The Pandemic’s “Holy Grail”, the Elusive Vaccine: For the “Global Public Good” or an Inward-looking Assertion of Vaccine Nationalism?

Commerce & Business, International Relations, Politics, Public health,, Science and society

At this point in the war on COVID-19 there are over 120 separate vaccination projects—involving Big Pharma, the public sector, academe, smaller biotech firms and NGOs—all working flat out worldwide trying to invent the ‘magical’ vaccine that many people believe will be necessary to bring the current pandemic to an end. While nothing is guaranteed (there’s still no cure for the HIV/AIDS virus around since the Eighties), the sheer weight of numbers dedicated to the single task, even if say 94% of the efforts fail, there’s still a reasonable chance of success for achieving a vaccine for coronavirus [“Former WHO board member warns world  against coronavirus ‘vaccine nationalism’”, (Paul Karp), The Guardian, 18-May-2020, www.theguardian.com].

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(Source: CEPI)

If and when the vaccine arrives, will it get to those in greatest need? The way the coronavirus crisis has been handled between nations so far doesn’t exactly give grounds for optimism. Collective cooperation on fighting the pandemic has been sadly absent from the dialogue. We’ve seen the US attack China over coronavirus’ origins with President Trump labelling it the “China virus” and the “Wuhan virus”, and China retaliating with far-fetched accusations of America importing the virus to Wuhan via a visiting military sporting team, and the whole thing becoming entwined in a looming trade war between the two economic powers.
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(source: www.socioecomonics.net)

The advent of COVID-19 has introduced us to terms such as “contact tracing”, “social distancing”, “covidiot” and the like, but recently we‘ve been hearing a new term thrown about, one with more ominous implications – “vaccine nationalism”. As the scattered islands of scientific teams continue the hunt for the “silver bullet” that presumably will fix the disease, there is a growing sense that the country or countries who first achieve the breakthrough will adopt a “my nation first” approach to the distribution of the vaccine. There are multiple signs that this may be the reality…the US government has launched the curiously named “Operation Warp Speed”, aimed at securing the first 300 million doses of the vaccine available by January 2021 for Americans [‘Trump’s ‘Operation Warp Speed’ Aims to Rush Coronavirus Vaccine’, (Jennifer Jacobs & Drew Armstrong), Bloomberg, 30-Apr-2020, www.bloomberg.com]. In the UK Oxford University is working with biopharma company AstraZeneca to invent a vaccine that will be prioritised towards British needs.

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(Source: IndiaMart)

A “vac race”
Not to be outdone, China, operating through Sinovac Biotech, is at the forefront of testing potential cures for COVID-19. The pressing need for a vaccine to safeguard its own population aside, Beijing’s rationale includes a heavy investment in national pride and the demonstration of Chinese scientific superiority (cf. Trump’s motivation). The Sino-US rivalry over finding a cure for the pandemic has been compared to the Cold War era ”Space Race” between the US and the USSR (Milne & Crow). A political war of superpower v superpower on a new battlefield…noted as bring part of a longer trend of the “securitisation of global health “ where the health objective increasingly has to share the stage with issues of national security and international diplomacy (E/Prof Stuart Blume, quoted in ibid.).

An environment of competition in lieu of collaboration
Even prior to the start of serious talk about the vaccine, the coronavirus crisis was provoking an “everyone for themselves”, non-cooperative approach. With the onset of equipment shortages needed to combat the virus outbreak, an international bunfight developed over access to PPE (personal protection equipment). 3M masks destined for Germany were intercepted by the White House and re-routed to US recipients; French president, Emmanuel Macron, seized millions of masks that were on route to Sweden; Trump purportedly tried to buy CureVac, a German biopharma company working on the vaccine [‘Why vaccine ‘nationalism’ could slow the coronavirus fight’, (Richard Milne & David Crow), Financial Times, 14-May-20320, www.ft.com/]. India (under Hindu nationalist Modi), the world’s largest supplier of hydroxychloroquine (touted as a cure for the virus), withheld it from being exported. As part of this neo-protectionism of the corona medical trove, more than 69 countries banned the export of PPE, medical devices and medicines [‘A New Front for Nationalism: The Global Battle Against a Virus’, (Peter S Goodman, Katie Thomas, Sui-Lee Wee & Jeffrey Gettleman), New York Times, 10-Apr-2020, www.nytimes.com].

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Politics and economics over science and global health?
Will narrow self-interest and economic advantage prevail? Will Big Pharma sell the virus panacea to the highest bidders? A zero-sum game  in which those who can’t afford the cost fall by the wayside? There are precedents…the distribution of the H1N1 vaccine for the 2009 Swine Flu was predicated on the purchasing power of the higher-income countries, not on the risk of international transmission [‘The Danger of Vaccine Nationalism’, (Rebecca Weintraub, Asaf Britton & Mark L Rosenberg), Harvard Business Review, 22-May-2020, www.hbr.org/]. The availability of the vaccine is seen as integral to restarting the global economy (Milne & Crow).

The eclipse of multinationalism?
With WHO in the eyes of some international players seemingly tarnished by its relationship with China, and by Trump’s undermining of its effectiveness by threatening to withdraw American support, multilateralism is on the back foot. There have been some attempts to stem the tide, CEPI (Coalition for Epidemic Preparedness Innovations’), with a mission of promoting a collective response to emerging infectious diseases, is trying to advance both the development of coronavirus vaccines and equitable access to them (http://cepi.net/).

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Getting to an “equitable distribution” of the vaccine
As CEPI recognises, and is committed to redressing, there is no formal mechanism in existence for fairly distributing vaccines for epidemics…one step being taken is to try to get  an equitable distribution strategy accepted by the G20 nations. The only way forward to ensure that allocation is fair and prioritised according to needs is through a coordinated global effort (Milne & Crow; Weintraub eg al).

The fear is thus well founded that if and when a vaccine is discovered and developed, the richer nations will secure a monopoly over it and prevent it getting to poorer nations where it would be urgently needed by the elderly, the immunocompromised and the “first responder” health workers. There are many who hope fervently that a different scenario will be played out, that a more enlightened type of self-interest will prevail. This would require the wealthier countries seeing the bigger picture – the danger that if they don’t redistribute the cures, the outcome will be an adverse effect on the global supply chain and on the world‘s economies. As Gayle Smith (CEO of “One Campaign“, a Washington-based NGO fighting extreme poverty) put it: it is in the richer countries‘ own interests ”to ensure that the virus isn’t running rampant in other countries” (Milne and Crow). “If an international deal can be reached“, CEPI CEO Dr Richard Hatchett said, ”Everyone will win, if not, the race may turn into a free-for-all” with the losers in plain sight [‘Why the race for a Covid-19 vaccine is as much about politics as it is about science’, (Paul Nuki), The Telegraph (UK), 10-Apr-2020, www.telegraph.co.uk].

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(Source: www.euroweeklynews.com)

PostScript: Its no done deal! – reining in the wave of vaccine optimism
Even some of the scientists working on developing a vaccine are less than sanguine about the prospects. As immunologist Professor Ian Frazer (UQld) explains: there is no model of how to attack the virus. Trying to come up with a vaccine for upper respiratory tract diseases is complicated due to “the virus landing on the outside of you”, as we have seen with the common cold. What’s needed is “an immunise response which migrates out to where (the coronavirus) lands” [‘No vaccine for coronavirus a possibility’, (Candace Sutton), News, 19-Apr-2020, www.news.com.au].

 

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a matter of getting “the maximum shots on goal” as Jane Halton, a former member of the WHO board, put it
with Trump aided and abetted in this mission by Peter Navarro (who Bloomberg calls “Trump’s Trade Warrior”) enthusiastically leading the charge in the undeclared trade war with China
with funding from the Bill and Melinda Gates Foundation

The Kerala COVID-19 Template: How to Lead in the Fight against a Pandemic

Comparative politics, Natural Environment, Politics, Public health,

When the coronavirus pandemic eventually reached India, it was always going to pose a challenge of epic proportions for a country of 1.3+ billion people, with such a dense population domiciled  in such close quarters, and with a widespread underbelly of poverty. The Spanish flu of 1918 inflicted a death toll on India in the many millions, something no doubt in the back of the minds of public health officials. So, two or three months into the crisis, on paper, India’s COVID-19 record, on paper, doesn’t look as frightening as many other nations. As at 17-May-2020, so far it has had a shade under 91 thousand confirmed cases and a total of 2,872 deaths (www.worldometers.info).

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(Photo: Indranil Mukherjee / Agence France-Presse – Getty Images)

There is a perception within medical circles however that these figures don’t portray the full extent of the outbreak. India’s urban areas are packed with masses of people living face to face, beset with poor sanitation conditions, up to 100 people sharing the same toilet in some cases, adding up to a recipe for catastrophe in plague time. Obtaining a test for coronavirus in India has tended to not be straightforward, thus the level of testing has lagged woefully behind what is desirable, eg, by well into March India was averaging only five tests per ten lakhs (one million) people, compared with South Korea which had managed 4,800 per ten lakhs.

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Too many migrant workers waiting for too few buses to take them home after the lockdown was announced (Photo: Yawar Nazir – Getty Images)

Containment measures have been far short of perfect, and with some glaring omissions…there has been passive resistance to the lockdowns from sceptical Indians, and the ban on public gatherings has from time to time been skirted round (some ‘scofflaw’ political parties continue to hold mass rallies). Although India’s borders were closed fairly promptly, some have been critical of the procrastination of Indian leaders’ during the crucial early days of the crisis, one Indian epidemiologist characterised it as a “let’s wait till tomorrow” attitude [‘India Scrambles to Escape a Coronavirus Crisis. So Far It’s Working’, (J Gettleman, S Raj, KD Singh & K Schultz), New York Times, 17-March-2020, www.nytimes.com]. This early reticence to act emanated from Delhi. The Modi BJP government, initially seemingly more concerned with the impact on India’s under-performing economy, issued no public health warnings or media briefings at the onset of the pandemic [‘What the world can learn from Kerala about how to fight covid-19’, (Sonia Faleiro), MIT Technology Review, 13-Apr-2020, www.technologyreview.com].

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(www.anayahotels.com)

Kerala, leading from the periphery
Kerala is one state that these general criticisms of Indian public health efforts against COVID-19 cannot be levelled. The small southwestern Indian state is one of the most picturesque parts of the land with its coconut trees and irenic and serene back-waterways. Known as a tourist mecca, Kerala, population 35 million, is more affluent than many parts of India (GDP per capital GB£2,200). 20% of India’s gold is consumed here, and it produces over 90% of the country’s rubber. Literacy is nearly 20% higher than the overall Indian average, and life expectancy too, is higher (www.holidify.com). All of these were contributing factors buttressing Kerala’s capacity to cope with the disease when it came.

Local vulnerabilities to the epidemic
Kerala was coronavirus “ground zero” for India’s very first patients. Three students returning from Wuhan were tested positive and hospitalised (in all 70% of the state’s total virus patients have come from outside India). Certain preconditions pertaining to the state exacerbated the risk of disease outbreak, including a large number of Keralite migrant workers in the Gulf states, a huge expat population (working in Kerala from other Indian states), porous borders, and an early summer monsoon season (contributing to Kerala’s high rate of annual communicable diseases) [‘Coronavirus: How India’s Kerala state flattened the curve’, (Soutik Biswas), BBC News, 16-Apr-2020, www.bbcnews.com].

Preparation and planning
Kerala was prepared for COVID-19 before the onset of the disease. The earlier Nipah viral outbreak (NiV) In Kerala (2018) proved a good trial run for the health service, giving the local authorities an opportunity to iron out chinks in it. Kerala’s communist-left coalition  government had established a strong social welfare foundation, investing in the state’s infrastructure with a focus on health and education, and on tackling the state’s poverty. [‘How the Indian State of Kerala flattened the coronavirus curve’, (Oommen C Kurian), Guardian,  21-Apr-2020, www.theguardian.com].

Minister Shailaja (Source: www.manoramonline.com)

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Shailaja ‘Teacher’, a woman with a plan
When the epidemic arrived in Kerala, the proactive state health minister KK Shailaja took charge. With the full backing of Kerala chief minister, Pinarayi Vijayan, she had already organised a rapid response team to focus on targeted clusters, and liaised with the provincial councils. Kerala adopted the WHO protocols of test, trace, isolate and support. Rigorous contact tracing was employed, utilising detailed “route maps”. Testing of suspected carriers was decisive, with a quick, 48-hour turnaround of the result [‘Kerala has best coronavirus test rate in the country, but is it enough?’, (Vishnu Varna), The Indian Express, 01-Apr-2020, www.indianexpress.com], allowing them to move quickly on to the quarantine phase. 17,000 people were quarantined under strict surveillance, the poor without quarantine facilities were placed in improvised isolation. Recovered patients were duly released back into the community. Quarantine compliance was achieved through an admixture of phone monitoring (>340,000 calls and a neighbourhood watch system [‘The coronavirus slayer! How Kerala’s rock star health minister helped save it from Covid-19’, (Laura Spinney), The Guardian, 14-May-2020, www.theguardian.com; Kurian].

One of the sternest challenges, very early on, came from the district of Pathanamthitta. A family returning from Italy tested positive, but refused to disclose their movements upon return to Kerala. The civil servant in charge of the district, PB Nooh, and his team, worked round this obstacle by accessing the family’s GPS phone data, allowing them to trace all of their contacts (almost 300 people!). Nooh’s staff then tested the contacts for infection, thus shutting down the risk of the virus being exponentially transmitted to others in the community, ie, “breaking the chain” (Faleiro).

The coronavirus certainly didn’t miss Kerala, one-fifth of all Indian cases of the disease have occurred in the state. Under Shailaja, Kerala hit the ground running, before the end of January, screenings of arrivals at all four of the state’s international airports was introduced. The government imposed a lockdown even before the national lockdown was called…schools, malls, cinemas, public gatherings, were closed down, and the lockdown was stricter and longer than the national one (Kurian). Face masks were distributed to slum dwellers. Planning was precise and focused, a state stimulus package of Rs20,000 crore was directed towards the economic and medical crises.The medical task force was mobilised (doctors on leave were recalled, others asked to delay their leave). Those suffering hardship included migrant workers from other states were provided with free lunches by the state.

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Communication with citizens informing them about all aspects of the crisis was clear and consistent (“Break the Chain” campaign which emphasises public and personal hygiene). Accordingly, community participation, both voluntary and active, was forthcoming. Some Keralites made accommodation available (including vacant homes in some instances) to those in need when requested to by the government [‘The Kerala Way of Tackling a Pandemic’, Times of India, 20-Mar-2020, www.timesofindia.com].

The Kerala government’s campaign against the virus has been aided by the polity’s decentralised nature of it’s structures. The coordination achieved allows the local councils to follow through on a lot of the public health measures needed to be implemented in the crisis (Biswas). The result of all this detailed planning and effort by Kerala – 587 confirmed cases and only four deaths and apparently no significant community transmissions (17-Apr-2020).

The state of Kerala and Shailaja ‘Teacher’ (so known because her occupation before entering politics was that of science teacher) are not resting on their laurels, being very mindful of the chance of a second wave of COVID-19 due to impending factors—Prime Minister Modi’s anticipated ending of the national lockdown, which will trigger a mass return of Kerala’s migrant workers based in the Gulf, and the approach of the tropical wet season in Kerala (June) [‘Kerala Lays Down Specific Plans To Tackle Monsoon Amid COVID-19 Pandemic’, NDTV, 15-May-2020, www.ndtv.com]. Minister Shaijala has been making preparations for such an event, many of the state’s teachers have been retrained as nurses to cope with a new upsurge in virus hotspots (Spinney).

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EndNote: No time for Kerala complacency but a most worthy blueprint on offer 
The threat of new clusters emerging in Kerala remains very real, especially coming from outside, with a spike as recent as this past Friday—imported from neighbouring Tamil Nadu and Maharashtra as well as from overseas—reminding Shailaja and Co that the battle’s still far from won. Nonetheless, for elsewhere in India and beyond, there are lessons from Kerala‘s formidable achievement to be had from the state’s “nimble-footed, community-oriented, cautiously-aggressive approach” to the outbreak [Kurian; ‘Kerala reports 11 new Covid-19 cases’, (Ramesh Babu), Hindustan Times,16-May-2020, www.hindustantimes.com].

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the Kerala government is Marxist in ideology but pragmatic in practice, it’s policies are moderately social-democratic, with a highly-privatised public health system (Kurian)