The Covid-19 vaccine inequity is one of the significant moral challenges to the global health community. The practice domain of International relationship provides a strategic framework to address the global Covid-19 vaccine crisis. The UN General Assembly 75th session’s agenda item 131 was global health and foreign policy. A political declaration on equitable global access to Covid-19 vaccines was the unprecedented outcome.
In a letter dated 24 March 2021, 15 ambassadors representing Brazil, Egypt, Fiji, India, Kenya, Lebanon, Mexico, Norway, Pakistan, Qatar, the Republic of Korea, Saint Vincent and the Grenadines, Senegal, the United Kingdom and the European Union to the United Nations presented a political declaration on equitable global access to Covid-19 vaccines to the Secretary-General. The political declaration has so far attracted the support of 179 delegations.
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It is increasingly evident that universal access to Covid-19 vaccine is hampered by the intellectual property rights regime controlled by the General Agreement on Tariffs and Trade (GATT), a legal agreement between countries whose overall purpose was to promote international trade by reducing or eliminating trade barriers such as tariffs and quotas.
India and South Africa have earlier called for World Trade Organisation (WTO) to suspend intellectual property rights related to Covid-19 for a limited period to ensure rapid scaling-up of manufacturing of vaccines and to ensure accessibility and affordability of vaccines for all
“We, representatives of the peoples of the United Nations and its member states, are determined in the face of the challenges of the Covid-19 pandemic and the devastating and multifaceted effects it has on humanity, to work together as one to defeat the pandemic and help people and the planet to recover better,” read the declaration.
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UN declaration lauds fast development of Covid-19 vaccines
The political declaration applauds the scientific community and recognises the unprecedented scientific research and collaboration among governments, international institutions and the private sector, which resulted in the development and production of several Covid-19 vaccines in record time, giving the world renewed hope after the severe disruptions the pandemic caused to societies, economies, global trade and travel, with devastating effects on livelihoods.
With optimism, the authors of the declaration have noted that they can see the end of the crisis. However, to reach it, the global community needs to work together with a more profound sense of collaboration — multilateralism and international cooperation as our only way to overcome the pandemic safely, equitably and sustainably. “No one can be safe until everyone is safe,” and equitable and affordable access to safe and effective Covid-19 vaccines must be ensured to have a speedy recovery and contribute to putting an end to the pandemic.
The declaration’s signatories are encouraged by the rollout of the first allocations of WHO-approved Covid-19 vaccines, mainly through the Covid-19 Vaccines Global Access (COVAX) initiative, reaching millions of people. The generosity of many member states, international organisations, philanthropists and vaccine producers must be commended for their initiatives to make the vaccine available to those who need it most, especially vulnerable countries and people in vulnerable situations.
The global community urges all governments and the Secretary-General of the United Nations to implement relevant UN resolutions and commitments, particularly on international cooperation, to ensure global access to safe and efficacious medicines, vaccines, and medical equipment to face Covid-19.
It is the government’s primary responsibility to adopt and implement responses to the Covid-19 pandemic and the central role of the United Nations system in coordinating the global response to the Covid-19 pandemic and immunisation. In this regard, the signatories of the declaration reaffirm the crucial role of governments, the Access to COVID-19 Tools (ACT) accelerator, including COVAX and the role of the World Health Organisation and other stakeholders.
Despite international agreements, initiatives, and general declarations, the distribution of Covid-19 vaccines is still uneven worldwide, both among and within countries. A considerable number of countries have not yet had access to COVID-19 vaccines. There is a renewed need for global solidarity and multilateral cooperation to increase vaccines production and distribution on regional and global levels.
The signatories to the political declaration pledge to treat Covid-19 vaccination as a global public good by ensuring affordable, equitable and fair access to vaccines for all. COVAX being the appropriate mechanism to guarantee it. The signatories recorded their deep concerns about the low availability of Covid-19 vaccines in low- and middle-income countries.
The signatories welcomed the efforts of countries that have donated Covid-19 vaccines and actively encourage further sharing of vaccine doses from all countries in a position to do so to low- and middle-income countries and other countries in need, mainly through COVAX, including based on the WHO allocation framework, for fair access and equitable allocation of Covid-19 health products.
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India’s Covid-19 vaccine diplomacy
India has supplied more Covid-19 vaccines globally than vaccinated its people. India has told the UN General Assembly and cautioned that vaccine inequity would defeat the collective global resolve to contain the coronavirus as the disparity in the accessibility of vaccines will affect the most impoverished nations the most.
Reminding everyone that India produces 60% of the world’s vaccines, the Indian health minister Harsh Vardhan said, “More than 61 million vaccine doses have already been administered in our country, and 64 million doses have been given to 84 countries under various programmes.” The government of India feels that benefits of science be delivered to the whole world.” According to the minister, half a dozen vaccines are under clinical trial in India and around a dozen are in a pre-clinical trial which is being monitored by the National Expert Group on Vaccine Administration for Covid-19.
More than 180 UN member states committed to solidarity and intensified international cooperation, giving equal regard to all human beings, especially people in vulnerable situations, to be protected from the coronavirus disease, regardless of nationality or location and without discrimination.
The global community is further committed to ensuring transparent and fair access to vaccines to those at a higher risk of developing severe Covid-19 symptoms and the most vulnerable based on medical and ethical standards. The global community must further demonstrate unwavering support for the call for Universal access to the Covid-19 vaccine and related technologies.
The international community has acknowledged the initiatives undertaken by the G20 since the outbreak of the pandemic and call on the group to further collaborate with the United Nations and the international community to upscale support and funding for vaccine production and distribution, to defeat the pandemic and put the world economy back on track while leaving no one behind.
The signatories of the dilatation welcomed the significant commitments of the G7 relevant to Covid-19 and called on the group to make vaccine equity and accessibility at the upcoming G7 summit one of the group’s top priorities. The 47th G7 summit is intended to be held 11–13 June 2021 in the United Kingdom. The G7 countries are Canada, France, Germany, Italy, Japan, the UK and the US. Represented jointly by the President of the European Council and the President of the European Commission, the EU participates in all discussions.
The signatories urged member states to significantly increase their support to the COVAX contracts with vaccine producers, not limiting the availability of vaccines due to competing bilateral contracts. COVAX is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO. It aims to accelerate the development and manufacture of Covid-19 vaccines and guarantee fair and equitable access for every country globally.
COVAX, formally known as the COVID-19 Vaccines Global Access Facility, is the vaccines pillar of the access to COVID-19 Tools (ACT) accelerator. The international community further called for total funding of the ACT Accelerator, including COVAX. The ACT Accelerator is a ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. The ACT Accelerator’s efforts to speed up the development, production, and equitable access to Covid-19 tests, treatments, and vaccines, are commendable but hampered by insufficient funding. These mechanisms represent the most effective ways to ensure that no one is left behind.
The signatories of the declaration encouraged all countries to include financial contributions to the ACT Accelerator in their recovery plans, mainly to COVAX, to reach the global financing goal while highlighting that investing in COVAX is also a sound and essential investment for a sustainable and resilient recovery.
The signatories further expressed their support for the Inter-agency Supply Chain Task Force. They requested the UN Secretary-General to ensure that the entire UN System is coordinated to deliver vaccines to all countries that request it, including distribution to the most vulnerable populations, wherever they may be.
More than 180 UN member states that signed the declaration called for the rapid scaling up and expansion of vaccine production globally, including developing countries. This could be done through appropriate dissemination of technology and know-how, e.g., licensing under World Trade Organisation (WTO) rules, using WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) — the most comprehensive multilateral agreement on intellectual property.
For the rapid scaling up and expansion of vaccine production globally, the political leaders must explore the provision of TRIPS flexibilities, if necessary, sharing knowledge and data related to COVID-19 health technologies.
The 180 member states expressed their willingness to forge a robust partnership with the private sector and international organizations, particularly the WHO, to increase production, distribution and access to COVID-19 vaccines.
The governments and the private sector must cooperate to ensure that all persons have greater certainty about equitable access to Covid-19 vaccines, addressing national challenges relevant to distribution. Such cooperation should ensure safety, effectiveness and transparency, and facilitate timely availability, accessibility, acceptability, affordability, and acquisition.
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UN members vow to ensure access to Covid-19 vaccines
The signatory countries committed to preventing vaccine inequity among countries while working together in the spirit of solidarity and cooperation. They also commit to preventing speculation and undue stockpiling that may hinder access to safe and effective vaccines. Stockpiling of vaccines is unnecessary, counterproductive and self-defeating, and can prolong the pandemic’s life instead of ending it.
The declaration’s signatories underscore the importance of vaccine preparedness and the critical role of resilient health systems in the fight against Covid-19. They requested further support and access to concessional funding and other financial measures by multilateral financial organisations. Such support should be in place for any country that requires it to meet national vaccine requirements and improve national health systems, preparedness, health infrastructure, and support to the health workforce and ensure efficient supply chains and logistics.
Often support is needed to overcome challenges related to vaccine storage, distribution, and management, especially in areas where health infrastructure is weak, including least developed countries and crisis-affected countries.
Ensuring world peace is an essential situation to ensure an effective repose towards the challenges of the Covid-19 pandemic. The declaration rightly called for immediate implementation of the Secretary-General’s call for a global ceasefire to facilitate vaccination processes and encourage governments to support vaccines rollout as part of their humanitarian assistance.
Deep appreciation for the UN personnel in UN peacekeeping operations, including efforts of troop- and police-contributing countries, in the face of the Covid-19 pandemic and its consequences, was in the declaration. The declaration also stressed the importance of ensuring the vaccination of peacekeeping contingents.
The declaration’s signatories expressed their concern about the impact of the Covid-19 pandemic on other immunisation programmes. They reaffirmed their commitment to universal health coverage, including immunisation. They called upon all governments, donors, and all relevant stakeholders to redouble their efforts to ensure that funding relevant to routine vaccination campaigns is not diverted to meet the requirements posed by Covid-19 and that national health systems are strengthened, including the health workforce, in order to address systemic health issues beyond Covid-19.
The signatories further committed to address misinformation and countering vaccine hesitancy and providing timely and transparent information regarding the prices, safety, and efficacy of different vaccines types.
The international community must ensure that vaccines are adequately tested and that relevant data is publicly available for transparency and credibility purposes. The signatories are cognizant of the need to sensitise populations on the need to receive the vaccine based on science, evidence and data. They acknowledge the UN Secretary-General’s “verified” initiative and urged the United Nations to counter vaccine hesitancy in all parts of the world.
All countries are called to launch public information campaigns capitalising on social media’s power to sensitize people on the importance and safety of Covid-19 vaccines. The signatories pledged to continued collaboration to ensure global coordination for equitable and timely allocation of Covid-19 vaccines. It is the time to go beyond rhetoric, and the forum to promote cooperation is the United Nations.
As a follow-up to this political declaration, the signatories invited the Secretary-General to continue working with member states, the ACT Accelerator, and other stakeholders to mobilise global resources, to address global vaccine inequality, and invite him to provide regular briefings to the General Assembly on the progress of global Covid-19 immunisation, including efforts and recommendations from the Organisation.
The international community must commit to engaging and working together so that no one is left behind from access to science’s life-saving contributions.
By addressing the Covid-19 related global health crisis, India has an opportunity to provide strategic depth to its foreign policy engagements. India is increasingly expanding its foreign policy engagements to the realm of global health. This may be an appropriate time for India to develop a formal health diplomacy strategy to harness its emerging health diplomacy skills.
(Dr Joe Thomas is associate dean, faculty of sustainability studies, and head, School of Public Health, MIT World Peace University, Pune.)
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Dr Joe Thomas is Professor of Public Health, Institute of Health and Management, Victoria, Australia. Opinions expressed in this article are personal.