Individual Scientists Share Blame in the Failure of COVAX
On why scientists should collectivize with the goal of a more equitable distribution of vaccines
Introduction/Abstract
The COVID-19 Vaccines Global Access (COVAX) initiative, directed by the Vaccine Alliance, WHO, and others, has the self-purported aim of ensuring “global equitable access to COVID-19 vaccines.”[1]
This paper aims to locate a failure point in the application of scientific research towards the development of vaccines in deployment programs like COVAX. First, the basic structure of COVAX will be explained. Next, the distribution model will be criticized on the basis of favouring high-income countries (HICs) over low-middle-income countries (LMICs). Finally, it will be argued that the individual scientist plays a role in the unjust distribution model and must take future steps to ensure global equity of vaccine distribution given the refusal of individual (HIC) governments and corporations.[2]
The COVAX System and Criticisms
COVAX funding consisted in self-funding from individual states, as well as donations to a greater pool called the Advance Market Commitment (AMC).[3] Such funding was then distributed to multiple vaccine candidates, thereby increasing the chances at successful and rapid vaccine development. The COVAX system is deployed in two phases: phase one distributes vaccines to meet 20% of each country’s population; phase two then distributes vaccines based on need.[4] The deployment model has been severely criticized on the grounds that it results in a less-than-equitable distribution of vaccines.
First, high-income countries (HICs) were able to pay inordinate amounts of money directly to corporations to put themselves to the front of the queue while simultaneously participating in the COVAX program.[5] Thus, for example, Canada was granted 1.6 million doses at a time when it had a far greater vaccination rate (from funding companies directly) than any other low/middle-income country (LMIC).[6] Second, these HICs were provided an late-option to pay extra to be given priority access to selection: they would be able to select which of the successful vaccines they want.[7] These are both clear forms of ‘vaccine nationalism,’ whereby “developed countries prioritize conducting their own bilateral agreements with pharmaceutical companies over the multilateral procurement system”[8] or are given privileged spots in the COVAX system.
It is also worth emphasizing that the inclusion of phase one clearly favours HICs who have healthcare infrastructure and funds to create these bilateral agreements.[9] It is worth seriously asking why these countries should have vaccines supplied by COVAX given the poor healthcare infrastructure that exists in most LMICs. Such countries must have priority access to vaccines that do not require such infrastructure, such as the Oxford-AstraZeneca vaccine that only must be stored between 2 to 8° C[10]; yet, the opposite is true given the selection advantage to HICs. Phase two should be the only phase: distribution based upon need.[11]
Space constraints prevent through-going discussion of the ethical justification for ‘vaccine nationalism’. However, it is taken for granted in this paper that such an attitude is unethical.[12] The biggest challenge to any needs-based ethical proposal against vaccine nationalism is that it ignores realpolitik. As the WHO’s chief scientist Soumya Swaminathan states: “There’s a big, big risk that if you propose a very idealistic model, you may be left with nothing.”[13] Political reality entails that those working on COVAX have very little leverage: they require funding by HICs or else the project will be failure for everyone involved, including LMICs. As such, they are seemingly forced to compensate and entice HICs by providing them advantages over LMICs.[14] Who, then, can force the hand of corporations and states to partake in multilateral (rather than bilateral) agreement such as COVAX, and to participate in deployment based on need? It will be suggested that individual scientists may be able to play a role.
The Scientist as Political Actor
How can the individual scientist play a role in fixing this failure? It is obvious that the state-corporate relationship makes any individual action largely fruitless. A single scientist leaving one major research lab will not make any significant difference. However, if large groups of scientists were to recognize the clear moral injustices associated with the worldwide COVID-19 vaccine deployment, then a mass movement may provide pressure for individual governments to focus on collaborate vaccine programs, rather than the ‘highest-bidder’ model associated with vaccine nationalism.
Such mass-action is not without precedent—the American Association for the Advancement of Science (AAAS) and Union for Concerned Scientists helped prompt a mass strike at over 30 universities in 1969, most prominently MIT, that led to a halting of all research and development until the universities ceased collaboration with the Department of Defense.[15] Similarly, they were able to help lead the effort towards nuclear disarmament, part of a larger antinuclear protest that effectively ended the exponential growth of the nuclear arms race.[16]
It was a refusal to partake in the production of materials and technology that were not utilized in a just or ethical way that led to these collections of scientists striking. This is what is occurring now globally.[17] Hundreds of thousands more will lose their lives as a result of vaccine nationalism, as HICs oversupply on vaccines or give shots to individuals who need them far less than those at risk in poorer countries.[18],[19] Setting aside the greater loss of life, there is the fact that distribution is not fair and not equitable under the COVAX system—one individual has a higher likelihood of survival based on the arbitrary factor of where they were born.[20]
This paper is suggesting that scientists partake in similar actions, whether as part of organizations such as the AAAS or Union for Concerned Scientists, or as a coordinated effort by individuals in both public and private institutions. Threats of mass-strike will necessarily force governments and corporations to negotiate given both the political and economic fallout of delays in vaccine development. As the generators of research and the foundation of new technological development, scientists have moral responsibilities and power that they must utilize to make the world a more just place.
Final Note
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[1] “COVAX,” World Health Organization, accessed January 24, 2021, https://www.who.int/initiatives/act-accelerator/covax.
[2] This is an unorthodox solution to the problem but the author fails to see little else given the threat of vaccine nationalism as will be argued. It is hoped individual scientists can, just as they have historically, find solidarity in fighting for the good.
[3] Ann Danaiya Usher, “A Beautiful Idea: How COVAX Has Fallen Short,” The Lancet 397, no. 10292 (June 2021): 2322.
[4] Siddhanth Sharma, Nisrine Kawa, and Apoorva Gomber, “WHO’s Allocation Framework for COVAX: Is It Fair?” Journal of Medical Ethics (2021): 1.
[5] Ibid.
[6] Ibid., 2324.
[7] Ann Danaiya Usher, “A Beautiful Idea: How COVAX Has Fallen Short,” The Lancet 397, no. 10292 (June 2021): 2322.
[8] Mark Eccleston‐Turner & Harry Upton “International Collaboration to Ensure Equitable Access to Vaccines for COVID‐19: The ACT‐Accelerator and the COVAX Facility,” The Milbank Quarterly 99, no. 2 (June 2021): 437.
[9] Jean-Louis Excler, Lois Privor-Dumm, and Jerome H Kim, “Supply and Delivery of Vaccines for Global Health,” Current Opinion in Immunology 71 (2021): 19-20.
[10] Abu Baker Sheikh, Suman Pal, Nismat Javed, and Rahul Shekhar, “COVID-19 Vaccination in Developing Nations: Challenges and Opportunities for Innovation,” Infectious Disease Reports 13, no. 2 (May 14, 2021): 431.
[11] This is just what is argued for in: Ezekiel J Emanuel, Govind Persad, Adam Kern, Allen Buchanan, Cecile Fabre, Daniel Halliday, Joseph Heath, et al., “An Ethical Framework for Global Vaccine Allocation The Fair Priority Model Offers a Practical Way to Fulfill Pledges to Distribute Vaccines Fairly and Equitably,” Science (American Association for the Advancement of Science) 369, no. 6509 (2020): 1309–12.
[12] In brief, the argument might go as follows: Why does one person within an artificial set of borders have a greater moral right to life-saving medicine than another? Such justifications are always grounded in some feature that is not intrinsically valuable, whether that be nationality, ethnicity, cultural standards, etc. Thus, all human beings hold equal moral worth (all individual things considered) and deployment should be based on need.
[13] Siddhanth Sharma, Nisrine Kawa, and Apoorva Gomber, “WHO’s Allocation Framework for COVAX: Is It Fair?” Journal of Medical Ethics (2021): 3.
[14] Hence the selection option, self-funding option, and the existence of phase one rather than a needs-based distribution model.
[15] Jonathan A. King, and Aron Bernstein, “Mobilize for Peace,” Science 363, no. 6430 (2019): 907.
[16] Ibid; Paul Rubinson. “The Global Effects of Nuclear Winter: Science and Antinuclear Protest in the United States and the Soviet Union during the 1980s,” Cold War History 14, no. 1 (2014): 47.
[17] Though the stakes are obviously different: nuclear winter is not the same thing as hundreds of thousands of deaths.
[18] Annabelle Timsit, “How many Covid vaccines go to waste?” Quartz, May 28, 2021, https://qz.com/2013918/some-countries-are-wasting-more-covid-19-vaccines-than-others/.
[19] Abu Bakarr Rogers, Mohamed Bailor Barrie, Mosoka P. Fallah, and J. Daniel Kelly, “Equitable and Feasible Distribution of SARS-CoV-2 Vaccines for All in Africa,” American Journal of Tropical Medicine and Hygiene (2021): 2. doi:10.4269/ajtmh.21-0264.
[20] Ibid., 1.