The present paper examines the concept of equitable access to vaccines in the context of the COVID-19 pandemic with the critical examination of approaches to international collaboration as suggested by Eccleston-Turner and Upton (2020). The COVAX initiative that aims at facilitating the development of vaccines and ensuring their equitable distribution among countries will be critically evaluated from the perspective of their economic and institutional sustainability. The role of capitalism in affecting the risks of epidemics and pandemics as well as determining the general structure of international response in this sphere will be analysed in a complex manner (Adams, 2020). The close attention will also be paid to redefining the role and key functions performed by international organisations such as the World Health Organisation (Eccleston-Turne & Burci, 2021). The historical cases of epidemics as well as successful and unsuccessful policy responses may be helpful for adjusting the current international strategies in the most appropriate and strategically correct manner. The review of the literature confirms the challenges of international collaboration as outlined by Eccleston-Turner and Upton (2020), although the exclusive focus on the COVAX initiative appears to be unsupported. The broader perspective with the consideration of capitalism influences and the international environment may allow developing more realistic and better-integrated equity promotion measures at all levels.
Equitable Access to Vaccines
Equitable access to vaccines is generally recognised as being one of the main determinants of the maximum utilisation of available socioeconomic and healthcare resources at the international level. Eccleston-Turner and Upton (2020) express their concerns in relation to equitable access to such vaccines in developing countries. The prevalence of vaccine nationalism, when national governments typically prioritise the health needs of their populations as compared with those of foreign countries, may likely to increase such gaps even further. The COVAX initiative declares the governments’ and international organisations’ devotion to providing equitable access to all people globally regardless of their country of origin, age, gender, socioeconomic status, and other characteristics. The existing infrastructure problems also constitute serious issues for all parties involved, leading to the higher concentration of health risks in developing countries (Eccleston-Turner & Upton 2020). According to Baker (2017), the goal of ensuring the adequate access to medicine for all people constitutes the major priority at the international level at the moment due to the growing contradictions between the formal declarations and actual policies implemented by various governments. Forman (2020) specifies the changing understanding of the right to health during the pandemic due to the fact that the access to vaccines and quality healthcare constitute the main determinants of people’s health standards in the long term.
The evaluation of temporary restrictions and other measures taken by governments and international organisations should be performed from the perspective of their ability to maximise the equitable access to vaccines, thus, protecting people right to health under the current conditions (Forman & Kohler, 2020). International health regulations may be helpful for establishing the general framework of optimal responses and justified measures to be taken, minimising the risks of significant deviations in both developed and developing countries (Habibi et al., 2020). The stable system of governance free of external influences is crucial for reaching the significant long-term improvements. Due to the high inequality in the socioeconomic development and resource availability in various countries, most developing countries need additional support, and precise international instruments beyond solidarity should be developed in this context (Johnson, 2020). The application of proportional sanctions to those international agents that deviate from their obligations may be justified. Yamin (1999) stresses the need to better articulate the right to health in international law, ensuring the adequate foundation for promoting more responsible healthcare practices globally. Overall, the critical account on the COVAX initiative and dominance of national interests in many countries as suggested by Eccleston-Turner and Upton (2020) is supported by the available academic literature.
Role of Capitalism and International Organisations in Access to Vaccines
Although the evaluation of the COVAX initiative’s effectiveness is important, the broader perspective on the causes of the problem and potential solutions may be needed to minimise the risks of biased conclusions and implications. Adams (2020) explains the close connections between capitalism and neoliberal policies on the one hand and the current inefficiencies in addressing such pandemics and disasters on the other hand. By neglecting those needs that are not associated with profit-generation opportunities and misrepresenting the interests of some vulnerable groups, capitalism both increases the likelihood of such disasters and prevents the delivery of timely assistance to affected populations. Global health diplomacy is also not always free and independent of such external influences (Fidler, 2010). The emergence of vaccine nationalism and subjective interpretation of the dominant needs and concerns of citizens from different countries can also be attributed to capitalism and the active utilisation of their status by many developed countries (Whyte 2009). Such countries tend to utilise their higher research potential, financial opportunities, and political influence for prioritising their citizens and restricting the access to people from developing countries, illustrating the long-term negative influences of neoliberal policies and capitalist approaches. The exposure of such incentives and specific methods used will cause inevitable modifications at the national level.
As the existing profit-generation and nationalistic incentives may continue to exist in the future, the maximum functions should be assigned to international organisations such as the World Health Organisation that may utilise their power to ensure the more equitable and responsible distribution of vaccines (Eccleston-Turner & Burci, 2021). Most of the current health regulations should be revised to prevent the emergence of conflicting and antagonistic interests among different countries and international agents (Gostin et al., 2020). According to Maldonado et al. (2019), new metrics in global health may be helpful for objectively evaluating the current scope and structure of global health needs. On this basis, many international decisions can be made, thus, contributing to the higher equity and recognition of all parties’ needs. According to Davies and Wenham (2020), the improved system of international relations is critical to developing more effective responses to the challenges posed by the COVID-19 pandemic. In this context, the role of the World Health Organisation may continue to increase with the possibility of formulating better-supported and objectively correct conclusions from the earlier responses to the pandemic in various countries (Montel et al., 2020). The latest technologies may successfully integrate a variety of relevant factors that should be considered in policy-making.
By reorienting the public and policy-makers’ attention to Africa and other developing countries, the World Health Organisation may assist in strengthening local community health systems (Nepomnyashchiy et al., 2020). Such a strategy may be important for properly reflecting the major local differences and conditions as well as neutralising the existing gendered impacts of the outbreak (Wenham et al., 2020). In this manner, the higher equity may be achieved both in relation to addressing the needs of different countries and vaccine distribution within a country or region. The previous history of epidemics may contribute to the formulation of more realistic policy solutions such as advance purchase agreements that may guarantee the higher predictability of long-term healthcare services’ delivery planning (Eccleston-Turner, 2015). By measuring the global burden of disease, the need for further adjustments can also be identified (Murray & Lopez 2013). The most important aspect is objectively applying global health metrics and harmonising the interests of all countries and international agents in their pandemic-related efforts (Mahajan 2019). Thus, the reliance on the broader approach with the recognition of complex influences of capitalism and international organisations may contribute to addressing the existing challenges more effectively as suggested by Eccleston-Turner and Upton (2020) and the COVAX initiative.
The provided analysis indicates that numerous obstacles to achieving equitable access to vaccines still exist at various levels. Eccleston-Turner and Upton (2020) correctly admit the presence of vaccine nationalism in many developed countries and the contradiction between the formal declarations and actual policies implemented by governments. The lack of effective policy instruments integrated in the COVAX initiative and high inequality of socioeconomic and political power may prevent the international community from adequately addressing the health needs of the global population in the most rational manner. At the same time, the broader perspective on examining this problem may be needed as capitalism contributes to the systematic neglect of health threats that do not allow generating the maximum profits for corporations (Adams, 2020). Moreover, subsequent responses may be asymmetric with the prioritisation of developed countries and privileged categories of people. The potential solution refers to increasing the role played by the World Health Organisation in accumulating the required resources and implementing a more formal and objective approach toward allocating resources and promoting equity globally (Eccleston-Turner & Burci, 2021). The close analysis of the earlier history of epidemics may assist in formulating strategic plans that contribute to the maximisation of positive health effects. For instance, advance purchase agreements may be helpful for ensuring the required predictability in the future vaccination efforts. Therefore, the major limitations of the perspective presented by Eccleston-Turner and Upton (2020) refer to the lack of systematic evaluation of broader influence that contribute to the equity problem and may provide potential solutions.
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