances are that no single manufacturer will be able to supply the vaccine doses needed globally, at least to start with. Another issue is that even if several manufactures are lucky enough to find the COVID-19 vaccine, prices could be higher, leading to market competition. This could inevitably drive the prices up, putting the COVID-19 vaccine further beyond reach for developing countries, whose economies are already strained. Besides, vaccine progress regarding other threatening diseases such as tuberculosis and HIV/AIDS in developing countries has been stalling. Roughly 15 years ago, investments were made to develop vaccines for HIV/AIDS and malaria; to date, none of the potential vaccines has reached the final stage of human testing. This then means that despite the rush, countries could still end up without any COVID-19 vaccine soon. As such, instead of waiting for the vaccine from some manufactures, investments should be directed to the scaling-up of manufacturing facilities.

As this paper was being finalised, efficacy results from Phase III trials by Pfizer and partner BioNTech, Moderna and AstraZeneca all came out positive between 9 and 23 November 2020. Effectiveness of the vaccines against COVID-19 ranged from an average of 70% to 94.5% (Palca, 2020a, 2020b). However, this breakthroughs did not come cheap, which is a focus of the next section.

Huge sums of money poured into vaccines development

Vaccine development does not come cheap. To this end Veugelers and Zachmann (2020) present typical costs of developing a vaccine. The process will require about £2.5 million for Clinical Trial Phase I, £20 million for Clinical Trial Phase II, £65-250 million for Clinical Trial Phase III and £20 million for Phase IV that focus on assessment for regulatory approval. Under normal circumstances, this will also take a period of more or less eight years. The USA is by far the biggest spender on COVID-19 vaccine and treatments. For example, the country purchased the entire supply of remdesivir on 5 July 2020 (Lexchin, 2020). The cost of the drug was going to be US$390 per vial in the USA, a figure that would amount to US$2,340 per five-day treatment course. However, it was estimated that remdesivir could be made for under US$1 a dose, compared to what Gilead, the USA-based company holding the patents was charging. Therefore, at US$2,340 per five-day treatment course (well beyond rich to developing nations), Gilead could earn more than US$2 billion in the first year the drug goes on sale. The Trump Administration’s advance purchases and agreements with COVID-19 vaccine candidate companies are shown in Figure 2.

Figure 2. USA COVID-19 vaccine candidates advance purchases (as of 26 July 2020). Source: Authors, based on Ben-Achour (2020), Bloomberg (2020); Roubein, (2020), Aljazeera (2020)

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The USA has been on the COVID-19 vaccines rush. It invested US$1 billion in a vaccine being developed by the Oxford University in partnership with AstraZeneca (Kelly, 2020) and provided advance funding for Janssen (US$600 million) and Novavax (US$1.6 billion) (Ben-Achour, 2020). The funding for Novavax means the USA government has ownership over the first batch of 100 million doses of any vaccine that comes out that will be administered for ‘free’. By 26 July 2020, Moderna Inc. had received an advance payment of US$1.427 billion to develop and test its COVID-19 vaccine – mRNA-1273 (Roubein, 2020). In addition, Dyer (2020) reveals that the USA President Donald Trump secretly approached the German company, CureVac, with a forward contract offer worth US$1 billion and luring the company to the USA. If this had gone through, the promising COVID-19 vaccine would be have been exclusively for the USA and its citizens. This led to Germany’s economy minister, Peter Altmaier reportedly indicating that the company had made a good decision as Germany is not for sale (Dyer, 2020). This resulted in the European Union announcing US$87.8 million to support CureVac’s scaling up of the development and production of a COVID-19 vaccine for Europe. However, the USA quest to get more vaccines from Germany did not stop. On 22 July 2020, the Trump Administration announced a deal to pay Pfizer and BioNTech SE, a Germany company, US$1.95 billion for 100 million doses of COVID-19 vaccine candidates to be delivered in December 2020 from the companies if successful (Aljazeera, 2020). The USA could also procure further 500 million doses under the same agreement. However, China was not to be outdone as it announced a US$1 billion COVID-19 vaccines loan facility for Latin America and the Caribbean (LAC) on 23 July 2020 (Suarez, 2020). Coupled with the announcement was the emphasis that the Chinese vaccines would be for the public benefit of universal access.

At an estimated 50 million vaccines in 2021 at US$50 per dose, Moderna could earn an estimated US$2 billion in 2021 and US$5 billion over a few years (Manfredi, 2020). Johnson & Johnson announced a US$1 billion partnership with the USA government’s Biomedical Advanced Research and Development Authority to develop a vaccine based on an engineered version of an adenovirus (Khamsi, 2020). The agreement could witness up to one billion doses produced some that could later find their way onto the global market. What emerges is that the USA has a huge stake in the vaccine development programme. The estimated cost per dose could be in the region US$10.

Kelly (2020) reports that the European Commission indicated it would make advance payments to six providers of COVID-19 vaccines from its €2.7 billion Emergency Support Instrument (ESI). At the time of the plan, the ESI had only released €320 million for other uses. This would increase the chances of securing rapid access to a vaccine for the region. Advance payments would allow manufacturers to build production capacity in Europe. The move followed the realisation that the demand for would-be vaccines had grown intense, and the region did not wish to be left behind. A European Commission approach would also bring combined purchasing power and avoid access to COVID-19 vaccines from the 27 members. The plan was also quickly devised following a small grouping on Inclusive Vaccine Alliance between France, Germany, Italy and the Netherlands that also wanted to ensure that COVID-19 vaccines were manufactured in Europe (Usher, 2020).

As indicated earlier, the CEPI estimated that US$2 billion was needed to develop candidate vaccines and produce such for trials (Khamsi, 2020). Selected governments promised up to US$690 million for the venture. An additional US$1 billion would be needed to produce and distribute a COVID-19 vaccine for the whole wold world. Other ideas emerging focused on assisting low-income countries is for donors to sell bonds to investors, an approach that was successful to finance children vaccines produced by GAVI. The International Finance Facility for Immunisation (IFFIm) was used as an investment vehicle.

The rise of COVID-19 vaccines and treatments nationalism

Signs of the rise of COVID-19 vaccines and treatments nationalism emerged with the tensions between the USA and partners on one hand, and China and partners on the other. Allegations of China hiding information on the origin and dates of the coronavirus outbreak were raised sharply by the USA (Mahase, 2020), with the WHO leadership drawn into the saga. The USA eventually withheld up to US$400 million of its contributions to the WHO as punishment for bad WHO leadership and alignment with China and went further to withdraw its membership from the organisation. To move quickly towards hoarding COVID-19 vaccines, in February 2020, the USA entered into an investment agreement with Sanofi to secure preferential and priority access to a future vaccine (Hein & Paschke, 2020). On the other hand, the United Kingdom joined the USA in giving GBP65 million and US$1 billion respectively to the Oxford University vaccine programme. This agreement had the same preferential treatment to the two countries in terms of vaccine access. Following this agreement, AstraZeneca, the company that will commercialise the Oxford vaccine entered into multiple bi- and multilateral agreements with several other countries for the future vaccine. The agreements included the formation of the European Inclusive Vaccines Alliance. Most worrying was the fact that the USA went further to procure all the world’s remdesivir stock, a drug that has been proved to be effective in reducing COVID-19 mortality (Khamsi, 2020). In a show of COVID-19 vaccines regionalism, on 21 July 2020 the European Union agreed on a record COVID-19 stimulus package of US$857 billion made up of grants and loans (The New York Times, 2020). As of 2 August 2020, the USA, European Union, United Kingdom and Japan had secured an estimated 1.3 billion does of potential COVID-19 vaccine doses (Paton, 2020). Further details regarding the nationalism agenda as drawn from the categories identified in the methodology are reflected in Figure 3. It is important to note that there are several countries with both a strong national and COVAX focus and this places such in the moderate nationalism category.

Figure 3. Emerging COVID-19 vaccines nationalism and COVAX support map. Source: Authors, based on GAVI (2020a, 2020b); Ben-Achour (2020); Bloomberg (2020); Aljezeera (2020)

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Jefferys (2020) notes the USA government’s Operation Warp Speed (OWS) as one of the fundamental pillars of COVID-19 vaccines and treatments nationalism platforms. Cohen (2020) recognises OWS as President Donald Trump’s America-first push for COVID-19 vaccine development and this initiative came into the public domain on 29 April 2020 through a Bloomberg posting. With the government pouring seemingly unlimited financial and other resources into OWS, the government initially aimed to have 300 million doses of any proven vaccine by January 2021 reserved for the American people. The first doses of the 300 million were planned for delivery in November 2020. The hopes for a vaccine were raised by an unprecedented 110 different COVID-19 vaccines that were under development then, with eight candidates leading as they had entered small trials in human populations. Of these eight, four were from Chinese companies. However, OWS narrowed its range for potential sponsorship on 14 non-Chinese vaccine candidates, possibly triggering a COVID-19 vaccine cold war and nationalism. Jefferys (2020) is of the opinion that the exclusion of Chinese vaccine candidates did not have a scientific rationale. From the outset it appears as if OWS’ purpose was solely to serve the USA. The key player in the OWS is the NIH-initiated Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) programme. Both the OWS and ACTIV programmes are public-private partnerships. Box 2 presents some of the favoured OWS COVID-19 vaccine candidates. What is evident from OWS is that the USA government decided to go it alone, removing itself from any association with WHO efforts.

Box 2. OWS COVID-19 vaccine candidates

  1. Moderna’s mRNA candidate

  2. University of Oxford/AstraZeneca AZD122 chimpanzee adenovirus vector

  3. Pfizer’s mRNA candidate that was in phase I/II trials. However, the programme was not accepting government funding

  4. Johnson & Johnson’s human adenovirus serotype 26 (Ad26) vector that was due to enter trials in July 2020.

  5. Merck, which is pursuing a recombinant vesicular stomatitis virus (rVSV) vector in collaboration with IAVI and an attenuated measles virus vector.

  6. Novavax’s recombinant protein vaccine.

Source: Authors, based on Jefferys (2020, p. 8)

Box 3. CEPI-supported COVID-19 candidate vaccine

  1. Inovio, United States of America (Phase I/II)

  2. Moderna, United States of America (Phase III)

  3. CureVac, Germany (Phase I)

  4. Institut Pasteur/Merck/Themis, France/ United States of America /Austria (Preclinical)

  5. AstraZeneca/University of Oxford, United Kingdom of Great Britain and Northern Ireland (Phase III)

  6. University of Hong Kong, China (Preclinical)

  7. Novavax, United States of America (Phase I/II)

  8. Clover Biopharmaceuticals, China (Phase I)

  9. University of Queensland/CSL, Australia (Phase I)

Source: Authors, based on WHO (2020b)

The USA is not alone in the COVID-19 vaccines nationalisation. On 20 July 2020, eNCA (2020) reported that the UK secured 90 million doses of two vaccine candidates from an alliance of Pfizer Inc and BioNTech, as well as French group Valneva. An additional 40 million doses would be acquired should the vaccine work. Earlier, the UK secured 100 million doses of AstraZeneca’s vaccine, bring the UK deals to a total of 230 million doses as of 26 July 2020. To build manufacturing capacity in the UK, the government was financing site sin Essex and Oxfordshire to operate in 2021 to the tune of £100 million (Partridge, 2020). These were in addition to a state-of-the-art manufacturing centre near Oxford worth £93 million. All these forward purchase contracts push low-income countries’ potential vaccine supplies down the line in the supply chain.

There were also signs of nationalism support from some pharmaceutical companies. For example, in March 2020, Gilead Sciences applied for ‘orphan drug’ designation in the USA, and this was followed in April 2020 by Sanofi proclaiming that the USA had ‘rights to the largest pre-order of a vaccine’ (Hein & Paschke, 2020). The worry grew louder, with AstraZeneca announcing priority access to vaccines for both the USA and UK in May 2020, with Gilead Sciences also proclaiming deals with generic companies to manufacture and distribute remdesivir. However, most of the supply from July to September was for the USA market. This is a three-month block sale of the drug to a single country. Civil society also kicked into action, with 62 European organisations calling on governments and reminding them that the COVID-19 investments had to be for the people in May 2020. There were also 250 organisations that raised a letter on COVID-19 Principles for Global Action, Innovation and Cooperation. Civil society further raised concerns on access to COVID-19 vaccines and treatments that was published by the European Alliance for Responsible R&D and Affordable Medicines. Furthermore, an open letter was drafted by the Médecins Sans Frontières/Doctors Without Borders (MSF) and other to FAVI before their board meeting raising access issues (MSF, 2020). The African Union issued a strongly worded statement demanding the ‘urgent need for countries to make full use of legal and policy measures, including flexibilities enshrined under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Doha Declaration, south-south and north–south collaboration to ensure monopolies do not stand in the way of access to COVID-19 vaccines’ (Jefferys, 2020). The quotation herein is an extract from SDG3 Target 3b (United Nations, 2015).

Christensen (2020) presents the COVID-19 relationship between the USA and China as a modern tragedy between the two countries and also the world at large. The author believes the initial responses to the COVID-19 pandemic from both ends led to mismanagement from both ends of the Pacific Ocean. There has been so much finger-pointing, while the pandemic continues to ravage the world. Yet, the two global powerhouses are supposed to show global leadership. To this end, Christensen calls for a ceasefire between Beijing and Washington, an element he believes will bring the needed collaboration and effort to address the challenge at hand. In this regard, there are six areas where the global powerhouses could work together to do more for the global good in addressing COVID-19. These areas are: (1) share good practices to stem the further spread of the coronavirus; (2) develop effective vaccines at the earliest possible date; (3) advance preparation for mass production and distribution of anticipated vaccines across the world; (4) assist the most vulnerable nations and territories in fighting the pandemic; (5) manage debt crises and combat famines in developing countries that would have emerged from COVID-19 and; (6) preserve global trade by privileging diversification of supply chains and national strategic reserves over economic nationalism and less efficient forms of production.

Apart from inequalities between continents, regions and countries, Ali et al. (2020) identify three groups of people that are disproportionately suffering from the COVID-19 pandemic namely: ethnic minorities, the socio-economically disadvantaged and the elderly. This resulted in the authors recommending that when a vaccine is found, these vulnerable groups, in addition to essential service workers, should be prioritised. When we raise the arguments to the global north and south, then there are many more individuals and countries in the southern hemisphere that require the need to be prioritised if vaccines are found. This argument should be adequate to erase the boundaries of COVID-19 vaccines and treatments nationalism that are being raised now. As Bishop and Roberts (2020, p. 20) sum it up,

In the 1990s, many countries around the world celebrated the increased connectivity and prosperity that came with globalisation. … [H]owever, with the COVID-19 pandemic, some commentators are now predicting the end of globalisation given that border walls are going up, trade restrictions are being imposed and international institutions have been side-lined.

As such, Bishop and Roberts (2020) are of the view that a long-term geopolitical lesson out of COVID-19 is that nationalism and supra-nationalism must not win. Other countries should facilitate international cooperation where greater powers like the USA fail to lead – the concept of ‘middle-power leadership’. In addition, nationalism, must be separated from dealing with COVID-19 domestically; a good example is drawn from such countries as Singapore, South Korea, Germany, New Zealand and Australia. Hence, these and other countries with similar capacity must rise to rebuild international trust and work towards a common COVID-19 global good.

Global cooperation towards universally accessible vaccines and treatments

Although there are raging COVID-19 vaccines, treatments and other contestations, there are pockets of goodwill emerging. The CEPI established a COVID Vaccines Development Taskforce in February 2020 (Hein & Paschke, 2020). The CEPI was founded in Davos in 2017 by the governments of India and Norway, the Bill & Melinda Gates Foundation, the Wellcome Trust, the World Economic Forum, and the World Bank. CEPI has identified nine COVID-19 candidate vaccine to support (Box 3).

In addition, the WHO initiated the Solidarity Clinical Trial for COVID-19 treatments, which involved over 100 member countries. The countries were to compare four treatment options, namely: remdesivir; lopinavir/ritonavir combined; lopinavir/ritonavir combined with interferon-beta; and hydroxychloroquine (or chloroquine) code-named ACT Accelerator. The ACT Accelerator brought together most stakeholders in the field of vaccine development and finance including CEPI, GAVI (the Vaccine Alliance, which is a public–private non-profit organisation based in Geneva), the Global Fund, Unitaid, and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). This move was coupled with the recognition that lessons from the HIV/AIDS medicines meant that the COVID-19 vaccines and medicines needed to be inclusive. From ACT Accelerator, the WHO aims to buy two billion doses of COVID-19 vaccines for global populations at the highest risk in partnership with CEPI, GAVI and the Vaccine Alliance (Jefferys, 2020).

Since the launch of COVAX in June 2020 with 92 low-income countries initially identified to benefit from subsidised vaccines, the WHO has successfully mobilised high-income countries to commit to support COVAX (Figure 4), including China. China only came on board in October 2020 (GAVI, 2020a).

Figure 4. COVAX global access facility country support growth 2020. Source: Authors, Data from GAVI (2020a)

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There were also a number of collective actions launched surrounding COVID-19 vaccines and treatments. In February 2020, the World Bank formed the COVID-19 Vaccine Development Taskforce. In April 2002, the G20 came up with a COVID-19 Action Plan, with the United Nations General Assembly passing resolution 74/274 on International Cooperation to Ensure Access to COVID-19 Technologies (Hein & Paschke, 2020). The WHO also launched the COVID-19 Supply Chain Taskforce. Furthermore, the EU and other countries raised EUR7.4 billion in a COVID-19 Global Response Initiative in May 2020. In June 2020, several countries joined the solidarity call for action, with EUR13.95 billion raised during two donor-pledging conferences. The emerging picture of global COVAX support from country commitments and interest as of 9 October 2020 is shown in Figure 5. However, two major countries were still not signed up to COVAX, namely, USA and Russia. On the other side, South Africa and India put across a proposal to the World Trade Organisation to relax intellectual property rules and agreements for COVID-19 vaccines and treatments to allow quicker access by nations (Methri, 2020). The proposal has gained traction and is being supported by the WHO.

Figure 5. Global COVAX support picture as of 9 October 2020. Source: Authors, Data from GAVI (2020a)

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Worried over the rise of populism, Bollyky et al. (2020) reveal their dissatisfaction with governments that have resisted multilateral institutions such as the WHO and international agreements that include the SDGs. To this end, the authors present a COVID-19 vaccines and treatments inclusive access and distribution framework. The framework includes having any government hoping to be involved to be flexible and trusted by the international community. It also involves having adequate and predictable global financing, as well as engaging on open collaboration and evidence-based, health-driven allocation of vaccines and therapeutics. The WHO should play a central role in the planning and coordination of this framework. Ho and Dascalu (2020) are also of the view that the globally coordinated effort on vaccines and treatments development and distribution must be based on the principle of solidarity. Such an approach will enhance equity in health care systems across countries as it has the potential to harmonise national, regional and international responses.

The MSF is also concerned about COVID-19 global vaccines access and has raised a positon document in June 2020. In the document, there are several key considerations raised for GAVI’s new global financing mechanism (MSF, 2020). A total of US$8.8 billion was raised for GAVI’s next five-year cycle during the donor meeting of 4 June 2020 (Usher, 2020). However, this amount was not exclusively for COVID-19 vaccines development, but rather other vaccines GAVI works on. Concerning the COVID-19 vaccines, the MSF (2020) wanted GAVI to negotiate an ‘at cost’ price, ensure equitable distribution, and safeguard affordable access long term by overcoming intellectual property barriers. GAVI should also not undermine existing functional procurement mechanisms, including humanitarian community and NGOs as eligible purchasers, be transparent, and lastly, include developing nations and civil society organisations in the process.

A welcome development from the 4 June 2020 meeting is that donors launched the GAVI Covax Advance Market Commitment (AMC) aimed at subsidising COVID-19 vaccines for lower-income countries (Usher, 2020), with US$500,000 committed. Through AMC, the COVID-19 vaccines would be manufactured and distributed as per the need, rather than who is able to pay. To this end, GAVI initially needed US$2 billion to manufacture the first 20 million doses. For adequate supplies of vaccines to be produced, an estimated US$74 billion is needed according to initial work by the Bill & Melinda Gates Foundation. Although GAVI has experience from similar 2008 arrangements for pneumococcal vaccines, the MSF (2020) is of the view that the AMC has flaws, with pharmaceutical companies demanding a relatively high price for the vaccine. Hence, continued and open debate was necessary (Usher, 2020). As of 8 October 2020, COVAX had received donations amounting to US$1.8 billion of the US$2 billion goal (GAVI, 2020b). Some of the big donors (US$10 million and above) are shown in Figure 6 and their total stood at US$1.73 billion of the US$1.8 billion realised commitments. The other donations came from Bhutan, Colombia, Greece, Iceland, Monaco, Netherlands, New Zealand, Gamers Without Borders, Mastercard, Transferwise and Soccer Aid. Team Europe, comprising the European Commission and European Investment Bank (EIB) also committed US$480 in guarantees.

Figure 6. Donations and pledges to COVAX (as of 8 October 2020). Source: Authors, Data from GAVI (2020b).

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Additional worries are emerging as the ramped-up manufacturing of new COVID-19 vaccines and treatments could lead to shortages in other vaccines. Key traditional vaccines are manufactured for influenza, measles, mumps and rubella, and other diseases (Khamsi, 2020). GAVI’s AMC has led to main donors including Italy, the UK, Norway, Canada, and the Bill & Melinda Gates Foundation shifting their share of US$177.5 million from the pneumococcal fund to the GAVI COVAX AMC (Usher, 2020). However, the Gates Foundation added US$100 million in fresh funding. Saudi Arabia, Germany and a few other nations pledged US$289.5 million, bringing the total to US$567 million. A total of 300 million doses will now be manufactured on a no-profit deal and were secured from AstraZeneca (Ibid.). Furthermore, the seemingly visible gap in COVID-19 vaccines and treatments cooperation between the BRICS adds to the layers of worries for people of the global south. While China has reached out to Brazil for trials of its Sinovac vaccine (Reuters, 2020), India and Russia seem to be doing their own thing, with border tensions and trade uneasiness high between China and India (He, 2020). South Africa has entered into an agreement for clinical tests of the AstraZeneca vaccine (Madhi, 2020).

While world leaders pledged US$8 billion for COVID-19 vaccines (Stevis-Gridneff & Jakes, 2020), it is evident that the USA decided to go it alone. On 4 May 2020, the European Union organised a teleconference to raise funds for COVID-19 vaccines. An estimated US$8 billion in pledges was raised. The biggest contributors were the European Union and Norway that each pledged US$1.1 billion. The Bill & Melinda Gates Foundation pledged US$100 million to buy vaccines exclusively for low-income countries. Other contributions were from Romania and Canada that chipped in with US$200,000 and US$850 million respectively. Some names that were also mentioned without amounts included Japan, Australia, a Prince and Madonna.

The Global Citizen (2020) partnered with the European Commission in a new campaign called ‘Global Goal: Unite for Our Future’. The campaign hosted its conference on 27 June 2020. The campaign focuses on ensuring that COVID-19 tests, treatments and vaccines are available to everyone. There was also a need to work towards minimising the impacts of COVID-19 on the most vulnerable, as well as address the root causes of extreme poverty that include hunger, gender inequality, and other aspects. The Global Goal campaign is a collaboration between Global Citizen, the European Commission, Bloomberg Philanthropies, Bill & Melinda Gates Foundation, and the Wellcome Trust. Some world leaders that lifted their hands to join the campaign include those from France, South Africa, Germany, Norway, Canada, Italy, Spain, the United Kingdom, Austria, Belgium, United Arab Emirates, Mexico, Saudi Arabia, Morocco, and New Zealand. The funds will go to eight organisations that include Therapeutics Accelerator, CEPI, GAVI, Foundation for Innovative New Diagnostics (FIND), Global Fund, WHO’s COVID-19 Solidarity Response Fund the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID, and the Global Citizen’s International and Regional Response, Relief and Resilience Network. Following the 27 June conference, a total of US$6.9 billion was raised (US$1.5 billion in cash grants and US$5.4 billion in loans and guarantees). The US$5.4 loans and guarantees were from the European Commission and the European Investment Bank. The initiative will result in 250 million COVID-19 vaccines available for poorest countries and other relief measures.

As identified by GAVI (2020c), developing countries also possess the capacity to manufacture and regulate frameworks needed for vaccine development. However, Branswell (2020) anticipates the backlog, which can be caused by inaccurately estimating the health impact in developing countries with weak disease monitoring infrastructure. This cannot be disassociated with the costs of enacting vaccine manufacturing facilities as these are very high. Besides, the delay could do more damage, costing lives and prolonging economic misery. In this case, developing countries just like developed countries need to backup and invest in their research institutions for large-scale vaccine manufacturing and for spurring research on the current and even future pandemics. Some vaccine developers (the likes of the Beijing Institute of Biological Products & Sinopharm) are at the forefront in leading the programme; they have merged with other institutions to maximise capacity and scale-up production for when demand strikes. This will not only ensure enough doses to go around, but can also support the development of various additional vaccine candidates, should one fail. Otherwise, another approach could be that of doing away with the selfish behaviour, and exercise fair allocation of the vaccine on the basis of countries identifying the population that is more at risk or needs the vaccine the most, such as the healthcare workers. This could allow time for all the health care systems to ease and open up. Lastly, in a move to galvanise the global push for universal COVID-19 vaccines and treatments access, eight presidents and/or prime ministers from Canada, Ethiopia, South Korea, New Zealand, South Africa (also current Chair of the African Union), Spain, Sweden and Tunisia signed an open letter featured in the Washington Post in July 2020 calling for global solidarity (Businesstech, 2020).

Conclusion

Having emphasised the challenges coming out of the new COVID-19 nationalism and regionalism agenda, the pandemic also presents opportunities for the long-planned universal access to treatments and vaccines as outlined in SDG3. Hence, we must learn from this crisis. What is needed is to have willing political systems and leadership, particularly from the rich nations of the global north. Making COVID-19 a proxy to fight perpetual trade, WHO leadership and other wars by China on one hand, and the USA on the other, will not be helpful. The advance contracts in vaccine and treatments purchases and hoarding by rich nations should be revisited, with the view to have more countries fully supporting the COVAX. As this paper was being finalised in October 2020, the WHO reported strong movement towards COVAX, having 183 countries aligning to it, including China. However, having all these countries and territories involved in COVAX may not necessarily guarantee full support from each one of them.

Drawing from the 2030 AfSD motor to ‘Leave no one behind’, more big pharmaceutical companies need to buy into the COVAX initiative. From the procurement and distribution of COVID-19 PPE and ventilators, to the outlook of possible vaccines and treatments, low-income countries and territories have been left behind. It is also necessary to highlight that methods of administering and storing the vaccine may need refrigeration. Hence, vaccines mat take even longer to reach the most remote parts in developing countries. There may also be a risk of contamination due to poor storage. To this end, the ideal vaccine candidate for the global south could be one that does not need special refrigeration and is administered as droplets in the mouth. Additional concerns are that the global south may further be left behind due to lack of capacity to store and even administer the drug if available.

Should the preaching on true corporate citizenship been heard, the world waits to be proven wrong through reduced and not-for-profit/at cost manufacturing and equitable global distribution of the COVID-19 vaccines and treatments. Ultimately, the world will be shooting itself in the foot should the interests of capitalists and nationalists prevail. This is not the time to decide who gets the COVID-19 vaccines and treatments bids first, and/or who pleases their shareholders the most. It is human lives at stake. More noise and action on the promotion of universal access to all upcoming COVID-19 vaccines and treatments must be heard, and those that oppose such should be held accountable. The right to health is slowly, but surely disappearing. What pain and loss of innocent lives, yet these also matter! The conclusion of the whole matter is that no one is safe from the risk of COVID-19 until every global citizen is covered.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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