By @HelenRamscar

Encouraging data released from the Pfizer[1], Moderna[2] and Oxford University[3] vaccine trials have hit headlines worldwide. Yet indications of a new SARS-CoV-2 variant named 20A.EU1[4], which originated in Spanish farms and spread successfully across Europe, followed by confirmation that a SARS-CoV-2 mutation found in mink in Denmark has transmitted into humans in no fewer than seven countries,[5] is troubling. Mutations pose challenges to the efficacy of vaccine candidates and exemplify the difficulty of predicting with a novel virus what strain vaccines should be tailored towards. Even targeting the annual winter ‘flu jab is difficult and its effectiveness fluctuates year by year.[6]

Before the Covid crisis, according to UN COMTRADE data for human vaccines for the period 2015-2018, 152 nations were net importers of vaccines – 111 were exclusively importers of vaccines, and did not export at all.[7]Yet as the Covid-19 pandemic struck and it was clear global demand for Covid vaccines would rapidly outweigh supply, an international scientific scramble began to develop the first safe and effective shots. Early signs of vaccine nationalism emerged too.[8] By the summer of 2020, vaccine nationalism had turned nasty.[9]

Recent analysis by the Global Trade Alert on the number of export controls on medical goods and medicines this year, which peaked in April 2020 (at 145), indicates that 68 are likely to be still in place by the end of 2021. The report warns that pandemic-era policy responses may scar international trade in vital medical goods and medicines over the medium- to longer-term.[10] This is no small matter to cross-border trade and international relations when worldwide imports and exports of medical products in 2019, before the first life-threatening viral pandemic in a century, totalled about $2 trillion.[11]

The arrival of safe and effective vaccines will not bring a quick end to vaccine nationalism. Public policy interventions like ‘vaccine passports’ may fuel uglier shades of nationalism, discriminating in public settings between who has and who has not had treatment – regardless of the effectiveness of the measure or the legitimacy of the piece of paper stating it. Indeed, the arrival of viable vaccines may not bring an end to the health emergency, anywhere. ‘Vaccine hesitancy’ within populations with the luxury of choice to accept a jab or not poses a serious problem; current surveys indicate that over 25% of the global population would not take a Covid-19 vaccine if it were available.[12] For others there will be a complete lack of access to any vaccine where conflicts or natural disasters are forcing them to flee. There is a grim possibility too that our current best shots simply may not work well enough. These combine to make placing all hopes on a vaccine a risky business.

The UK’s Chief Scientific Officer talked about the need to “de-risk” society, in his recent interview with the British Medical Journal.[13] It is hoped that vaccines, medicines and treatments will all contribute to de-risking society from Covid-19. But as the virus mutates, possibly rendering current countermeasures less effective – in turn requiring more funding, more research, more time taken for clinical trials on new candidates – it seems logical, albeit grim, that society should prepare to oscillate in and out of periods of ‘de-risking’ when measures appear to be working and ‘re-risking’ when they are not.

At some point soon, drugs to treat the Covid-19 disease – as opposed to vaccines to try stop the virus from infecting bodies in the first place – are likely to take on the baton in public discourse and, if unchecked, ‘medical nationalism’ will run alongside it. As scientists and medics learn more about the chronic vascular health damage caused by Covid-19, safe and effective anti-inflammatories, anti-virals, antibiotics and treatments are likely to become high currency. Competition, tension and conflict surrounding patents for existing drugs being repackaged for Covid-19, intellectual property over new medicines, and affordable access to them, will all matter. So while there may be promising news regarding vaccine breakthroughs, the competitive problem is far from over – stand by for renewed competition over highly coveted, urgently needed Covid-19 drugs.

As with nationalism throughout history, leaders have sought to blame externals for ills besetting their people. In the case of the fiasco over essential PPE, leading to protectionist measures on the likes of ventilators, masks and gowns worldwide, the finger of blame has been pointed at ‘supply chain vulnerabilities’. In reality, the root cause may be more about government policy failure than a market failure.[14] Nevertheless, the protectionist measures slapped into place in the heat of the crisis risk a rise in ‘medical nationalism’; once commercial flows have been altered or halted it may be harder to revert them. While the spotlight is on the quest for vaccines, political and global health leaders are rightly speaking out on the damaging effects of vaccine nationalism. Yet they must not be blinkered to the risk of the emergence of ‘medical nationalism’ more broadly harming the international body politic.

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[1] Pfizer, ‘Pfizer and BioNTech Conclude Phase 3 Study of Covid-19 Vaccine Candidate, Meeting All Primary Efficacy Endpoints’, 18 November 2020, ‘https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine

[2] Moderna, ‘Moderna’s Covid-19 Vaccine Candidate Meets its Primary Efficacy Endpoint in the First Interim Analysis of the Phase 3 COVE Study’, 16 November 2020, https://investors.modernatx.com/news-releases/news-release-details/modernas-covid-19-vaccine-candidate-meets-its-primary-efficacy

[3] Ramasamy et al, ‘Safety and immunogenicity of ChAdOx1nCov-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial’, The Lancet, 18 November 2020, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32466-1/fulltext

[4] Emma B. Hodcroft et al, ‘Spread of a novel SARS-CoV-2 variant across Europe in summer 2020’, University of Basel, 29 October 2020, https://www.unibas.ch/en/News-Events/News/Uni-Research/Spread-of-a-novel-SARS-CoV-2-variant-across-Europe-in-summer-2020.html

[5] Sophie Kevany and Tom Carstensen, ‘Covid-19 mink variants discovered in humans in seven countries’, Guardian, 18 November 2020, https://www.theguardian.com/environment/2020/nov/18/covid-19-mink-variants-discovered-in-humans-in-seven-countries

[6] Centres for Disease Control and Prevention, ‘Vaccine Effectiveness: How Well Do the Flu Vaccines Work?’, CDC, https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm   

[7] Simon J. Evenett and Johannes Fritz, ‘Collateral Damage: Cross-Border Fallout from Pandemic Policy Overdrive’, The 26th Global Trade Alert Report, CEPR Press, 2020, p.16, https://www.globaltradealert.org/reports/60

[8] Helen Ramscar, ‘Vaccine Nationalism in the Age of Corona’, RUSI Commentary, 19 May 2020, https://rusi.org/commentary/vaccine-nationalism-age-coronavirus

[9] Helen Ramscar, ‘Vaccine Nationalism: The Ugly Face of Sciences and Politics’, RUSI Commentary, 17 August 2020, https://rusi.org/commentary/vaccine-nationalism-ugly-face-science-and-politics

[10] Simon J. Evenett and Johannes Fritz, ‘Collateral Damage: Cross-Border Fallout from Pandemic Policy Overdrive’, The 26th Global Trade Alert Report, CEPR Press, 2020, p.32, https://www.globaltradealert.org/reports/60

[11] WTO, ‘Trade in Medical Goods in the Context of Tackling Covid-19: Information Note’, 3 April 2020, https://www.wto.org/english/news_e/news20_e/rese_03apr20_e.pdf

[12] For example see, Nicolas Boyon, ‘Covid-19 vaccination intent is decreasing globally’, IPSOS, 5 November 2020, https://www.ipsos.com/en/global-attitudes-covid-19-vaccine-october-2020

[13] Fiona Godlee, ‘The BMJ interview: Chris Whitty, England’s chief medical officer, on covid-19’, British Medical Journal, 4 November 2020, https://www.bmj.com/content/371/bmj.m4235

[14] Gary Gerrefi, ‘What does the COVID-19 pandemic teach us about global value chains? The case of medical supplies’, Journal of International Business Policy, 15 July 2020, Volume 3, pp. 287–301, https://link.springer.com/article/10.1057/s42214-020-00062-w