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Vaccine nationalism and COVID-19

Why we’re not all in this together, and why we must be

By: and /
25 January, 2021
Premier David Makhura visits Steve Biko Academic Hospital in South Africa
Health care workers and patients in the temporary area outside Steve Biko Academic Hospital created to screen and treat suspected COVID-19 in Pretoria, South Africa. Alet Pretorius/Gallo Images via Getty Images

The coronavirus has been dubbed a “great equalizer” that is blind to “man-made diversity.” That may be true at the most basic level, but the resulting crisis has not affected us all equally. The pandemic and its aftermath have and will be experienced differently by the Global North and South.

While most countries say they support universal access to vaccination, the World Health Organization (WHO) fears some low-income countries won’t get them until 2024 because of nationalist responses to the pandemic by governments that put their own countries first. But an internationalist approach is the only way to effectively deal with the consequences of the pandemic. Ottawa can do far better in this regard than it has so far. The pandemic is a chance for Prime Minister Justin Trudeau to live up to his 2015 promise that Canada is “back” as a compassionate and constructive actor on the world stage.

Vaccine wars on the horizon?

Rhetoric surrounding the fight against COVID-19 is all about international solidarity. UN Secretary-General António Guterres insisted on global access to the vaccine, and the WHO established a universal vaccination plan through its Global Access Facility (COVAX). The initiative gained broad acceptance and 180 countries have signed binding commitments to offer vaccine doses free of charge to low-income countries.

But competition over vaccine doses looms on the horizon. We saw hints of what this can look like last year when America, in an effort to secure protective equipment, outbid other countries and reportedly diverted masks intended for German police to America. Under then-president Donald Trump, America was one of the few countries that did not sign on to COVAX.

The WHO’s internal assessment that there is a “high risk” poor countries won’t have access to vaccines before 2024 is partly due to an  intellectual property regime that prioritizes profit over the common good. Indian Economist Jayati Ghosh fears an “every-country-for-itself” approach will lead to “vaccine apartheid.” Even the Vatican’s permanent observer to the United Nations, Ivan Jurkovič, asked countries to prioritize “the common good” over market incentives and profit, arguing that universal access is the only way to collectively put an end to this pandemic.

Long-term economic turmoil

Many countries of the Global South lack the financial means or political leverage to compete for vaccine access. For the time being, the pandemic has not ravaged the Global South, but infection rates are rising, with South Africa recently registering over a million cases. A leading African think tank warns Africa’s dependence on Chinese commodity exports, high debt burden and weak currencies makes it especially vulnerable to the potential economic fallout of the pandemic.

The effects of the economic turmoil generated by the pandemic will be long lasting and will mainly hit low- and middle-income countries, which will face a dreadful debt crisis. In late 2019, the level of total debt of emerging economies was $US72 trillion, twice what it was in 2010. About 46 countries already devote more resources to debt servicing as a share of GDP than to public healthcare.

The pandemic has made the situation worse. The rise in worldwide unemployment is expected to translate into a sharp drop in remittances. In 2016, money transferred by migrants to their families back home represented 10 per cent of the GDP of 30 countries, all located in the  Global South. As if matters could not get worse, this will likely unfold against the background of an epic worldwide recession. Bilateral development aid, most of which was already rerouted to COVID-related relief, will become more difficult to access. Nigeria, whose economy was dealt a devastating blow by the joint impact of collapsing oil prices and rising costs of the fight against COVID-19, is asking for US$6.9 billion in new loans from international financial institutions.

For countries with unmanageable debt levels, the spectre of insolvency may rise because of their obligations to follow the financial advice of these international financial institutions. Probable austerity measures, for example, risk further undermining public services such as health and education. If this comes to pass, the crisis will amplify current inequalities between developed countries and the rest. It will strain fragile states that are already dealing with a combination of food insecurity, climate stress and societal conflict. And it will further delay their ability to access COVID-19 vaccines because poorer countries won’t have the means to buy the vaccine and secure necessary equipment to administer it, and few rich countries have abided by their COVAX commitment to offer vaccines free of charge.

Internationalism: the only way out

“Parochialism will only come back to haunt us. We need an internationalist exit strategy.”

The pandemic threatens globalization. Countries have closed borders and suspended immigration. Economic nationalism abounds as protectionist governments urge businesses and consumers to buy local. But parochialism will only come back to haunt us. It will prevent a global solution to the pandemic, deepen the problems of the Global South and feed into mounting migration and refugee crises. To avoid that, we need an internationalist exit strategy.

Canada’s response falls short. According to the WHO, Ottawa has pledged $75 million in funding to support the delivery of COVID-19 vaccines in lower income economies as part of the Global Vaccine Alliance’s COVAX Advanced Market Commitment. This includes a $5 million investment in the development of a mechanism to equitably reallocate vaccine doses through COVAX, either by donation or exchange. But while COVAX guidelines on how these donations should work stress the need for donations to be available early, Minister of International Development Karina Gould  recently said Canada would be “taking it one day at a time” in reply to a question about when those donations would begin.

Canada is also spending $230 million to procure COVID-19 treatments for developing countries in response to priorities identified by the WHO and its partners. And it will invest another $255 million to support the effective deployment of medical solutions against COVID-19 in developing and vulnerable countries. But this response focuses on the health dimension of the pandemic and fails to address its global social and economic dimensions. A truly internationalist COVID exit strategy would require Ottawa to take bolder initiatives and advocate for a coordinated, worldwide effort involving some or all of the following:

1. Work to temporarily suspend intellectual property rules

Current trade rules, which give pharmaceutical companies control over the development of generic medicines, stand in the way of effective access to COVID vaccines and treatment in the Global South. Only by suspending intellectual property rules will vaccines and medicine be available to all. There is a precedent: In 2009, several Latin American countries secured the suspension of intellectual property rights for H1N1 antiviral therapy. Unless efforts to break the chain of COVID-19 transmission are undertaken concurrently worldwide, localized virus outbreaks will continue to threaten full economic recovery.

2. Open and inclusive immigration policies

The fight against COVID cannot be won if migrants and refugees cannot access healthcare. Worldwide, the rights of migrants and refugees are particularly at risk since the outbreak of the pandemic. Most migrants and refugees are hosted in countries whose health systems are already under strain. Whether they live in camps or are held in formal or informal detention centers, their living conditions make them particularly vulnerable to COVID outbreaks. As countries have closed their borders and restricted cross-border movements, refugee protection standards, including the principle of non-refoulement, which forbids forcing migrants to return a country where they will be abused, have not been respected.

3. Raise international development budget allocations

A recent report by Cooperation Canada, an umbrella organization of more than 90 groups working in the international development and humanitarian sector, argues that a just global recovery requires increased spending on official development assistance.

If they are to overcome the coming economic crisis, countries of the Global South will need immediate cash flows. These will support health sectors and enterprises and will address the challenges faced by workers in informal sectors of the economy. These workers often represent a majority of the workforce in the Global South and have no employment-based social protection or insurance. While the International Labour Organization, a UN agency, predicts 25 million jobs could be lost due to the crisis, it does not count all informal incomes which will be lost especially in the Global South. Cooperation Canada has called on Ottawa to commit at least one per cent of what it is spending on Canada’s domestic COVID-19 response — or, about $2 billion — to new and additional international assistance.

4. Prevent violent conflict

The economic fallout of the pandemic will hurt fragile states most. Scarcity too often breeds conflict. Unable to meet the demands of citizens, some governments may be tempted to use violence to maintain order. Preventing conflicts and fostering social cohesion will be crucial for countries of the Global South if they are to avert what President Cyril Ramaphosa of South Africa warned might be “a human catastrophe of enormous proportions.” Economic disaster and social and political disorder in the Global South could also translate into new waves of migrants and refugees that the North has had difficulty dealing with already. Canada’s ability to mitigate conflict abroad is limited but it must do what it can — by supporting democratic institutions, courts, and peace-building efforts in fragile states, for example, and by backing mediation efforts through the UN when conflicts do erupt.

5. Support international organizations

Trump initially halted funding to the World Health Organization, then announced the United States would withdraw from it altogether because, he said, it was “China-centric” in its pandemic response. Reducing the WHO’s budget by about US$ 400 million or 15 per cent will slow efforts to flatten the curve by reducing the organization’s capacity to share scientific knowledge and implement the COVAX initiative. Most of all, it will impede our collective ability to deal with future pandemics. Now is not the time to abandon international organizations. The world needs strong leadership and coordinated action on health, but also on the economy and security.

António Guterres, the UN secretary-general, said that we must “defeat the virus and build a better world.” He’s right, but building a better world may also be the only way to defeat the virus and its cascading repercussions.

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