Covid-19 was an instance, wherein the entire world’s humanity and solidarity was put to test. In fact, when the World Health Assembly (WHA) held its 73rd annual meeting on 18-19 May, 2020, it called out for the Resolution WHA73.1 titled Covid-19 Response, which emphasized on ensuring cooperation and multilateral support among nations, along with other stakeholders. They stressed upon the importance of a concerted effort to ensure that there is a spirit of mutual support and cooperation among all, rather than engaging in the power politics of the vaccine race. However, these directives and declarations for global cooperation were neglected by the resourceful nations. Instances of vaccine nationalism in the form of advance purchase agreements were observed at a rampant pace and the national interests were put above the global humane efforts again.

Vaccine Nationalism refers to a short -sighted approach of putting the interests of their country first, by securing access to Covid-19 vaccines, to ensure their populations’ access to these medicines. Quite naturally, these are done by the nations who have the adequate resources to make the advance purchase agreements, i.e., the developed nations like the USA, European Union nations. The advance purchase agreements (APAs) in such cases, are in the form of legally binding contracts, which are usually made by parties (governments and vaccine manufacturers in this case) to ensure that a certain number of doses will be bought by the government, in case the vaccine turns out in the market, which implies that usually such agreements are made way before the development of the vaccine. This often affects the vaccine equity as poor nations who ordinarily cannot afford to make such agreements, fail to procure them even after they are introduced, as usually the vaccines are reserved for the nations with whom the agreements are made.

Again, vaccine nationalism and APAs are not novel concepts. During pandemics like H5N1 i.e., Avian flu and H1N1 i.e., swine flu, there were a list of APAs observed. European Union, became the proprietor and nearly 16 nations had APAs at the time of H1N1, which worked efficiently for them and managed to provide vaccines in nearly 3 months, but lead to negligible manufacturing capacity for WHO and the other low income countries. The situation became worse, and WHO had to ask for donations, leading to the developed nations pledging for donating 10 percent of their vaccines to the low income countries. The donations reached eventually, when the worst phase of the pandemic had already passed, killing nearly 284,000 people.

Similar instances were observed during Covid and APAs were formed even before the effectiveness of the trial results. Brands like Johnson and Johnson/Janssen, Moderna, and Pfizer-BioNTech got a whopping amount of $11.92 billion, under the Operation Warp Speed by the USA administration. This led to nearly 700 million doses reserved for the USA by 2021, severely affecting their manufacturing capacity for other nations. During the 72nd meeting of the WHA, the then President Donald Trump while addressing the session, declared that his priority is his nation, and his government will put his citizens, his people first, and the same was reflected in the form of these agreements.

These instances of vaccine race and hoarding severely affected the accessibility as too many people have to wait too long for too little. The history of political behaviour during pandemics was repeated and Latin American nations like Colombia, Paraguay, African nations started facing acute shortage.

Now, WHO backed the COVID-19 Vaccines Global Access (COVAX) facility under the Access to COVID-19 Tools (ACT) Accelerator, which was an initiative by the global organizations, to tackle the problem of vaccine inequity. This initiative was further co- led by the Coalition for Epidemic Preparedness Innovation (CEPI) and Gavi, the Vaccine Alliance and UNICEF. Other initiatives like MPP (Medicines Patent Pool) by creating vaccine pools, TRIPS waiver were directly aimed at mitigating the results produced by these agreements. As a result, the low income nations observed an increase in the vaccine coverage recording an average of 55 % in April, 2023. But these statistics also depict how late the vaccines have reached the nations which were the most severely affected ones. In fact there were concerns as to how the African nations would become hotbeds of infections, but the situation of poor access continued even after these records, as the supplies were reserved for other nations.

There are theoretical arguments as well, as to how the agreements help the manufacturers to scale up production, by providing monetary incentives. There were certain medical equipments like 0.3 mL Auto Disable syringes, which had no other purpose other than Covid-19 as they were of a different size from the ones used for routine immunization, and had severe constraints with respect to storage, affecting manufacturers. Similar situation was observed during the PPE production as well, when even UNICEF had to deploy an APA. Such APAs reduced the risk for manufacturers, and helped them in further expanding their production capabilities. However, the intent and the effects produced by such agreements in extreme cases like the pandemic need to be re-assessed. This is why there is an urgent requirement to address this recurring problem, and to ensure the creation of a more permanent solution. There is a necessity to create more concrete policies and permanent structures or platforms rather than the temporary arrangements which serve as a knee-jerk reaction.

*The Kautilya School of Public Policy (KSPP) takes no institutional positions. The views and opinions expressed in this article are solely those of the author(s) and do not reflect the views or positions of KSPP.