the geopolitics of

The geopolitics of vaccine equity

• ILONA KICKBUSCH• GRADUATE INSTITUTE GENEVA

• UNIVERSITY OF GIRONA

• WEBINAR 22. MARCH 2021

Kickbusch © Graduate Institute Geneva 2021

Health diplomacy and geopolitics 2020 focused on

World Health Organisation

• POLITVIRUS

• Proxy conflict

• Strategic weakening of multilateralism

• US CHINA conflict held up many important collective approaches to deal with COVID19

• Now in 2021 WHO is part of the solution not the key problem


Vaccine equity will be the defining global health issue in 2021

linked inextricably to geopolitics


Two promises in 2020- a global public good- fair distribution within and between countries


Vaccine diplomacy

• responding to public health crisis – crisis diplomacy WHO UN G7 G20

• creating alliances in support of health and well-beingoutcomes WHO support - COVAX

• establishing new governance mechanisms in support of health and well-being ACT-Accelerator technology pool

• building and managing donor and stakeholderrelations Solidarity Fund COVAX

• negotiating to promote health and well-being in the face of other interests – WTO vaccine IP waiver

• improving relations between countries through health and well-being – mask diplomacy vaccine diplomacy VD-GP QUAD

• contributing to peace and security No one is safe until everyone is safe


Vaccine diplomacy

• There are two types of vaccine diplomacy:

• One for global solidarityand global cooperationusing multilateral mechansims

• One for geopolitical gainand alliance building


Vaccine Diplomacy for Solidarity• The COVAX initiative is a multilateral and collaborative response to

the pandemic, promoted by several international bodies, including the United Nations, WHO, G20 and EU. International organisations and initiatives such as GAVI, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM); UNITAID and the Coalition for Epidemic Preparedness Innovations (CEPI).

• COVID19 technology access pool


ACT Accelerator initiative

• World Health Organisation (WHO) helped build a global collaboration that brings together governments, scientists, manufacturers, businesses, civil society and global health organisations in support of

• strengthening international collaboration to accelerate research and development and support efforts that will lead to the production and equitable global distribution of diagnostics, treatments and vaccines for COVID-19


COVAX donations vs pre-ordering


Vaccines



Call by scientists (BMJ March 17, 2021) immunological equity -need for a diplomatic push

Background: Global capacity to produce vaccines is about 1/3 of what isneeded – produce at scale

It must become easier for countries to produce more vaccines – presentprojections: production 2021 10-14 bill - 2/3rds for high income countries (CEPI) Announcements by companies to make doses available to LMIC

It needs initiatives that support financing and ensuring technical capacityAtra Zeneca willing to share technology Moderna patents

Requires temporary waver of IP on COVID19 vaccines as we are in a PHEIC and pooling of know how – 2/3 of WTO members support this

Projected profits: Moderna 18.5 bill Pfizer 15 bill

Vaccine nationalism

the whole world and the global economy are in crisisbecause of this approach says WHO


Vaccine diplomacy

• There are two types of vaccine diplomacy:

• One for global solidarityand global cooperationusing multilateral mechansims

• One for geopolitical gainand alliance building


Rapid geopolitical shifts


A systemscompetition and hard and soft power competition - trust


Who dealt well with COVID19 at home – shift from looking at infections and deaths to looking at vaccinations

Who contributed to global solidarity – but not only money also political support (Trips waiver, export restrictions etc.)

Who demonstrated scientific innovation –vaccine development

Who supported WHO and COVAX – possiblypandemic treaty

Who helped concretely on the spot by providing vaccines

Tensions betweenmultilateralismand self-interest: European Union• EU has been one of the main drivers and

funders of COVAX; • EU as a group has entered into bilateral

negotiations with manufacturers for the acquisition of doses for all its Member States. The EU COVID-19 vaccine strategy authorizes the European Commission to conduct these negotiations and has made available €2.7 billion for this purpose under the Emergency Response Instrument (ESI)2

• Vaccine race leads to domestic pressure” especially in comparison with USA, Israel and UK

• WTO positions


Russia:EU• “The vaccine nationalism of western

countries created the space for these other countries to practice vaccine diplomacy,”

• Yanzhong Huang CFR

• Russia has already sent its Sputnik V to Hungary and Slovakia and offered to supply 50 million more doses to Europe. On 9 March, it announced that Sputnik V will be produced in Italy from July at the factories of the Italian-Swiss pharmaceutical company Adienne in Lombardy.

• Larger destabilization agenda


China – vaccine diplomacy BRI


China plans to provide 10 million doses of COVID-19 vaccines to global vaccine sharing scheme COVAX, as three Chinese companies have applied to join the initiative for approval,

IN DIA «Share ressources, ex perience and knowledge» (PM M odi)

LeadingVaccine producer

3.5bill 2021

Vaccine diplomacyWTO trips

waiver

Vaccine diplomacy

#maitri20mill

Vaccine diplomacy

COVAXQUAD

Vaccine commercial

delivery –gov to gov


Most developed vaccine diplomacy strategy

Pharmacy of the world:Pharma and science power is becoming geopolitical power

• India supplies 62% of global demand for various vaccines

• 40% of generic demand for USA• Turnover 20.03bill USD

• History: turned the tide on Anti HIV Drugs (CIPLA) Future: digital

• Use power regionally, globally and for specific alliances


Quad IndoPacific March 2021

• Vaccine Diplomacy is everywhere: • Quad members announced plans to work

together with the World Health Organization to develop and distribute COVID-19 vaccines to one billion people in the Indo-Pacific region

• The US described the vaccine programme as “a massive joint commitment today with Indian manufacturing, US technology, Japanese and American financing and Australian logistics capability”.

• Huge investments to be made to produce a billion vaccines by next year to cater to Southeast Asia and the wider region.

• “there is no doubt India will set the rules of COVID diplomacy and be the main party to the major vaccination drives across the globe”


https://aje.aj-harbinger.com/economy/2021/3/12/quad-goals-us-indo-pacific-allies-to-up-indias-vaccine-output

https://aje.aj-harbinger.com/economy/2021/3/12/quad-goals-us-indo-pacific-allies-to-up-indias-vaccine-output

Vaccines and geopolitics

• We see systems competition played out geopolitically through different types of vaccine diplomacy

• This offers opportunities for positioning and new alliances

• Vaccine nationalism – «us first» -becomes a destabilizing factor –between HIC and between global North and South

• But: democracies must show they function at home and abroad and many are not delivering on both counts

• Context of declining democracies –(index of democracies)


Health inequitiesand vaccine accessdrive geopolitics• India's foreign minister describes his country’s vaccine

diplomacy as "Acting East. Acting fast." China is redirecting its activities along its far-reaching "Health Silk Road" to fit with the pandemic and at the multilateral level is calling for a “Community of common health”.

• French President Emmanuel Macron has recognized the geopolitical dimensions of this development and has called on Europe and the US to urgently allocate up to 5% of their current vaccine supplies to developing countries.

• Vaccine diplomacy and COVID19 impact will significantly influence G7 and G20 negotiations

• Asia is gaining strength through fighting COVID successfully (beyond China)

• New alliances will influence negotiations in the WTO and the WHO (Pandemic treaty)

• The old “developing world” is no longer – ODA is losing much of its influence


Counteract the decouplingof global health• WHO plays a key role in keeping the key global

health actors together despite their geopolitical tensions and competitions

• Its needs to be strengthened to do this work• No one is safe until all are safe


Turnaround?

• The world‘s democracies have a unique chance to show that democracies can deliver solidarity

• All out mobilization „led“ by USA (?and?)

• Multilateral whole-of-society effort to help COVAX and WHO vaccinate the world

• New pragmatic multilateralism• PLUS• EU – global pandemic treaty


the geopolitics of

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