Vaccine nationalism is one of the greatest challenges standing in the way of a global equitable response to COVID-19. 

Because this pandemic knows no borders, delivering vaccines to everyone, everywhere, is crucial to stopping the spread of the virus; yet most rich nations are hoarding doses for their own populations, often with devastating consequences on the rest of the world. 

As of April 2021, while half of the US population has received at least one dose of a COVID-19 vaccine, it is estimated that poor countries won’t achieve widespread vaccination coverage before 2023.  

A few countries have pledged to donate safe and effective vaccines to low- and middle-income countries via COVAX, the vaccine pillar of the Access to COVID-19 Tools (ACT) Accelerator, but the global vaccine equity track record remains abysmal. Most rich nations have bought enough jabs to vaccinate their population multiple times over, hindering their availability and putting the world at risk of facing new vaccine-resistant strains.

Global Citizen spoke with Eloise Todd, one of the co-founders of the Pandemic Action Network, about the importance of sharing vaccine doses to overcome COVID-19 once and for all. Todd, whose network consists of around 100 organizations working to help end this pandemic and prevent the next as quickly as possible, stressed the need to combat vaccine stockpiling to build a fairer world in the long term.

Global Citizen: Could you tell me more about the current state of global vaccine distribution? 

Eloise Todd: The problem we've got is that we have many vaccines around the planet, but they’re all concentrated in the [hands of] rich countries. So we desperately need to get those spare vaccines that are [of] no use to people in rich countries that have bought multiple times what they need.

The EU, for example, has 1.9 billion vaccine [doses] confirmed, and they've already got options on even more [doses]. The UK has confirmed nearly half a billion doses, and even if they were all double-dose vaccines, that'd be at least three or four times its population. So we’re [asking] governments to give their excess doses away, and for free — not as [official development assistance (ODA)]. We also want them to do it now so that COVAX can plan, and ideally, we want all of these to be channelled through COVAX as a sort of central mechanism that is best situated to distribute these [doses] around the world. 

Why do these vaccines need to be donated through COVAX? 

Well, there's a couple of different reasons. First of all, we need somebody, somewhere, to have an overview of what's going on — of the gaps and what's needed. COVAX is the multilateral mechanism that's been set up to deliver to [low- and middle-income countries]. 

The second reason is that we're getting more and more signs of so-called vaccine diplomacy, with countries giving doses to their closest friends and near neighbors. Sometimes that's legitimate because there's also a need there, but frankly, if this is to be a truly equitable global response, we need to live by that to the letter and the spirit of what we've signed up to … What that means is giving the doses centrally so that the needs of those that most need it can come first.

It's also really important to remember that the number one priority for the Access to COVID-19 Tools Accelerator (ACT-A) and for COVAX, the vaccine pillar, to get full funding. Dose-sharing is an important complement to that resource mobilization, but really, we need governments to put their hands in their pockets and give the relatively small amounts needed to fully fund [ACT-A]. It's in the billions, which [seems like] a lot of money, [but] nothing close to the trillions we've spent for our own countries getting bailed out and furlough schemes ... Given that we know that there's at least a billion — some say 1.3 billion doses in excess in 2021 alone — it's madness to think that they’re sitting in a warehouse becoming outdated. We need them to go where they're needed. 

What would you say to world leaders who prioritize their own population before even considering donating vaccines? 

Well, I think it's a difficult question, if we’re being honest, because governments have a mandate to look after their own people, but what is not is buying multiple times what they need. They know that they've got enough [vaccine doses] in the pipeline and more, so they need to divert that excess towards COVAX and other countries. I think we have to acknowledge that governments have a responsibility to their own people, but what isn't OK is vaccine hoarding — and waiting until [countries] reach 50, 60, or 70% coverage before giving the excess away. There's no need for that. 

So, while there are some nuances and political realities to this [issue], it's a crazy situation we’re in, where we have 1.3 billion excess doses around the world in relatively few rich countries. Of course, not all of these doses have arrived where they're needed … If we were to have a similar situation in the future, we’d need a much more structural response. We need to make sure that the system is set up and that it can't [prioritize] rich countries first, with every country putting themselves first, and with no limits on how many doses you can buy. It puts companies in a difficult position and it sets COVAX and ACT-A on the back foot, running to catch up and deliver the equitable response that governments have signed up for. So [world leaders] need to walk the walk and not just talk the talk. 

How do we determine the number of doses that high-income countries are supposed to donate?

I think there are no firm and fast kind of rules of thumb at the moment. You could argue that there's some kind of small excess that would be appropriate for unforeseen events and for potential booster shots. But you can hoard the vaccines all you want; if you don't share them equitably, you're doing harm to your own economy and your own people. 

The longer COVID resides in the world, the more chances we've got to get the kind of variants that actually might not be responsive to vaccines. The longer this goes on, the more the mutations will take us away from where we are right now, making it harder and harder and constantly [forcing us to] play a game of catch up. So the mental leap we're asking everybody to make is [to give] doses away to help [their] own people … It’s counterintuitive in many ways because everybody wants to see their own people protected, but unless we do it fairly and evenly, we could be in this perpetual cycle that we've all been in for a very long time. And frankly, we'll be set to continue unless we nail this equitable response. 

COVAX has a one-pager saying that countries that donate their doses should adhere to the COVAX principles of dose sharing. That includes alerting COVAX as early as possible and donating through the facility to keep track of where the doses are delivered. COVAX and Gavi [the Vaccine Alliance] are the best placed and most experienced people in delivering vaccines at scale in [low- and middle-income countries], and we need them to keep doing that job and do it more broadly. 

At the Pandemic Action Network, we're working closely with Global Citizen to make sure that we fully fund ACT-A this year and secure dose-sharing so we can reach as many people as possible, but also to have that essential road map to collective immunity so the whole world can get to 80% coverage and not just rich countries. 

What do you think we need to achieve within the next year or so?

We need to fully fund ACT-A. There's a $22 billion funding gap, $2 billion of which is for vaccines, and there's a separate pledging moment in June for COVAX.

I would also highlight the importance of the other ACT-A pillars. There is nearly $8 billion missing from the health system-strengthening pillar. And of course, the more health systems are strengthened, the easier it will be for [low- and middle-income countries] to actually deliver the vaccines. There's a big gap in terms of diagnostics and therapeutics, and we shouldn't be drawn into a sort of a false competition between any of these. If the vaccines are being rolled out more slowly than we'd like, then we actually need testing even more. We need diagnostics even more. 

So, while we're very much focused on this roadmap … to 80% collective immunity, we also need to make sure that we don't leave any element behind. We’re looking at fully funding ACT-A, hopefully by the global health summit [in May]. If that doesn't finish the job, we would expect the G7 summit and the COVAX pledging moment in June to do just that.

This interview has been edited and condensed for clarity.