Vaccine Nationalism and COVID-19 Global Health Inequities

COVID-19 and health inequities

The COVID-19 pandemic has put a spotlight on the inequities that exist in the world. In the United States, people of colour (including Black, Indigenous and Hispanic people) disproportionately contract, develop, die and are hospitalized from the virus. There has been an increase in gender-based violence associated with physical confinement policies, lockdowns, and quarantines implemented around the world.

The pandemic has also resulted in restricted movement, the closure of some services, reduced interaction with non-household members, and worsening socio-economic conditions.

One’s ability to stay home and physically distance, in order to help control the spread of the virus, is a privilege and is not possible for many, especially for frontline workers.

The COVID-19 pandemic has indeed amplified societal and interpersonal inequities, in addition to global inequities between countries, which is evident with global COVID-19 vaccination distribution.

Inequitable global distribution of vaccines

In April 2021, the World Health Organization reported that 87% of global COVID-19 vaccine supplies have gone to high-income countries (HICs), while low-income countries (LICs) have received only 0.2% of global vaccine supplies.

COVAX, the global initiative that was formed to catalyze the purchasing of COVID-19 vaccines by LICs, has experienced shortages. This has left COVAX negotiating with HICs to share their surpluses, as several HICs have been buying vaccines in excess, essentially hoarding COVID-19 vaccine supplies. For example, Canada has bought more doses per person than any other country with enough immunizations procured to vaccinate every Canadian over 5 times.

This dynamic of HICs hoarding resources, wealth, and power is one that parallels how much of our global systems and structures work on a large scale. And it’s important to put these power dynamics into context: HICs have been able to achieve their wealth and power because of historical injustices through colonialism, exploitation and violence against regions that we now refer to as LICs.

Such historical injustices have contributed to the resource and financial constraints that LICs face today and have consistently put them at a disadvantage in terms of their ability to secure essential medical treatments, such as vaccines, and their ability to achieve improved public health.

Given the historical context of factors that have created and continue to exacerbate health disparities between HICs and LICs, the following questions come to mind:

  • If HICs have committed historical acts of imperialism, colonialism and exploitation that continue to place LICs at a disadvantage and increase their vulnerabilities to being severely impacted by public health crises, why are HICs hoarding vaccines from LICs?
  • Why must LICs settle for the surpluses of HICs, when the pandemic is a highly urgent issue affecting all of us?
  • Why have HICs been steadfast in their support of stringent patent protection of intellectual property rights for vaccines? 

Vaccine nationalism and its threats to global public health

Vaccine nationalism has presented itself in several ways throughout the course of this pandemic.

First, in national vaccine hoarding.

Second, in the nation’s perception of a vaccine being “theirs”, despite the development of vaccines being a result of years of international research and labour, and signing agreements with pharmaceutical manufacturers to supply their own populations with the vaccine before becoming available for other countries. National agreements between pharmaceutical companies and countries that had a vaccine developed within their borders have led to vaccines being a market commodity and less of an essential, life-saving public health tool, which has placed HICs in a better position to secure vaccines and LICs at a disadvantage.

Third, in several HICs opposition to the Trade Related Intellectual Property Rights (TRIPs) agreement, convened by the World Trade Organization (WTO), which would temporarily suspend intellectual property rights on vaccines allowing countries to produce and manufacture COVID-19 vaccinations. The TRIPs agreement would not only enable and advance COVID-19 vaccination production, but also likely advance global vaccination rates, which would ultimately contribute to resolving the pandemic. 

A global collective approach to the pandemic

Dr. Tedros Adhanom Ghebreyesus, Director of the World Health Organization, has identified vaccine nationalism as a global threat and has emphasized the need for the pandemic response to be collective, on a global scale. While of course every country has the responsibility of public health within their borders, some proponents of vaccine nationalism will argue that every country should prioritize the health of their own citizens above a collective global response to the pandemic.

However, vaccine nationalism risks enabling the spread of the virus in countries that do not have sufficient vaccination supplies to control the spread of the virus, leading to economic consequences and the risk that the virus will continue to mutate and perhaps nullify the vaccines that have been developed.
A collective global response to COVID-19 is optimal in terms of ensuring equity and in terms of effectiveness in resolving the pandemic. It is also a form of justice. The ability of HICs to produce vaccines and implement vaccination programs is tied to historical injustices, exploitation and hoarding of resources.

Unlike nations, the COVID-19 virus does not acknowledge international borders and will continue to spread even if citizens in HICs are vaccinated. It would be a major injustice for HICs to continue to engage in vaccine nationalism and hoarding of vaccines, leaving LICs with the potential for endemic COVID-19 virus.

Stephanie Wiafe (she/her/hers) is a Ghanaian-Canadian woman, currently located on the unsurrendered territory of the Musqueam, Squamish, and Tsleil-Waututh people. She is a highly skilled global public health professional and researcher, with a graduate degree in Public Health from Queen’s University and a Honour’s Bachelor of Interdisciplinary Health Sciences from the University of Ottawa. Steph has cultivated a career dedicated to global public health equity, working alongside communities that experience severe social exclusion, isolation and health disparities.


May 25, 2021


Stephanie Wiafe