Public opinion on global COVID-19 vaccine procurement and distribution policies: A nationally representative survey in Aotearoa New Zealand 2022.

The World Health Organisation and many health experts have regarded vaccine nationalism, a "my country first" approach to vaccines procurement, as a critical pandemic response failure. However, few studies have considered public opinion in this regard. This study gauged public support for vaccine nationalism and vaccine internationalism in a representative survey in New Zealand (N = 1,135). Support for vaccine internationalism (M (mean rating) = 3.64 on 5-point scales) was significantly stronger than for vaccine nationalism (M = 3.24). Additionally, support for openly sharing COVID-19 vaccine manufacturing knowledge and technology (M = 4.17 on 5-point scales) was significantly stronger than support for safeguarding vaccine manufacturers' intellectual property (M = 2.66). The public also supported a utilitarian approach that would see distributions based on need (M = 3.76 on 5-point scales) over an equal proportional international distribution (M = 3.16). Akin to the few preceding studies, the present observations suggest that the public is likely to be more supportive of pandemic responses that are globally equitable and long-term orientated. Our findings have substantial implications for pandemic preparedness as the congruence or lack thereof of public vaccine-related values with government policies can affect public trust, which, in turn, can affect public cooperation. It may pay for governments to invest in proactive public engagement efforts before and during a pandemic to discuss critical ethical issues and inequities in global vaccine procurement and distributions.

Vaccine nationalism is not unethical from a political ethics perspective: Learning from the global COVID-19 vaccine distribution failure.

During the COVID-19 pandemic, there was an apparent conflict between medical and political ethics regarding the ethical evaluation of vaccine nationalism - the "My Country First" vaccine allocation policy. Medical ethics sees this policy as selfish, leading to an unequal global vaccine allocation. Political ethics, however, argues that this policy is in the national interest and should not be labeled unethical. This conflict is one of the fundamental reasons why various medical ethics-based global vaccine allocation schemes, including the COVID-19 Vaccines Global Access Facility, have been difficult to implement. As long as the international community remains composed of different countries, vaccine nationalism will be difficult to eradicate. Therefore, international organizations, including World Health Organization, should focus on universal vaccine access rather than allocation based solely on medical ethics. Countries, especially low-income countries, must strengthen vaccine-related capacity-building to immunize their citizens as early as possible. Otherwise, they may still be at the bottom of the global vaccine allocation queue when the next globally challenging outbreak occurs. High-income countries should work to expand the distribution of vaccines, including donating vaccines to countries that lack them, helping other countries set up vaccine factories, and sharing vaccine production technology and intellectual property, which is the right choice from medical and political ethics perspectives.

Vaccine Nationalism Counterintuitively Erodes Public Trust in Leaders.

Global access to resources like vaccines is key for containing the spread of infectious diseases. However, wealthy countries often pursue nationalistic policies, stockpiling doses rather than redistributing them globally. One possible motivation behind vaccine nationalism is a belief among policymakers that citizens will mistrust leaders who prioritize global needs over domestic protection. In seven experiments (total N = 4,215 adults), we demonstrate that such concerns are misplaced: Nationally representative samples across multiple countries with large vaccine surpluses (Australia, Canada, United Kingdom, and United States) trusted redistributive leaders more than nationalistic leaders-even the more nationalistic participants. This preference generalized across different diseases and manifested in both self-reported and behavioral measures of trust. Professional civil servants, however, had the opposite intuition and predicted higher trust in nationalistic leaders, and a nonexpert sample also failed to predict higher trust in redistributive leaders. We discuss how policymakers' inaccurate intuitions might originate from overestimating others' self-interest.

Ética y negociaciones para el acceso a vacunas: excepcionalismos metodológicos y éticos

Propósito/Contexto. En este artículo se analizan los distintos factores que han afectado el acceso a las vacunas para la prevención de la infección por SARS-CoV-2, con particular atención a los intereses que atraviesan las negociaciones. Se detalla un análisis de los procesos de investigación, producción, contratación, distribución y comercialización de vacunas, así como las normas éticas internacionales que orientan estas prácticas. Metodología/Enfoque. De igual modo, se identifican un marco de excepciones científicas, metodológicas, éticas y legales para la investigación, la producción y la comercialización de vacunas, al tiempo que se ha mantenido y profundizado, sin excepciones, las normas impuestas por el sistema global de mercado en lo referente a protección de propiedad intelectual (Adpic), negociaciones y contratos, defensa de intereses privados y de las empresas. También se pone en evidencia el rol que han tenido los países más ricos, acumulando más dosis de las necesarias, lo cual impactó seriamente en el acceso de los países de bajos ingresos. Resultados/Hallazgos. Se analizan las normas éticas internacionales y los acuerdos realizados por los gobiernos que deberían limitar conductas como estas, evitar sus consecuencias y que no han sido cumplidas. Discusión/Conclusiones/Contribuciones. Se concluye con una propuesta concreta que podría aliviar la situación actual y se incluye una reflexión sobre el impacto en la vida y la salud de los países y los grupos más vulnerables, si el orden internacional sigue regido por el sistema global de mercado en lugar de un nuevo pacto global más justo.

Purpose/Context. This article discusses the various factors that have affected access to vaccines for the prevention of SARS-CoV-2 infection, with particular attention to the interests involved in the negotiations. An analysis of the processes of vaccine research, production, procurement, distribution, and marketing is detailed, as well as the international ethical standards that guide these practices. Methodology/Approach. Similarly, a framework of scientific, methodological, ethi-cal and legal exceptions for research, production and commercialization of vaccines is identified, while the rules imposed by the global market system regarding intellec-tual property protection (TRIPS), negotiations and contracts, defense of private and corporate interests have been maintained and deepened without exceptions. It also highlights the role played by the richest countries, accumulating more doses than necessary, which seriously impacted the access of low-income countries. Results/Findings. The international ethical norms and agreements made by gover-nments that should limit conducts such as these, avoid their consequences and that have not been complied with, are analyzed. Discussion/Conclusions/Contributions. It concludes with a concrete proposal that could alleviate the current situation and includes a reflection on the impact on the life and health of the most vulnerable countries and groups, if the international order continues to be governed by the global market system instead of a new and fairer global agreement.

Finalidade/Contexto. Este artigo discute os vários factores que afectaram o acesso às vacinas para a prevenção da infecção pelo SRA-CoV-2, com especial atenção para os interesses envolvidos nas negociações. Detalha uma análise dos processos de investigação, produção, aquisição, distribuição e comercialização de vacinas, bem como as normas éticas internacionais que orientam estas práticas. Metodologia/Aproximação. Do mesmo modo, é identificado um quadro de excepções científicas, metodológicas, éticas e legais para a investigação, produção e comercialização de vacinas, enquanto as regras impostas pelo sistema de mercado global em termos de protecção da propriedade intelectual (Adpic), negociações e contratos, defesa de interesses privados e empresariais foram mantidas e aprofundadas sem exceções. Salienta também o papel desempenhado pelos países mais ricos, acumulando mais doses do que as necessárias, o que teve um sério impacto no acesso dos países de baixos rendimentos. Resultados/Findings. Normas e acordos éticos internacionais feitos pelos governos que deveriam limitar comportamentos como este e evitar as suas consequências são analisados e não têm sido cumpridos. Discussão/Conclusões/Contribuições. Conclui com uma proposta concreta que poderia aliviar a situação actual e inclui uma reflexão sobre o impacto na vida e saúde dos países e grupos mais vulneráveis, se a ordem internacional continuar a ser regida pelo sistema de mercado global em vez de um novo pacto global, mais justo.

Global COVID-19 vaccine inequity: Preferences for overseas vaccine donations over booster shots.

As the supply of COVID-19 vaccines to low-income countries (LICs) remains limited, governments of high-income countries face a trade-off between domestic containment through booster shots and global containment by helping LICs acquire first doses ("vaccine nationalism" vs "vaccine internationalism"). We provide empirical evidence on how residents of a high-income country view this ethical dilemma by surveying 1527 UK adults recruited online. Support for vaccine donations to LICs is high. On average, study participants chose to donate 65% of UK's COVID-19 vaccines, which were ordered for booster shots, to LICs. Holding all other factors constant, women, younger individuals, and those who are not fully vaccinated preferred to donate a larger percentage to LICs. The UK public's preferences for prioritizing vaccine donations over booster shot programs suggest broad support for national policies that strike a balance between domestic containment and global philanthropy.

Vaccine nationalism will persist: global public goods need effective engagement of global citizens.

Covid-19 presents a unique opportunity to transform democratic engagement in the governance of global public goods. In this paper, I describe a global public goods framework and how it relates to Covid-19 vaccines, and summarize some of the global responses to Covid-19. I discuss some of the global threats to health and prosperity posed by the inequitable distribution of vaccines, and propose transformative thinking to democratically engage citizens in the governance of global public goods. In recent years, public-private partnerships and philanthropic organizations have successfully stepped in to help international organizations like the UN and WHO provide global public goods, but they are not democratically elected or publicly accountable. Global public goods are critical to addressing Covid-19, future pandemic preparedness, global health policy, health equity, and the unfolding climate crisis. To make us more resistant and resilient to future global health crises we need transformative thinking to democratically engage global citizens. We need to lay the foundations for a 'global social contract' on global public goods.

Solidarity across borders: A pragmatic need for global COVID-19 vaccine equity.

The COVID-19 pandemic is one of the most disruptive social, political and economic crises of the modern era. In today's interconnected world, the pandemic shows how quickly infectious disease outbreaks can spread across continents. Since the initial outbreak, the introduction of several vaccines has brought hope to a virus-weary world. In spite of the remarkable results of approved vaccines, many lower-middle countries are yet to receive a single vaccine shot. This manuscript highlights the fact that global health inequities have intensified during the pandemic. While many wealthy nations have ramped up vaccination efforts and cautiously opened their borders, many in the developed world are still waiting to be inoculated. With the rise of several resistant variants, this work argues that public health policy experts demand a greater need for global solidarity in vaccine access. This is not only important ethically, but it is also a pragmatic response.

We Charge Vaccine Apartheid?

Vaccine apartheid is creating conditions that make for premature death, poverty, and disease in racialized ways. Invoking vaccine apartheid as opposed to euphemisms like vaccine nationalism, is necessary to highlight the racialized distributional consequences of vaccine inequities witnessed with COVID-19. This commentary clarifies the concept of vaccine apartheid against the historical and legal usage of apartheid. It reflects on the connections and important disjunctions between the two. It places the intellectual property regime under heightened scrutiny for reform and transformation. This commentary finds that drawing on the intersections between a human rights and health justice approach can provide creative and novel approaches for anti-subordination. It concludes that acknowledging and naming the structural injustice of vaccine apartheid is only the first step towards providing redress.

Building mass support for global pandemic recovery efforts in the United States.

Containing the COVID-19 pandemic will confer global benefits that greatly exceed the costs but effective solutions require the redistribution of vaccines, technology, and other scarce resources from high-income to low-income countries. The United States has played a central role in coordinating responses to previous global health challenges, and its policy choices in the current pandemic will have a far-reaching impact on the rest of the world. Yet little is known about domestic support for international recovery efforts. We use a series of conjoint and persuasive messaging experiments, fielded on two national surveys of the US adult population (N = 5,965), to study mass support for international redistribution. We find clear evidence that the general population strongly supports allocating vaccines to own-country recipients before others. But despite this "vaccine nationalism," Americans are also willing to support the US government playing a major role in global pandemic recovery efforts, provided policymakers forge international agreements that ensure moderate domestic costs, burden-sharing with other countries, and priority for certain types of resources, such as domestically manufactured vaccines and patent buyouts. Finally, we test five different persuasive messaging strategies and find that emphasizing the relatively low costs and large economic benefits of global vaccination is the most promising means of increasing domestic support for international redistribution. Overall, our results demonstrate that policymakers can secure broad public support for costly international cooperation by crafting responses aligned with the economic interests of the United States.

Guarding against COVID-19 vaccine hesitance in Ghana: analytic view of personal health engagement and vaccine related attitude.

Vaccination is the most effective preventive measure against COVID-19 spread. While the WHO and other stakeholders fear vaccine nationalism, vaccine-hesitancy has become a topical issue among experts. Based on the evidence of vaccine hesitancy among Blacks, we explore the interrelatedness of psycho-social factors (personal health engagement, fear of COVID-19, perceived susceptibility, and vaccine-related attitude) likely to thwart vaccine acceptance in Africa. We sampled 1768 Ghanaian adults over 2 weeks from December 14, 2020, the first day a successful COVID-19 vaccine was administered in the US using an online survey. A higher level of personal health engagement was found to promote vaccine-related attitudes while reducing COVID-19 related fears, susceptibility, and vaccine hesitancy. Fear of COVID-19 and perceived vulnerability are significant contributors to the willingness to accept vaccination. This is an indication that health engagement alone will not promote vaccination willingness, but the fear and higher level of perceived susceptibility out of personal evaluation are essential factors in vaccination willingness. We recommend promoting health educational messages on COVID-19 vaccination ahead of any vaccination rollout in Africa, and such messages should contain some element of fear appeal.

Brief communication International cooperation in a non-ideal world: the example of COVAX.

The world witnessed one of the fasted responses in history to a new disease in terms of drug and vaccine development. However, despite the fact that safe and effective vaccines for COVID-19 were developed at a remarkable pace, international cooperation seems to have failed regarding the global equitable allocation of vaccines. This article explores challenges to international cooperation in global health and specifically to the fair allocation of vaccines at a global scale. We will present major obstacles to cooperative efforts and an interesting answer such as the COVAX facility, a cooperative redistribution scheme that has recently been launched by WHO, CEPI and Gavi. Considering COVAX a laudable and necessary first step to improve international cooperation in health, we nevertheless argue that the facility needs to identify key areas of potential improvement.

O mundo foi testemunha de uma das respostas mais rápidas da história a uma nova doença em termos de desenvolvimento de medicamentos e vacinas. No entanto, apesar do facto de que as vacinas seguras e eficazes para COVID-19 foram desenvolvidas a um ritmo notável, a cooperação internacional parece ter falhado no que diz respeito à distribuição global equitativa de vacinas. Este artigo explora os desafios para a cooperação internacional em matéria de saúde global e, especificamente, para a distribuição justa de vacinas à escala global. Apresentaremos os principais obstáculos aos esforços cooperativos e uma resposta interessante, como o mecanismo COVAX, um esquema de redistribuição cooperativa que foi lançado recentemente pela OMS, CEPI e Gavi. Considerando o COVAX como um primeiro passo louvável e necessário para melhorar a cooperação internacional em saúde, argumentamos que o mecanismo precisa de identificar as áreas de potencial melhoria.

El mundo ha sido testigo de una de las respuestas más rápidas a una nueva enfermedad, en términos de desarrollo de drogas y vacunas. Sin embargo, pese al hecho de que se han desarrollado vacunas seguras y efectivas para el COVID-19 a un paso impresionante; la cooperación internacional en relación al acceso equitativo a las vacunas parece haber fallado. Este artículo explora los desafíos a la cooperación internacional que se plantean en relación a la salud global y, específicamente, a la distribución justa de vacunas a escala global. Presentaremos algunos obstáculos a los esfuerzos cooperativos, así como también una respuesta interesante como lo es la del mecanismo COVAX, un sistema cooperativo de redistribución que ha sido recientemente introducido por la OMS, CEPI y GAVI. Aunque consideramos a COVAX un primer paso meritorio y necesario para mejorar la cooperación internacional en salud; argumentamos que el mecanismo necesita identificar áreas de mejora.

Global impact of vaccine nationalism during COVID-19 pandemic.

Vaccines are the best chance to control the pandemic-unless leaders succumb to vaccine nationalism. Vaccine nationalism is a frequent recurrence, especially during a brand-new market distribution. The development of safe and effective COVID-19 vaccines in such a short space of time is a testament to modern scientific abilities. It will also test the world's political will and moral commitment to end this pandemic. As desperate as the COVID-19 pandemic, vaccine nationalism is already setting a foundation for itself and is considered socially and economically counterproductive. Vaccine equity is not just a theoretical slogan, and it protects people worldwide from new vaccine-resistant variants. Understanding and anticipating the consequences is vital, and creating a global solution approach to avoid them. This article evaluates the common issues previously faced and the plausible ones during this pandemic. A few recommendations are made to warn and accentuate the reality of this dire matter.

COVID-19 vaccine demand, hesitancy, and nationalism: a case of protection motivation behavior in Bangladesh.

INTRODUCTION: Immunization, as a process of fighting against the COVID-19, has gained important research appeal, but very limited endeavor has been paid for vaccine behavioral studies in underdeveloped and developing countries. This study explores the vaccine demand, hesitancy, and nationalism as well as vaccine acceptance and domestic vaccine preference among young adults in Bangladesh. METHODOLOGY: This quantitative study followed the snowball sampling technique and collected responses from 1,018 individuals from various social media platforms. The analysis covered both descriptive and inferential statistics including chi-square, F-statistic, and logistic regression. RESULTS: The findings of the fully-adjusted regression model suggest that the individuals who had more vaccine demand were 3.29 times (95% confidence interval = 2.39-4.54; p < 0.001) higher to accept vaccine compared to those who had no vaccine demand. Conversely, vaccine hesitancy was negatively associated with vaccine acceptance. Here, the odds ratio was found 0.70 (95% confidence interval = 0.62-0.80; p < 0.001), which means that those who had higher vaccine hesitancy were about 30% less likely to accept vaccines than those who had no hesitancy. In addition, the persons who had vaccine nationalism were 1.75 times (95% confidence interval = 1.62-1.88; p < 0.001) more prone to prefer domestic vaccine. CONCLUSIONS: This study suggests that policymakers may take initiatives for making people aware and knowledgeable about the severity and vulnerability to specific health threats. In this concern, perception and efficacy-increasing programs may take part in increasing protection motivation behaviors like vaccine acceptance and (domestic) vaccine preference.

COVID-19 vaccines and vaccination: how prepared is Africa?

The approval of vaccines for emergency use signifies a great milestone to end the COVID-19 pandemic. However, less than 2% of the global vaccines have been administered in Africa, putting the continent in a precarious situation in the eventuality of another wave that may consume its health system. There is still an enormous task in Africa in the face of vaccine nationalism. In most countries, vaccine acquisition and deployment have been suboptimal. Leaving out Africa in the race to achieve global herd immunity may be catastrophic. Stakeholders must continue engagement to ensure a successful deployment of the vaccines on the continent. There is a need to build capacity in Africa for rapid vaccine development and deployment in the long term.

The Vaccination Cold War.

Surveying the early responses to the Covid-19 pandemic among nation states, one finds a veritable babel of responses, some predictable and some not. Would these results have been different half a century or more ago, when smallpox was eradicated and hopes were high that international cooperation would yield similar results for other infectious diseases? Is this a story about the stability provided by the bipolar postwar world, juxtaposed with the complex geopolitical repositioning that finally followed the collapse of the Soviet Union, or is that too rich an irony? A multipolar world may indeed be less prepared to cope with an international health crisis than a bipolar one. In any case, the patterns of global response are not only reminiscent of the Cold War era itself but also suggestive of a new vaccination cold war.

International cooperation in a non-ideal world: the example of COVAX / Cooperação internacional num mundo não ideal: o exemplo do COVAX / Cooperación internacional en un mundo no ideal: el ejemplo de COVAX

The world witnessed one of the fasted responses in history to a new disease in terms of drug and vaccine development. However, despite the fact that safe and effective vaccines for COVID-19 were developed at a remarkable pace, international cooperation seems to have failed regarding the global equitable allocation of vaccines. This article explores challenges to international cooperation in global health and specifically to the fair allocation of vaccines at a global scale. We will present major obstacles to cooperative efforts and an interesting answer such as the COVAX facility, a cooperative redistribution scheme that has recently been launched by WHO, CEPI and Gavi. Considering COVAX a laudable and necessary first step to improve international cooperation in health, we nevertheless argue that the facility needs to identify key areas of potential improvement.

O mundo foi testemunha de uma das respostas mais rápidas da história a uma nova doença em termos de desenvolvimento de medicamentos e vacinas. No entanto, apesar do facto de que as vacinas seguras e eficazes para COVID-19 foram desenvolvidas a um ritmo notável, a cooperação internacional parece ter falhado no que diz respeito à distribuição global equitativa de vacinas. Este artigo explora os desafios para a cooperação internacional em matéria de saúde global e, especificamente, para a distribuição justa de vacinas à escala global. Apresentaremos os principais obstáculos aos esforços cooperativos e uma resposta interessante, como o mecanismo COVAX, um esquema de redistribuição cooperativa que foi lançado recentemente pela OMS, CEPI e Gavi. Considerando o COVAX como um primeiro passo louvável e necessário para melhorar a cooperação internacional em saúde, argumentamos que o mecanismo precisa de identificar as áreas de potencial melhoria

El mundo ha sido testigo de una de las respuestas más rápidas a una nueva enfermedad, en términos de desarrollo de drogas y vacunas. Sin embargo, pese al hecho de que se han desarrollado vacunas seguras y efectivas para el COVID-19 a un pasoimpresionante; la cooperación internacional en relación alacceso equitativo a las vacunas parece haber fallado. Este artículo explora los desafíos a la cooperación internacional que se plantean en relación ala salud global y, específicamente, a la distribución justa de vacunas a escala global. Presentaremos algunos obstáculos a los esfuerzos cooperativos,así como también una respuesta interesante como lo es la del mecanismo COVAX, un sistema cooperativo de redistribución que ha sido recientemente introducido por la OMS, CEPI y GAVI. Aunque consideramos a COVAX un primer paso meritorio y necesario para mejorar la cooperación internacional en salud; argumentamos que el mecanismo necesita identificar áreas de mejora.

Vaccine alliance building blocks: a conjoint experiment on popular support for international COVID-19 cooperation formats.

The design principles of institutions that visibly and significantly affect citizens' lives are likely to be politically salient. Popular support for these principles is in turn crucial for institutional viability and effectiveness. Transboundary pandemics are a case in point. Understanding citizens' preferences regarding the design of international alliances set up to mass-produce and distribute vaccines is likely to determine citizens' subsequent cooperation with vaccination campaigns. This study explores Germans' preferences for international COVID-19 vaccine alliance design principles. We conducted a conjoint experiment at a recurring cognitive moment in many pandemics' cycles, between the initial outbreak and a more devastating but still-unknown second wave, when infection rates were very low, yet no policy solutions had been developed. We analyzed preferences regarding four building blocks: (1) alliance composition (size; EU-centrism), (2) alliance distribution rules (joining cost; vaccine allocation), (3) vaccine nationalism (cost per German household; coverage in Germany) and (4) vaccine producer confidence (origin; type). Distribution rules, political ideology and personal perceptions of pandemic threat matter little. But a larger alliance size and dominant EU-country composition increase alliance support. And vaccine nationalism is key: support increases with both lower costs and larger coverage for own-nation citizens. Moreover, support goes down for Chinese and American producers and increases for Swiss and especially own-nation producers. In sum, a realist and technocratic outlook is warranted at the cognitive stage in pandemic cycles when no solutions have been found, yet the worst already seems to be over, as national self-interest reigns supreme in popular attitudes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11077-021-09435-1.

Vaccine nationalism: a predicament in ending the COVID-19 pandemic.

In a recent correspondence, vaccine hesitancy and its pressing issue in possible delaying of being triumphant in the pandemic was discussed. This paper highlights vaccine nationalism as a predicament that would not just delay but worsen the present situation of the pandemic. This study suggests a global response among countries that people must see the world as a global village and as one community it must save collectively.

Crisis Nationalism: To What Degree Is National Partiality Justifiable during a Global Pandemic?

Are countries especially entitled, if not obliged, to prioritize the interests or well-being of their own citizens during a global crisis, such as a global pandemic? We call this partiality for compatriots in times of crisis "crisis nationalism". Vaccine nationalism is one vivid example of crisis nationalism during the COVID-19 pandemic; so is the case of the US government's purchasing a 3-month supply of the global stock of the antiviral Remdesivir for domestic use. Is crisis nationalism justifiable at all, and, if it is, what are its limits? We examine some plausible arguments for national partiality, and conclude that these arguments support crisis nationalism only within strict limits. The different arguments for partiality, as we will note, arrive at these limits for different reasons. But more generally, so we argue, any defensible crisis nationalism must not entail the violation of human rights or the worsening of people's deprivation. Moreover, we propose that good faith crisis nationalism ought to be sensitive to the potential moral costs of national partiality during a global crisis and must take extra care to control or offset these costs. Thus, crisis nationalism in the form of vaccine nationalism or the hoarding of global supplies of therapeutics during a global pandemic exceeds the bounds of acceptable partiality.