It seemed that the vaccine could have been the light at the end of the tunnel, but the enduring struggles of the vaccine endeavours make it seem unlikely any time soon. There are evident issues with the ongoing vaccination campaign. Aside from the blatant divide between the countries which hoarded tens of doses per person and those who simply were unable to do so, there are considerable discrepancies on the distribution of the vaccine.
The most intuitive culprit is the patent system. Patents aim at incentivising innovation by ensuring a long-lasting intellectual monopoly and subsequent monopolistic profits to their holder. Nevertheless, they are a rigid barrier to the wide distribution of a good, because no competitor can produce that good (in this case a vaccine) and increase its supply. Still, patents are not the fundamental issue with the vaccination campaign. On the one hand, the EU has arranged a set of agreements between pharmaceutical firms, prompting some companies to produce additional quantities of other vaccines. For instance, Sanofi will provide the European Union with 100 million additional doses of the Pfizer/BioNTech formula. On the other hand, Moderna has waived its enforcement of the patent during the pandemic. Hence, although patents generally limit supply, during the vaccination campaign there have been found workarounds for this barrier, and there are at least two more significant constraints to vaccination in developed countries.
Firstly, production factors are insufficient to satisfy the immediate demand, even from developed countries only. There are hardly enough facilities and qualified workers to quickly manufacture additional doses. In fact, even the aforementioned agreement between Sanofi and Pfizer will arguably bear its fruits in the last months of 2021. But the most troubling difficulties in the vaccination campaign come from lacklustre local distribution processes. To organise the most urgent and pervasive inoculation campaign ever is clearly a complex task, with coordinated chains of production, transport and injection, and where public confidence in the vaccine plays a vital role. This combination of objective and societal obstacles is the fundamental reason for the current slowdowns of the rollout.
There are countless examples of how seemingly negligible factors can coalesce into a systematic failure. In January and February, France struggled with vaccine hesitancy and with one of the lowest vaccination rates among EU countries. Again, in Lombardy a flawed bookings structure, controversial privileges to professional categories and the internal political feuds made the wealthiest and most productive of Italian regions an international case study for weak vaccination governance. Clearly, the continuous hindrances fuel the temptation of establishing a vaccine autarchy, in the illusion that hoarding vials – regardless of one’s commitment to other countries – might compensate for administrative and communicational shortcomings. At first Italy requisitioned 250 thousand AstraZeneca doses destined to Australia, and the latter asked the European Union to review this restriction to no avail. Afterwards, the European Commission has threatened to restrict exports of AstraZeneca to Great Britain for 6 weeks, drawing criticism from both the UK government and the WHO.
Note that this phenomenon is limited in scale; out of 258 shipments to foreign countries such as New Zealand, the UK and the US, the EU blocked only 9 so far. Nonetheless, there are notorious risks to vaccine autarchy, no matter the quantities involved. Obviously, there is a direct deterioration of diplomatic relationships with the country that ordered a set number of doses and has them partially blocked. The already tense relationship between the EU and the UK are escalating with the EU’s aforementioned decision to restrict the exports of vaccines. Eventually, this might lead to further Brexit-like confrontations on trade and financial regulations and the Ireland-UK border.
Finally, this protectionist behaviour triggered an indirect, yet system-wide effect, partially eroding the trust between allied nations and multilateralism. Many of these countries are also part of the Ottawa Group, a WTO faction with the aim to facilitate the exchange of pharmaceutical goods. Thus, such moves by the Commission put a strain on the pivotal concept of this WTO initiative, and thwarts present and future global public health targets. Given how easily the virus can continue to spread among heavily linked regions, such as the US, the UK and Europe, it is necessary to share the access to vaccine doses, instead of short-sightedly limiting it.
Barriers to the vaccination campaign:
Why patents are not the problem:
Worldwide COVID-19 vaccinations:
Mismanagements in France and Lombardy:
UK-EU conflicts on vaccine exports:
Restricting vaccine exports:
WTO Ottawa group for global public health: