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COVID-19 Vaccination Rollouts Expose Underlying Inequalities, Underscore the Need for Equitable, Coordinated Response to Global Health Crises
Monday, June 07, 2021

By Michelle Ngirbabul, Max Kampelman Fellow, and
Shannon Simrell, Representative of the Helsinki Commission to the U.S. Mission to the OSCE

More than one year into the COVID-19 pandemic, over 169 million cases and nearly four million deaths have been reported worldwide.

The development and rollout of mass vaccination campaigns have proved to be the most effective, and most important, tools in combating the deadly virus. However, supply chain issues and geopolitical struggles have plagued vaccine rollout efforts, and subsequent delays have exposed and exacerbated existing social, health, and economic inequalities within and among OSCE participating States. To control the ongoing pandemic and prepare for the threats of future global health crises, governments must rely on extensive cooperation and coordination to ensure that vaccination programs and relevant policies are equitable among States.

COVID-19 Vaccinations are the Key to Ending the Pandemic

Vaccines always have been an important part of managing public health crises. During the COVID-19 pandemic, pharmaceutical companies based in the United States, Germany, China, India, Russia, the United Kingdom, and Sweden rapidly developed the nine leading approved or authorized coronavirus vaccines using various approaches.

Vaccines produced by Pfizer, Moderna, Oxford-AstraZeneca, and Johnson & Johnson have been approved or authorized for wide use either in Europe or the United States. The U.S. Food and Drug Administration granted emergency use authorization (EUA) to the Pfizer and Moderna vaccines in December 2020 and to Johnson & Johnson’s Janssen vaccine in February 2021. Likewise, the European Medicines Agency authorized Pfizer for use in December 2020 and Moderna, AstraZeneca, and Janssen in early 2021. The highly effective vaccines inspire hope that an end to the pandemic may soon be within sight both at home and abroad.

Systemic Challenges Hampered Effective Vaccination Rollout

Despite the number of approved vaccines available, systemic challenges have impeded vaccine procurement and rollout. For example, in the weeks following the Moderna and Pfizer vaccines’  EUA, vaccine supply shortages, bottlenecks in distribution by manufacturers and production errors, and bureaucratic challenges complicated distribution amid a surge in demand globally.

While Moderna and Pfizer expanded production, in the absence of a clear national strategy, confusion, delays, and shortages plagued early U.S. vaccination efforts.

Across the Atlantic, the European Union’s stuttering vaccination rollout was beset by vaccine shortages, partially due to its insistence on a joint EU vaccine procurement strategy and related bureaucratic delays.

Unlike the United States and other countries that rushed to secure agreements with vaccine producers as early as August 2020, the EU’s 27 Member States were caught in lengthy price negotiations, forcing the region to wait at the back of the line to receive shipments. Shortly thereafter, the region’s vaccination efforts were dealt a massive blow when AstraZeneca, the company with which EU leaders signed a contract for at least 300 million doses of its COVID-19 vaccine, informed leaders in January that it was unable to meet agreed supply targets for the first quarter.

Despite missteps, at least 12 of the EU’s 27 countries remain confident they will reach targets to vaccinate at least 70 percent of the adult population by the end of summer 2021.

Pre-existing socioeconomic inequalities within countries have further complicated early vaccination rollouts. In the United States, the lack of a coordinated, federal response led to the significant disparity of access to vaccinations, varying widely depending upon one’s location, age, occupation, and underlying health conditions. Similarly, the United Kingdom reported lower vaccination rates among Black, Asian, and minority ethnic groups. 

Additionally, inequalities among countries also severely impacted efforts to control and end the pandemic.

Vaccine Nationalism and Inter-State Competition

Vaccine shortages also disproportionately affected certain countries in the EU, leading to inter-state competition for vaccines and varied vaccination rates among states. Frustrated with slow vaccine deliveries, authorities have coordinated restrictions on exporting vaccines—Italy, for example, had blocked a shipment of the AstraZeneca vaccine bound for Australia and warned of possible vaccine export restrictions to non-reciprocating countries outside the bloc.

In March 2021, European Commission President Ursula von der Leyen stated that the EU would not consider donating vaccine supplies to developing countries until they have “a better production situation in the EU,” as the bloc struggles to maintain its own supply of vaccines

EU unity was further challenged as leaders from Austria, Bulgaria, Croatia, the Czech Republic, Latvia, and Slovenia complained to Brussels that vaccines were not being proportionately delivered as originally agreed in the EU’s joint vaccine strategy.

Under the modified agreement, less wealthy EU states that could not afford the more expensive Pfizer or Moderna vaccines were forced to wait for AstraZeneca vaccines amid ongoing shortages. The protesting states were also those that had received the lowest number of vaccines at that time, which raised concerns about individual states’ progress to vaccinate their populations and reach herd immunity.

Despite early concerns of sustained and widening disparities, technical specifications agreed in April have charted a course for the bloc’s Digital Green Certificates—a digital COVID-19 vaccination record program to be launched in June 2021.

Emerging Vaccine Diplomacy

Political, economic, and logistical challenges created an opening for Russian and Chinese influence in the region through so-called “vaccine diplomacy.” Amid shortages and uncertainty, Russia and China have filled the vaccine gap by offering exclusive deals or free vaccines in dozens of countries globally.

In August 2020, Russian President Vladimir Putin announced that Russian regulators had licensed Sputnik V, the world’s first COVID-19 vaccine, and claimed that clinical trials demonstrated an  efficacy rate of over 90 percent. In December 2020, approximately one month after Pfizer and Moderna received approval in the United States and the European Union, China-owned Sinopharm also brought its vaccine to market, claiming a 79 percent efficacy rate.

Global experts in vaccine immunology and epidemiology have since criticized Moscow’s and Beijing’s lack of transparency, questioned the reliability of clinical trial data, and raised safety concerns. Despite such skepticism, Russia and China are determined to implement an elaborate international rollout of their vaccines to strengthen their  influence abroad, even at the expense of their domestic vaccinations. 

Between the two countries, China and Russia have secured deals to supply more than 800 million vaccine doses in 41 countries. Hungary, the Czech Republic, and Slovakia were among the first European countries to forego waiting for Sputnik V’s and Chinese-made Sinopharm vaccine’s full approval or authorized emergency use from the European Medicines Agency. In mid-February, 500,000 doses of the initial batch of five million Sinopharm vaccines arrived in Hungary, making it the first member of the EU to receive the Chinese vaccine and authorize emergency use within the country.

As of May 2021, nearly 60 countries have registered to administer the Sputnik V vaccine, including OSCE participating States Azerbaijan, Belarus, Hungary, Kazakhstan, Moldova, North Macedonia, Serbia, Slovakia, Ukraine, and Uzbekistan. Austria seemingly used negotiations with Russia for one million doses to bolster its bid for a greater portion of the EU’s pool of bloc-approved vaccines. 

Although Sputnik V is not approved for use in the EU and received negative ratings by Russia’s own domestic drug regulating body, Slovakia authorized the vaccine for use in late May and followed Hungary as the EU’s second country to administer the Sputnik V vaccine.  In Hungary, which leads the EU in COVID-19 deaths per capita, demand remains high for EU-approved doses despite a pervasive government-supported campaign to increase interest in Russia’s jab.

As countries attempted to procure vaccines, the Russian Direct Investment Fund was reaching deals with various companies in Italy, Spain, France, and Germany to produce Sputnik V, pending approval by the European Medicines Agency, promising to deliver vaccines for 50 million Europeans from June 2021. China has also signaled further investments in vaccine donations, particularly in countries in or near the Western Balkans—as they turn towards Russia and China for COVID-19 vaccine doses amid the EU’s struggles, intensifying the EU’s geopolitical problem.

Adapting Approaches to Meet Emergent Challenges

The emergence of varied and highly transmissible mutations of the virus risk in late 2020 and early 2021 outstripped the ability of vaccines to contain the virus, led to the extension or reintroduction of lockdowns, hampered economic recovery, and overburdened health care systems. Emergent variants have further highlighted the need to prioritize vaccination rollouts amid spiking case numbers.

Also underscored is the role that effective vaccination programs can play to limit threats against democracy and misuse of global crises by corrupt leaders. Across the globe, challenges posed by the pandemic have provided governments with pretexts to consolidate power and restrict civil and human rights through measures such as imposed lockdowns, allegedly to curb high case counts or deaths.

For example, Hungarian Prime Minister Viktor Orbán assumed extraordinary emergency powers with no sunset clause to seize unchecked power.  While Orbán eventually opted to remove the most widely-condemned feature of his emergency powers in January 2021, the other elements of the measure remain in place.

Systemic challenges also exist in inequities among countries as wealthier countries stockpiled batches of vaccines despite the efforts of COVAX—a global program led by the Coalition for Epidemic Preparedness Innovation (CEPI), GAVI, the WHO, and UNICEF that aims to ensure equitable distribution of COVID-19—to help prevent vaccine stockpiling and subsequent inequities.

However, there is hope. An EU summit in March 2021 led to an agreement to improve vaccine production and distribution to its Member States and abroad.  As of mid-May 2021, COVAX has shipped more than 59 million vaccines to 122 countries. In the United States, the Biden administration launched a campaign to improve cooperation among industry rivals, increase vaccine production and distribution, promote access to reliable information, enhance cooperation with the EU, and waive vaccine patents.

Increased U.S.-EU cooperation could alleviate vaccination shortages, secure supply chains, successfully and safely develop vaccine passports, and achieve widespread resistance to the virus and its powerful variants to save lives and reopen the global economy. 

Lessons Learned for a More Equitable and Secure Future

Vaccines have the potential to mitigate the spread of the virus and help orient the world within a “new normal” post-COVID-19, but only if they are sufficiently deployed. The pandemic illustrated that political leaders, scientists, and citizens cannot operate in silos during health crises. Rather, health emergencies must be viewed as global security crises that require coordination and cooperation among all stakeholders. To reap the full health, societal, and economic benefits of vaccines, programs must be coordinated, inclusive, and equitable.

The COVID-19 pandemic demonstrates the enduring importance of the OSCE’s comprehensive approach to security: none are safe until we all are safe.

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