Governments are handling the ongoing coronavirus pandemic in a haphazard manner, with little coordination and a World Health Organization that is limited to commentary and recommendations from the side lines. Crucially, the crisis shows a fundamental lack of strategic foresight.

The existence of a vaccine would just be the beginning

Nowhere is the lack of foresight more obvious than when it comes to vaccines. Without vaccines being widely available, the outbreak is unlikely to permanently subside. Due to the time required for research, development, clinical testing and regulatory approval, coronavirus vaccines are unlikely to hit the markets before 2021.

While policy makers, experts and other stakeholders universally understand vaccination as the ultimate solution to the pandemic, one crucial issue is being overlooked: as global vaccine production capacities are limited, who will get vaccinated first and who will have to wait? Few would dispute that medical criteria should prevail, taking into account that societies differ, both in the capacities of their national health systems and in their respective social vulnerabilities.

The outbreaks of H5N1 "avian flu" and H1N1 "swine flu" in 2005 and 2009 show how, instead, purchasing power determines who gets access to the limited vaccine supply. So, couldn't governments just design an international mechanism which ensures an adequate amount of fairness and equity in distributing vaccines during the course of a viral pandemic.

Fair and equitable access to vaccines?

In fact, they already have. In 2011, the member states of the World Health Organization adopted an international instrument that requires the vaccine industry to freely share parts of its production with the international community for combating a pandemic. Unfortunately, this instrument applies exclusively to influenza viruses. During the negotiations, some governments had proposed to also include coronaviruses, yet could not garner sufficient political support.

Florian Rabitz
Foto: KTU archyvas

As we know now, this was a mistake. It's not that the health risks of coronaviruses were unknown before 2020. The 2002 and 2012 outbreaks of Several Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) were both caused by coronaviruses. However, since some World Health Organization member states attempted to limit potential costs for their domestic biomedical industries, the Pandemic Influenza Preparedness Framework remains exclusively focused on influenza viruses. The question of who gets the coronavirus vaccine first thus remains unresolved.

Considering how wealthy governments scrambled to buy up the entire market supply of vaccination during the H1N1 and H5N1 crises, it is maybe not totally surprising that we are now hearing reports about international shipments of face masks being intercepted en route by the US government.

Seeing that various governments have already introduced export controls for medical equipment, it is also an open question of how uncoordinated and unilateral policies will affect vaccine production and distribution, with manufacturers being concentrated in just a handful of countries and a significant share of active pharmaceutical ingredients being produced in China and India.

Lessons from the crisis

The global coronavirus crisis generally takes place within a vacuum of international law. Besides some rather vague rules on international coordination and reporting requirements in the 2005 International Health Regulations, there is very little that clarifies what state actions are expected, required, recommended or prohibited (just as there is not much which would exempt national lockdown measures from the requirement of legal compliance with international human rights law). However, and besides the bitter irony of concluding a legal instrument for pandemic influenza response in 2011 and facing a coronavirus pandemic in 2020, the ongoing crisis holds important lessons.

21st century global challenges, whether those are viral pandemics, antimicrobial resistance or climate change, require that effective policies and regulations are in place long before a crisis hits with full force. While nobody could have expected a coronavirus pandemic to happen in early 2020, experts have for years been pointing out the systemic risks that viruses, especially those of animal origin, pose to global health security.

While the timing and the epidemiological details are surprising, the fact itself is not. This makes it difficult to explain why governments have largely been reacting to the crisis without a clear vision and strategy that extends beyond the next few weeks of lockdown, why some of the richest countries in the world did not even possess adequate stockpiles of basic protective gear, and especially why no robust international legal framework has been put in place under the World Health Organization after the recurrent viral outbreaks of the last decades.

In addition, there are the potentially enormous costs to social welfare that result from states catering to special interest groups. In the case of the Pandemic Influenza Preparedness Framework and its exclusion of coronaviruses and other pathogens, those were the interests of the pharmaceuticals industry, but the story is very much the same for climate change and carbon-intensive economic sectors. Policies in the name of the public good may not always be popular with organized special interest groups, but, in the long run, they prove superior.

Discussions on governance reform do not help with the current crisis in the present moment. However, once the crisis has passed, there will be an opportunity to reconsider the ways in which governments and international organizations manage global risks - and, possibly, to finally take concrete steps for creating responsible and forward-looking governance structures.