By Gordon Brown
This inequality is not difficult to explain: a recent survey by Airfinity has shown that the world’s richest countries have bought 89% of all COVID-19 vaccines, and currently retain control of 71% of future deliveries.
The Global North has fallen short of its pledges to donate vaccines to the Global South. The U.S. has sent only 25% of what it promised, while the European Union, the United Kingdom, and Canada have performed even worse, dispatching just 19%, 11%, and 5%, respectively, of their pledged doses. The COVID-19 Vaccine Global Access (COVAX) facility, which had hoped to distribute 2 billion vaccines by December, now expects to deliver just three-quarters of that amount.
Such is the scale of vaccine hoarding in rich countries that Airfinity estimates that by the end of 2021, 100 million doses in the G-20 stockpile will pass their expiration date and be wasted.
For G-20 countries to hoard lifesaving vaccines and deny them to the poorest countries, while allowing tens of millions of doses to go to waste, is a morally indefensible act of medical and social vandalism that should never be forgotten or forgiven.
Vaccine inequities show why more fundamental changes are needed in the international global public-health architecture of health decision-making. Of course, among international organizations, only the Appellate Body of the World Trade Organization and the International Criminal Court, whose decisions are final, have the freedom and authority to make binding decisions that national governments are obliged to follow. And because of that, these bodies are under assault from a coalition of anti-internationalists. Securing a binding treaty will not be easy.
Legally binding agreement needed
There is already a global-health treaty to reduce tobacco demand and supply, and a 2011 agreement to ensure that the WHO can commandeer supplies of flu vaccine when needed. But the legally binding international pact necessary to enable global-health authorities to do more to prevent, detect, prepare for, and control a pandemic has so far eluded us. At a time when new variants of COVID-19 are appearing, it is imperative that the special summit launches a process to develop a legally binding agreement under the auspices of the WHO constitution.
Moreover, governments can draw on several important recent reports. These include one by a G-20 high-level independent panel , co-chaired by Larry Summers, Tharman Shanmugaratnam, and Ngozi Okonjo-Iweala; the Mario Monti-led report to the WHO European Region; and the WHO review led by former Liberian President Ellen Johnson Sirleaf and former New Zealand Prime Minister Helen Clark.
A robust agreement should contain several key elements.
First, global-health leaders must have more authority to develop and upgrade health surveillance. Second, we need to build on the pioneering work of the Access to COVID-19 Tools Accelerator (ACT-A) and COVAX, and ensure equitable manufacturing and distribution of personal protective equipment, tests, treatments, and vaccines, so that all countries can protect themselves better against current and future pandemics. Third, we need a global pandemic preparedness board.
But such arrangements will work only if leaders devise a sustainable financing mechanism to address the glaring global inequalities in health provision. Too often in times of global crises, we are reduced to passing the hat or convening ad hoc donor conferences.
Ideally, pandemic preparedness should be financed according to a burden-sharing formula that allocates the costs among countries with the greatest capacity to pay. Even now, less than 20% of the WHO’s budget is covered in this way. The eradication of smallpox in the 1960s and 1970s was historic not least because the final push was initiated by a cost-sharing agreement among the richest countries.
Failure to meet global COVID-19 vaccination targets could cost $2.3 trillion in lost GDP by 2025 . Given that prospect, the G-20 high-level independent panel’s proposed $10 billion annual budget for pandemic prevention and preparedness would offer one of the greatest returns on investment in history. But we must act now—and this week’s WHA summit is the place to start.
Gordon Brown, former prime minister and chancellor of the exchequer of the United Kingdom, is United Nations Special Envoy for Global Education and chair of the International Commission on Financing Global Education Opportunity.
This commentary was published with permission of Project Syndicate — A New Global Architecture for Health