A few weeks ago, Prime Minister Trudeau announced yet another financial commitment to securing COVID-19 vaccines for Canadians. This round of funding, which totals $214M, is primarily supporting domestic research, development, and manufacturing capacity for a COVID-19 vaccine. The majority of the funding is supporting the pre-purchase of around 76 million doses of Quebec-based Medicago Inc.’s vaccine candidate, while the remainder has been committed to Vancouver-based Precision NanoSystems (PNI), and several other early-stage candidates. All told, when combined with the contracts Canada has already signed with pharmaceutical companies, the government has spent over $1billion to pre-buy over 358 million vaccine doses for Canadians. In doing so, the government is betting on vaccine candidates, with the understanding that not all candidates will be viable vaccines, buying up more doses to ensure Canadians will be vaccinated. You’ve probably heard about this type of “pre-purchasing” of essential vaccines: it’s vaccine nationalism; in other words, richer countries hoarding the world’s short term supply in advance.
The Gates Foundation is the largest private foundation globally, and have pledged billions of dollars towards vaccine research over the past two decades in addition to founding Gavi, the Vaccine Alliance. According to the foundation, governments rushing to pre-buy doses of vaccines is not inherently bad: it is a needed investment in research and development (R&D) to secure a safe and effective vaccine, and helps to secure global manufacturing capacity for vaccines once they are developed. The level of investment to date in a COVID-19 vaccine is promising: more than 200 candidates are in development, with 45 of these currently in the clinical evaluation phase. However, without a plan for equitable global distribution of a vaccine, the pandemic death toll will be much higher. Research into global vaccine allocation points towards the fact that “it is better to vaccinate some people in all countries, rather than all people in some countries.” But as richer countries buy up the global supply, the question of how equitable vaccine rollout can be achieved remains.
The COVID-19 Vaccine Global Access Facility (COVAX) is a joint international initiative to make a vaccine globally accessible. COVAX positions a COVID-19 vaccine as a “global public good,” and intends to provide vaccines to more than 90 countries, via international cooperation and funding to “hedge bets” on multiple vaccine candidates as a group. Last month, the Canadian Coalition for Global Health Research (CCGHR) called on Canada to increase its contributions to the COVAX facility in line with its current spend for Canadian doses, and to also advocate for other countries to do the same. Further, CCGHR calls on Canada to speak out against vaccine nationalism: moving its efforts entirely in line with the goal of global equity. As it stands, Canada has committed a total of $440M to the COVAX fund, with half of that earmarked for procurement of doses of vaccines for Canadians via COVAX. It’s optimistic, but not impossible, to consider that rich countries buying up doses will be able to distribute them “more equitably” at a later date. However, formal government statements on how vaccines will be distributed, even within Canada, are yet to be released. What’s more, prioritizing this type of a post hoc model reinforces a “charitable” model of global aid, rather than one rooted in global health solidarity. These contradictory actions indicate that Canada’s primary goals are nationalistic in nature.
While governments of wealthy nations can (and should) be criticized for undermining global efforts via vaccine nationalism, it is necessary to remember that the set of conditions entrenching global financial inequality is also responsible for creating and enabling vaccine nationalism. Even as the pandemic has set off an economic depression globally, some individuals and corporations have and continue to profit from the pandemic, including Amazon, Microsoft, Johnson and Johnson, and Pfizer (for a full list see here). Rather than reinvesting these profits into security for workers, the top 25 profitable companies have paid out the lion’s share of these profits to their primarily white, predominantly male, shareholders.
Simultaneously, it has been noted by The Conversation that existing global debt structures make it largely unfavorable for many countries to take on COVID debt relief packages, with the consideration that taking on additional debt could be punitive later on. This rising insurmountable debt, paired with pandemic profiteering, underscore the fact that though there is a possibility for more equitable tax and debt policies to temper the effects of the pandemic globally, there are a select few who continue to benefit at the detriment of everyone else. In Winners Take All, Anand Giridharadas calls out the philanthropic system through this premise: it exists as a result of disparity, and as it increasingly takes on the role of “building the social safety net”, it entrenches this disparity. The global health financing system, too, is built to leverage resources existing within this ecosystem; and has thus increasingly relied on private philanthropy tempered by national investments in global aid in the recent past.
While Bill Gates himself has been praised for everything from predicting the pandemic to being a “voice of reason” counter to those choosing not to take the pandemic seriously, there is a question of whether serious overreach on the basis of financial power has taken place over time. Lack of transparency and accountability structures enable philanthropic bodies to exert increasing influence, especially as their global profile is raised. Non-Profit Quarterly has highlighted that as both an investor and a funder in COVAX, and a leader in global health philanthropy, the Gates Foundation has “used its position to support and increase the power of corporate interests over that of national and international governments,”, especially as it potentially stands to gain considerably from the pandemic.
So where do we go from here? As Canada struggles to navigate its role in these waters, and as scientists get closer to a viable vaccine candidate, the conversation surrounding vaccine supply and distribution will continue to be more pressing, especially after the current election focus fades. If we aspire to global equity, it’s worth our time to consider how private philanthropy operates as a stand-in for government intervention, and how this undermines political decision-making and solidarity in critical moments like this one. We need to combat vaccine nationalism, but to get there we also need to rethink structures for global solidarity.