Tedros Adhanom on why vaccine nationalism harms efforts to halt the pandemic

This guest commentary for The Economist is part of a series on responses to the pandemic. Around 20 countries have yet to join COVAX, the global covid-19 vaccine alliance, including America, China and Russia. Read more about the economics of covid-19 vaccines here. For the rest of our coverage, visit our coronavirus hub.

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THE WORLD is suffering but rays of light are visible. Several covid-19 vaccines are in the final stages of their trials. Factories are already producing doses, in the hope that they will receive approval. There is a chance that by the end of the year, mass vaccinations could start for high-risk people. Although we absolutely must not let down our guard, it is possible to imagine the beginning of the end of the health and economic crises caused by the coronavirus.

Yet to stop the pandemic quickly and efficiently the world needs to resist “vaccine nationalism”—the desire of countries to go it alone. That approach will not end the crisis but perpetuate it. It invites the same problems that were seen at the outset of lockdowns in March, when different authorities scrambled for personal protective equipment like face-masks, gowns and sanitiser. Once new vaccines, drugs and tests become available, demand will vastly outstrip supply and things will get much worse.

A covid-19 vaccine will be a precious resource. Unless we have an international plan to manage it fairly, there will be unnecessary price spikes, with unneeded hoarding in some places and life-threatening shortages in others. That suits no one’s interests. Although governments have a responsibility to protect their own populations, in an interconnected world, the reality is that no country is safe until every country is safe. It means little if one place quells a disease if it rages nearby or is a plane ride away. Vaccine nationalism would condemn many countries to prolonged suffering, which means a slower economic recovery worldwide.

Instead, global co-ordination is essential. This will ensure that the vaccines are distributed on the basis of those who need it most. It also spreads a country’s risk, ensuring it has access to numerous vaccine candidates in case its preferred one doesn’t work. A co-operative approach is both morally right and the smart way forward. It’s more efficient, with fewer lives lost and a faster return to normal life.

The past few months have shown that the quickest way to control the pandemic and reopen economies is to start by protecting the highest-risk people, rather than the entire populations of just some countries: it stabilises health systems, ensures that essential services restart and allows for a reopening of society. Rolling out vaccines equitably to all nations, so that they can protect their at-risk populations at the same time, is the fastest way to save lives and livelihoods.

In fact, rich countries stand to benefit considerably from a global recovery. And no one nation has access to all the research and development, manufacturing and the full supply chain of essential materials and medicines. Hence, using finite supplies strategically and globally is in every country's national interest, not an act of altruism.

The good news is that 170 countries have resisted the false allure of vaccine nationalism and come together under the COVAX Global Vaccines Facility. It aims to co-ordinate access to a wide portfolio of covid-19 vaccines being developed and tested, co-led by two non-profit groups, GAVI and the Coalition for Epidemic Preparedness Innovations, along with the World Health Organisation. There are nine vaccines so far in the portfolio; including two in the final stage of trials and being manufactured. These, and other candidates that are on track to be added, give the world the best chance of finding multiple, effective vaccines.

The COVAX alliance is a groundbreaking way to pool development and procurement risks across multiple vaccines. It jointly finances research and will purchase billions of vaccines from many companies, providing a significant share of the money up front so firms can invest right away in production. This enables countries to place collective bets on all vaccines in the portfolio and scale up the manufacturing capacity so that no matter which ones are found to work, all countries in the consortium have access to them at the same time.

In the first phase of the roll-out, doses will be allocated according to population size to all participating countries at the same time, so as to protect those at greatest risk of infection and of severe disease. These include frontline health and care workers, the elderly and those people at high risk of death because of underlying conditions like heart disease and diabetes.

This is in the interests of all countries, even those that invested in pharmaceutical companies to secure access or those that pre-purchased doses. This is because COVAX provides additional insurance thanks to its broad portfolio and high likelihood of having a successful product. It also means that all countries can plan the timing and scale of vaccine distribution for an optimal global recovery. Having more than 170 countries in the programme guarantees large-scale supply and the best possible collective price—perhaps as little as a tenth of what go-it-alone countries must pay.

In the second phase of the roll-out several months later, as more doses are produced, the vaccine will go to groups less at risk of being infected or of suffering badly. The programme aims to provide at least 2bn doses by the end of 2021. Although that is not enough for everyone, it may be enough to end the acute stage of the crisis and put the world on the road to recovery.

Importantly, COVAX also co-ordinates the distribution. It has an allocation plan to see that every country gets the initial limited supply and works with manufacturers and transport firms to manage delivery. It has earmarked funds to support the logistics, which will end up requiring billions of needles and syringes, hundreds of millions of glass vials and potentially specialised “cold chain” transport. For example, the programme has access to 43,000 vaccine refrigerators that have been installed in 50 low-income countries since 2016 by GAVI.

The majority of the world has already got behind COVAX, though some countries are still deliberating whether to join and a few are contemplating going it alone. This is a critical issue, because the more countries that are involved, the more likely it is that vaccines will be rationally distributed and the more efficient the work to stamp out the pandemic. Symbolism is important, too. For example, America’s commitment to HIV/AIDS reduction in Africa over two decades did more than bring treatment: it brought hope, something the world needs now more than ever.

The whole world is watching, in the hope that undecided countries join COVAX by the September 18th deadline. Yet the initiative can still be effective even if some choose to go their own way. COVAX extends an open hand, and stands ready to find a way to welcome them into the initiative when the time is right for them. But joining now, with the rest of the world, allows each country to have access to the full portfolio and receive vaccines as soon as they are ready, at the best price. Hence it’s vital that countries step up, so COVAX can get down to work.

At a time when countries have committed to spending an estimated $10trn to ease the economic disaster, a relatively small investment of $40bn in COVAX, and a broader initiative called ACT-Accelerator, for research on mass testing, drug therapies and distribution, would send a powerful message that a common threat to humanity will be tackled in a spirit of global solidarity.

For now, the world needs to remain vigilant. Though it is possible to see an end to the crisis, it will still take a long time and hard work to reach the finish line. It is critical that individuals and countries do not let down their guard. We are still in the midst of the danger and leaders need to lead.

Ending the pandemic and restarting our economies is in our collective hands. Over the coming days, the decision that countries make about whether to share or keep an oversupply of vaccines will not only determine how fast the world comes out of the crisis, it could also be a defining moment of this new decade and set a new norm for international co-operation.

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Dr Tedros Adhanom Ghebreyesus is the Director-General of the World Health Organisation.