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Global access to a COVID-19 vaccine

Covid-19 vaccine vials in a row

Covid-19 vaccine (credit: MarsBars/GettyImages)

Since COVID-19’s emergence, researchers around the world have been working to develop a potential vaccine. UKRI funding has helped the Oxford and Imperial vaccine projects reach human trial stages, and invested millions in vaccine manufacturing hubs in the UK.

Elsewhere, results from phase 3 of the Pfizer-BioNtech vaccine have provided initial evidence of its ability to prevent COVID-19.

Once a vaccine becomes available, who will have first access, how will it be distributed, and how will lower-income countries get their supply?

Dr Mark Eccleston-Turner from Keele University has been funded by the Arts and Humanities Research Council (AHRC) to investigate how a vaccine might be fairly and equitably distributed around the world.

Eccleston-Turner is approaching the subject from a legal perspective, looking at the mechanisms that could be used by high-income countries to ensure or limit the equitable distribution of any vaccine.

Why is global distribution necessary?

COVID-19 is endemic in almost every country, and a vaccine is an integral part of every nation’s response, says Eccleston-Turner.

If a vaccine isn’t made widely available to lower and middle-income countries, the virus will keep returning to the UK. There is a strong public health argument for equitable distribution.

The other imperative, Eccleston-Turner points out, is a moral one:

Why should someone who lives in a rich country have a stronger claim to a dose of vaccine than a person in the global south?

Swine Flu 2009: lessons learned

The majority of vaccine research and development, and manufacturing capability, lies in high-income countries, which then ‘dominate’ access and supply, according to Eccleston-Turner.

Developing countries may not have access to a COVID-19 vaccine without some sort of a governance framework guiding international allocation.

That is what has happened in previous pandemics, such as the 2009-H1N1 pandemic. Developing countries were reliant on donations from wealthy countries.

COVID-19, vaccines and the law

The current pandemic is a global health problem with legal implications, like the human rights challenges arising from enforced quarantines and travel bans.

Eccleston-Turner is examining the legal levers at the disposal of the UK, and other countries in the running to discover or manufacture a vaccine, that could affect how the vaccine is distributed.

States could sign contracts with manufacturers that guarantee them a portion of a vaccine, 50 million doses out of the first 100 million, for example.

But that contract law could then be overruled by export rules. A country like the UK, Japan or America could add a vaccine to an export ban list, meaning it has to stay in the country until domestic needs are satisfied.

Our project is looking at how countries could support equitable distribution of the vaccine around the world, through their own initiative or regimes like COVAX, and how they could limit this process through domestic law.

The COVAX Facility provides a platform for international cooperation to ensure equitable access to vaccines for COVID-19 in all participating countries and aims to deliver two billion doses by the end of 2021.

Read about the COVAX pillar (Gavi website).

By pooling resources, the COVAX Facility can invest in multiple vaccine candidates and enter advance purchase agreements to reserve and procure a significant number of doses. These doses will then be shared equally between all participating countries, proportionate to their populations.

The project team is working towards presenting their findings at the 2021 World Health Assembly to member states and non-governmental organisations.

Last updated: 13 November 2020

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