3 April 2021 – Mukesh Kapila
In these peculiar times of Covid-19, there is little that stirs up a more heated discussion than the issue of vaccination against the coronavirus. Should I get it or not? Are they safe? Have you had yours? When is my turn? Which vaccine is best? How unfair is the sharing of vaccines within and among nations?
So, while vaccine nationalism and vaccine wars appear to be smouldering here and there, at least there is more-or-less consensus on one thing: universal vaccination against the coronavirus is the only route out of the devastating human, social, and economic impacts of the pandemic.
That means not just vulnerable older people and those with underlying health problems who suffer most deaths and serious sickness. Of course, they are rightly at the front of the queue to receive the jabs. But, in addition, the general public – including eventually children – will also need vaccination to reduce general virus spread in the community.
On the basis of current science, some 80% of the population will have to be rendered immune through vaccines so as to check virus transmission. It is also highly likely that vaccinations will have to be renewed periodically, probably annually. That is because first, immunity from available vaccines may not last; second, because the emergence of coronavirus variants means that the vaccines will need to be continuously updated; and third, because, new cohorts being born each year will need protection.
Therefore, economic recovery that is sustained in the face of the permanent presence of the virus requires robust national vaccination systems. For lawmakers and legislators, this implies their active attention on several critical fronts.
The top priority is to convince and prepare the public to receive the vaccine. While there is much concern nowadays about shortages in vaccine supplies, this is a short-term problem. It will be overcome over coming months as more vaccines are approved and more production facilities come on stream.
The much bigger problem is, instead, vaccine hesitancy i.e. the large numbers of people in many countries that are reluctant to accept a vaccine. They are either poorly educated on the benefits and risks (especially with confidence-sapping publicity on very rare side-effects), or mistrust the authorities, or are misinformed by fake news. To tackle this through education, social mobilisation, trust-building, and countering anti-vax lobbies, must be a first priority.
Second, it is important to ensure that national health authorities only utilise vaccines that are certified safe and effective by the World Health Organization or one or more of its designated stringent regulatory authorities: EU, UK, US, Switzerland, Australia, Canada. Many countries are understandably desperate to accept any vaccine from anywhere. But countries should not use vaccines that offered by other through so-called vaccine friendship or diplomacy initiatives – unless they have been authorised by one of the above authorities. To use uncertified vaccines is risky and undermines public trust even further.
The third priority for a country is to secure its own vaccine pipeline. That means, at a minimum, planning and forecasting vaccine demand in a systematic but realistic manner. If countries rush in a panicked way, they will make vaccine nationalism and competition worse, as well as push up prices. Because supplies are currently restricted, a great deal of international co-operation is needed. But we should not be disappointed if this falls short of the high ideals of global solidarity; it is understandable that every country seeks to prioritise the protection of its own population first.
For low and lower-middle-income countries, the multilateral COVAX scheme – imperfect as it may be – represents their best chance to get vaccines as soon as possible for their most vulnerable groups. Meanwhile, countries can aspire towards universal vaccination but not expect instant gratification. Coverage will steadily increase during 2021-22 but reaching herd immunity everywhere may take till 2023-4. Thus, patience is needed with, in the meantime, the maintenance of prevention and public health measures.
Meanwhile, vaccine jealousy among nations will arise and require soothing. The reality is that the richer world will get vaccinated first and – unfair as that may be – the sad reality in our unequal world is that recovery for poor countries depends on recovery first in rich ones. That is because poorer nations depend on the rich to resume business interactions through trade, travel, tourism, importing raw materials, and resuming investment. While we want the world to become a fairer place, that is a long term project that will not be realised on the back of Covid-19 vaccines.
The fourth priority is to make health systems ‘vaccine ready’ for what is, for most countries, the biggest public service delivery programme challenge they face. While every country has its own traditional way of doing things, the main lesson learnt from the experience of early vaccine adopters such as Israel and UK is that decentralised vaccination delivery is better using local doctors and pharmacies that are familiar to, and better trusted by communities. While ‘mega vaccination centres’ have a role front-loading campaigns, it is better to build on existing vaccination services that are common everywhere. In contrast, specially constructed vaccination arrangements just for Covid-19 and highly centralised and controlled systems are not so effective or efficient. Needless to say, the vaccines need to be provided free at the point of uptake – and so there must be adequate national budgetary provision.
Fifth, it is important to give special attention to hard-to-reach populations. For example, groups like refugees and displaced, undocumented migrants, and vulnerable people who don’t want to or can’t reach the state’s official facilities. They need dedicated outreach effort. This is vital for national herd immunity as “no one is safe until all are safe”. Thus bureaucratic or legislative obstruction such as the requirement to show residence or other papers before receiving a vaccination need to put aside, as far as these groups are concerned. As a matter of general principle, vaccination or other health-related data should not be used for other purposes such as immigration and security.
Conflict -torn countries such as Myanmar, Ethiopia, Syria, and Yemen, for example, will need specific strategies to reach people on all sides of the divide. Ceasefires for vaccination purposes, as for example, successfully used in the past for polio in Afghanistan provide a model. In any case, Covid-19 vaccine access should not be used as leverage or as a ‘weapon of war’ against enemies. Vaccinators in fragile states may also need special protection as they go about their work serving all sides on an impartial basis. Like other humanitarian workers, they come under the umbrella of international humanitarian law.
The sixth issue is to foster an open debate on rapidly emerging policy matters that test social and political consensus. For example, should vaccinations be made compulsory? The short answer is ‘no’ – experience suggests that coercive pressure harms the longer-term goal of public compliance with health measures, apart from this being an infringement of basic human rights and liberties.
In that case, what about compulsory vaccination as an employment condition, for essential workers whose roles bring them into greater contact with vulnerable people such as in health, social care, teaching, and transport. There is some justification for this but even here, any compulsory measures should be taken reluctantly as a last resort, and only if public systems are collapsing under pressure. Even then, such a measure is justified only if there is reliable epidemiological evidence that these settings are causing outbreaks in particular contexts. In short, any coercive measures must be short-term and proportionate to the emergency need.
Then there is the debate around “vaccine passports”. Should those who are vaccinated get greater freedom such as to travel and mix socially in bars, restaurants and sports venues? Would that not help to open up businesses and drive recovery. Could it also incentivise the vaccine hesitants to come forward? Or would that be unacceptable coercion and create greater inequalities, in an already unequal world?
On balance, vaccination certificates would bring more good than cause harm. And the possible harms can be mitigated, for example, by making sure that those who have a medical or other well-founded reason not to be vaccinated, are not prejudiced against. There is a libertarian argument against vaccine passes. But balanced against that is the entitlement of a person not to be hurt by another from whom a service is sought. If vaccination passes are introduced, they should only be a temporary measure – perhaps for 2-3 years – until there is sufficient vaccination coverage. When we move into the “living permanently with the virus” phase, such individual passes will probably not be necessary if there is broad universal coverage.
Countries should debate and decide on their vaccine pass policies in the context of their own circumstances, and the balance to be struck between their domestic and international spheres. In any case, there is a very high probability that vaccine passes will become an international reality, sooner than later. In terms of COVID-19 vaccine certification for international travel, a common format is obviously better, perhaps one that is endorsed by the World Health Organization.
If these short-term challenges around rolling out vaccination everywhere are successfully met, the job is still not done, and the guard can’t be let down. The pandemic could rebound and, in any case, as the saying goes, a ‘good’ crisis should never be wasted! It brings opportunity to build longer term arrangements not just to keep Covid-19 under permanent control but also to become better prepared for future pandemics. Countries also need to address the social factors that created the disease risks and vulnerabilities that spawned the crisis.
Perhaps the trickiest post-pandemic question will be for nations who have not had a good war against the virus. How much of that was their own poor governance or imprudent policy choices? Or was it because they became too dependent on the products and services, or too trusting of favours and indulgences from others, even as globalisation and multilateralism failed them in their hour of greatest need?
It will not be a bad outcome if such soul-searching resets the world order. However, the winners and losers of the Covid-19 war are not settled yet, and it is not assured that the world that will emerge will be an automatically better one.
This is an adapted version of a presentation to legislators on 30 March 2021 at a joint meeting of the Parliamentary Assembly of the Mediterranean (PAM) and the Parliamentary Assembly of Turkic Speaking Countries (TURKPA) on “Cross-regional cooperation in shaping a resilient economic recovery”. The event’s full video recording is available here.