Since the global coronavirus pandemic, vaccines have been the direction of common expectations and efforts of all countries.
The rapid emergence of the coronavirus vaccine is due to multilateral mechanisms, and the rational distribution of the coronavirus vaccine is also inseparable from multilateralism.
The coronavirus vaccine cannot be separated from multilateral mechanisms.
The coronavirus vaccine can break through the conventional timeline of vaccine research and development, complete three phases of clinical trials in less than one year and get approved, and put them into use immediately.
Relevant research and development institutions and scientists have made great contributions. The World Health Organization’s blueprint for pandemic prevention research and development program also plays an accelerator role as the Coronavirus Vaccine Implementation Plan (COVAX).
After the Ebola pandemic in West Africa in 2014, at the request of Member States, WHO developed a blueprint plan for pandemic prevention research and development, developed a road map for research and development for important pathogens of concern, and coordinated stakeholders in clinical trials and product development.
The plan specifically lists the disease “X”, which represents an unknown pathogen that may cause a pandemic and the disease it causes.
After the outbreak of COVID-19, WHO quickly convened a meeting on the R&D blueprint plan to identify key issues in vaccine research and development and discuss how to strengthen information sharing and fund key research projects.
These basic work, together with the information on the genome sequence of the novel coronavirus shared by China on January 12, 2020, laid the foundation for the development of a global coronavirus vaccine.
According to the World Health Organization, there are more than 169 candidate coronavirus vaccines under development worldwide, which can be said to be “blooming”.
Because the vaccination population must reach a considerable size to achieve the effect of “herd immunity”, the global demand for vaccines is very large.
However, vaccine research and development and production costs are very high, but the pricing should be moderate to facilitate promotion, so the profit margin is very low.
Vaccine manufacturers often lack sufficient motivation to expand production, and it is more risky to start production at the same time as clinical trials.
To this end, WHO launched the COVAX program in April 2020 in conjunction with the Global Alliance for Vaccines and Immunization (GAVI) and the Alliance for Innovation in Epidemiology Prevention (CEPI).
One of its aims is to invest in vaccine research and development projects that are most promising to succeed, encourage them to complete clinical trials, and Support the establishment of production lines with a view to starting production as soon as possible.
Moderna vaccine and AstraZeneca vaccine, which are leading in research and development, are supported by CEPI funds.
Therefore, the rapid emergence of the coronavirus vaccine cannot be separated from the strong support of multilateral mechanisms.
Although the winner of the competition deserves flowers and applause, the people who help people win the competition should also be hidden behind the scenes.
Nationalism aggravates the battle for vaccines
In addition to ensuring that the international community has access to available vaccines as soon as possible, another purpose of the COVAX mechanism is to promote the equitable international distribution of COVID-19 vaccines.
If each country fights separately and purchases vaccines separately through market mechanisms, except for a few countries that can sign pre-order agreements with manufacturers to achieve self-sufficiency with strong economic strength, most countries will have difficulty in obtaining vaccines.
“Vaccine nationalism” that puts self-interest first is not only morally unacceptable, but also an inefficient pandemic prevention behavior.
A study shows that if two-thirds of the world’s first 3 billion coronavirus vaccines are occupied by developed countries, the number of deaths caused by the pandemic will be twice as much as the average distribution of vaccines among countries.
WHO Director-General Tedros Tedros has been calling on countries to resist the temptation of “vaccine nationalism” on vaccine allocation, because it is “only beneficial to the virus”.
COVAX seeks to establish a global procurement mechanism to solve this problem.
That is, using the huge market size of countries in the future as a leverage, sign a “low-cost group purchase” agreement with manufacturers who have successfully developed vaccines, promising to join the countries and economies to obtain vaccines in a fair manner.
Under the arrangement, low- and middle-income countries that meet the conditions can obtain the COVID-19 vaccine free of charge, while the remaining countries that join on a self-financing basis have signed a legally binding agreement with COVAX to obtain eligibility for future purchase of vaccines at a lower price on the basis of “advance payment”.
COVAX can offer a combination of multiple effective vaccines compared to bilateral pre-order agreements that “bet” specific vaccines (any vaccine development risks failure).
Therefore, for many developed countries, this multilateral mechanism actually plays the role of double insurance.
For countries that have not signed pre-purchase agreements, especially low- and middle-income countries, this is the only way to obtain vaccines in the future.
From the perspective of system design, the COVAX mechanism is beneficial to all parties involved: vaccine manufacturers have obtained market guarantees and profit margins, countries have access to vaccines, and the overall governance efficiency of the international community has been improved.
It is based on the idea of win-win cooperation that COVAX has received wide support. Since its launch in April 2020, 187 economies have joined the mechanism.
After the COVID-19 vaccine was successively approved by the United Kingdom and the United States, Pfizer also completed negotiations with COVAX and joined the supplier.
However, for the system to function smoothly in the future, some key issues need to be solved.
The first is the issue of fund-raising.
In order to provide vaccines to at least 20% of the population in various countries, especially to solve the problem of vaccine access in low- and middle-income countries, it is estimated that WHO will need an additional $23.9 billion in the pool in 2021.
Although non-governmental organizations such as the Gates Foundation can provide some funds, the role and role of the state are still irreplaceable.
Against the backdrop of the pandemic hitting the global economy, whether to sweep the snow in front of the door or to find a way out from a global perspective will test the wisdom of world leaders.
Second, the decision-making process of COVAX mechanism is not transparent.
If global vaccine production capacity cannot be rapidly improved in the short term and the vaccine available is limited, how will COVAX allocate resources? How to make scientific decisions when the pandemic figures in most countries are not very accurate? How to avoid interference from political factors? These questions still need to be answered.
Third, it is difficult for the COVAX mechanism to put an end to the practice of “vaccine nationalism”.
Regardless of whether the United States has not joined COVAX, even some developed members who joined the mechanism have recently intensified the battle for vaccines, and the number of pre-orders far exceeds the needs of citizens.
This may slow down the speed of access to vaccines by international procurement mechanisms and reduce the number of vaccines available, thus weakening the practical effect of multilateral cooperation.
Obviously, increasing the availability of vaccines is an important way to effectively hedge “vaccine nationalism” and hoarding behaviors, and also helps to alleviate the trend of politicization of vaccine distribution.
As early as the 2020 World Health Assembly, Chinese leaders solemnly promised that the coronavirus vaccine developed by China would be an international public product.
By expanding production capacity and transferring international technology to increase the supply of vaccines, China will directly benefit the people of developing countries and make an important contribution to multilateralism.
Global immunization still needs the path of multilateralism
There is still a long way to go from smooth access to vaccines to successful implementation of immunization programs, especially for developed countries and developing countries.
In the future, there are still many key links in the process of curbing the pandemic through immunization programs in the world that need multilateral cooperation.
The first is the international transportation of vaccines, including the construction of cold chains.
Most of the transportation and storage of vaccines require cold chain support, but due to the pandemic, the number of international commercial flights has plummeted, and many developing countries lack the corresponding infrastructure.
If there is a lack of holistic solutions and simply relying on market mechanism regulation, a dilemma similar to the international distribution of vaccines will reappear.
Second, the design and implementation of the immunization plan.
Traditionally, the main target of national immunization systems is children, while the vaccination of COVID-19 is mainly targeted at adults.
To avoid coronavirus vaccinations disrupting child immunization programs, health systems must “increments.” In this area, WHO should be supported in its leadership by providing personnel training, planning support and other necessary help to developing countries.
Third, international mutual recognition of immunization certificates.
In the short term, it is difficult for the global pandemic to be completely ended through the immunization program, but the application of vaccines can at least be convenient to resume international exchanges to some extent.
This requires countries to recognize immunization certificates and coordinate border measures. Compared with bilateral arrangements, the multilateral system will obviously be more efficient.
In short, an effective global health crisis response cannot leave multilateralism.
International multilateral agencies, represented by WHO, have played an active role in the development of a COVID-19 vaccine and are leading the trial of a fair and efficient vaccine distribution mechanism for all parties.
The only way to resist vaccine nationalism and avoid the logic of international immunization programs sliding into economic interests or power and political domination is to consolidate multilateralism with the concept of a community of human destiny and support WHO to play an active role.