Remember back in the spring when the nations of the world competed for personal protective equipment (PPE)? Canadians were shocked when US President Donald Trump tried to block the shipment of PPE to Canada. That wasn’t a one-off event. The fight to secure domestic and international sources of medical supplies has continued.

The problem, alas, is that medical supplies are an area where cooperative solutions will outperform competitive solutions. The questions thus arise: How can cooperative solutions emerge? And what role will Canada play? COVID-19 is, after all, widely regarded as a “starter pandemic”.

In recent months, rich countries have placed huge orders for PPE from factories in China and elsewhere, resulting in a 1000% spike in PPE prices that pushed poorer countries’ governments out of the market just as COVID-19 started showing up on their shores. But rich countries have also chosen to lock down sources of domestic supply.

Rich country after rich country has assessed the length and fragility of its health system supply chains and found them wanting. They are thus now increasingly aiming for self-sufficiency in medical supplies. As a result, increased global supply of PPE may not result in equivalent savings (and, hence, affordability) being passed on to poorer countries.

Canada is no exception to this trend. Canadian taxpayers are supporting a Plan to Mobilize Industry to Fight COVID-19 which will “directly support businesses to rapidly scale up production or retool their manufacturing lines to develop products made in Canada that will help in the fight against COVID-19”.

Soon, however, the competition moved from PPE to vaccines against COVID-19. For Gavi, the global Vaccine Alliance of which Canada is a member, the first step was to assist countries to protect health staff and to strengthen the existing vaccine supply infrastructure and delivery systems. Such measures would allow it to continue vaccination programs and to deliver a COVID-19 vaccine once one becomes available.

Over the years, Gavi has pioneered the use of advanced market commitments (AMCs) to provide incentives for commercial pharmaceutical companies to invest in the development of drugs and vaccines against diseases that primarily afflict the poor, such as rotavirus. It does so by ensuring that there will be a guaranteed large market for a successful product. Advanced market commitments were thus originally a progressive and cooperative measure to overcome an important market failure that afflicted the poor.

Faced with the COVID pandemic, Gavi joined with the World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI) to establish COVAX, a mechanism “to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world”. According to CEPI, over 320 possible vaccine candidates are in different stages of development.

COVAX is using advanced market commitments to advance the equitable sharing around the world of any successful COVID-19 vaccine that may be developed in the near future.

At the same time, however, wealthier nations are now practising vaccine nationalism by making advanced market commitments to ensure access to vaccines for their own populations. The Government of Canada has signed six such agreements for over 280 million potential doses. In September, Oxfam International noted that a “small group of rich nations have bought up more than half the future supply of leading COVID-19 vaccine contenders”.

While governments clearly have a responsibility to protect their own populations, the danger of such vaccine nationalism is obvious. The pandemic will end much faster and more lives will be saved if high-risk populations in all countries are vaccinated first.

But if the rich countries vaccinate all (even most) of their populations first, large number of low-risk people in rich countries will get the vaccine ahead of most high-risk people in poorer countries. Since the virus is no respecter of borders, vaccine nationalism in the rich countries will prolong the pandemic and push its impact onto the poorer people in the poorer countries.

At the same time, to “lure” richer countries to invest in COVAX, Gavi will allow investing countries to be given early access for up to 20% of their populations. Thus, Canada’s recent announcement of $440 million to COVAX is not as generous as it might seem: Half the money is to ensure 15 million vaccine doses for Canada, while the other half will go for the 92 countries eligible to receive COVID-19 vaccines through Gavi.

Oxfam International advocates a People’s Vaccine, not a profit vaccine. But in a world where multilateralism has been hollowed out by the active malice or passive neglect of many countries, is such a cooperative solution possible? As the Canadian government said in the recent Speech from the Throne, “We cannot eliminate this pandemic in Canada unless we end it everywhere”.

In view of the pandemics to come, is vaccine nationalism the model we want? Or should Canada and what we used to call “like-minded” countries put another billion dollars into COVAX to ensure that low- and middle-income countries have access to COVID-19 vaccines at the same time as the rich countries?

As our Prime Minister once again preaches the virtues of multilateralism on the world stage, the time has come to put principles into action. Canada should take the lead in building a more cooperative solution to the allocation of any future COVID-19 vaccines. We will all reap the benefits.

By Diana Rivington and Lauchlan T. Munro : McLeod Group : 04-11-2020.