COVID-19 vaccine apartheid and the failure of global cooperation
| Published date | 01 August 2023 |
| DOI | http://doi.org/10.1177/13691481231178248 |
| Author | Stephen Brown,Morgane Rosier |
| Date | 01 August 2023 |
| Subject Matter | Special Section: The Global Politics of the Covid-19 Pandemic |
https://doi.org/10.1177/13691481231178248
The British Journal of Politics and
International Relations
2023, Vol. 25(3) 535 –554
© The Author(s) 2023
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/13691481231178248
journals.sagepub.com/home/bpi
COVID-19 vaccine apartheid
and the failure of global
cooperation
Stephen Brown1,2
and Morgane Rosier3
Abstract
The equitable distribution of COVID-19 vaccines is one of the most important tests of global
cooperation that the world has faced in recent decades. Collectively, global leaders failed that
crucible abysmally, creating a ‘vaccine apartheid’ that divided the world according to income into
countries with widespread access and those without. Why, given that leaders were fully aware
of the risks and injustice of vaccine inequity, did governments of wealthy countries hoard doses,
impede the expansion of vaccine manufacturing and otherwise prevent equitable access to vaccines?
We argue that their decisions to act selfishly are best explained by governments’ accountability
to domestic constituencies, their lack of leadership and commitment to multilateralism and their
adoption of short-term perspectives, as well as their unwillingness to curb the influence of profit-
oriented global pharmaceutical companies and, to a certain extent, of an additional private actor,
the Bill and Melinda Gates Foundation.
Keywords
COVID-19, equity, global governance, global health, multilateralism, pandemic, self-interest,
vaccines
Introduction
The response to the COVID-19 pandemic and in particular the equitable distribution of
vaccines is one of the most important tests of global cooperation that the world has
faced in recent decades. Without global cooperation, as one author starkly noted, ‘the
course and consequences of the pandemic cannot be resolved or addressed’ (Fazal,
2020: E91). It is not the only such vital challenge – the need to stop climate breakdown
is another major one – but the pandemic irrupted onto the global stage very suddenly in
1School of Political Studies, University of Ottawa, Ottawa, ON, Canada
2 University of Cambridge Centre for Gender Studies, Department of Politics and International Studies,
Cambridge, UK
3School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
Corresponding author:
Stephen Brown, School of Political Studies, University of Ottawa, 120 University Private, 7th Floor, Ottawa,
ON K1N 6N5, Canada.
Email: brown@uottawa.ca
1178248BPI0010.1177/13691481231178248The British Journal of Politics and International RelationsBrown and Rosier
research-article2023
Special Issue Article
536 The British Journal of Politics and International Relations 25(3)
late 2019/early 2020 and posed a very serious, immediate threat to lives and economic
well-being across the entire world.
Although various non-pharmaceutical interventions could help slow the spread of the
virus, it soon became evident that vaccines would be essential for protecting the global
population. The scientific community developed several very effective vaccines at ‘warp
speed’, assisted by massive public investment in private endeavours. As a result, vaccina-
tion began in late 2020, one year after the disease had been identified – sooner than anyone
had expected and far faster than any other vaccine in history. Nonetheless, the vaccine
rollout ‘fell tragically short’ of what could have been achieved (Glassman et al., 2022: 28).
Even before any vaccines had been developed, governments faced the question of how
they would eventually distribute them equitably, both nationally and internationally,
which was a challenge on a scale that they had never faced before. Early on, they recog-
nised that global cooperation was ethically and medically essential, rallying around slo-
gans such as ‘None of us is safe until all of us are safe’ (Trudeau et al., 2020). Indeed,
global vaccination is not only a moral imperative in terms of protecting lives, especially
those of vulnerable populations regardless of where they happen to live; it also helps
protect from the emergence of new variants, which could be more deadly and more able
to evade vaccines (Yamey et al., 2022: 3). Global cooperation on COVID vaccines was
thus in the collective long-term interest.
Nonetheless, leaders, especially those from high-income countries, failed abysmally to
live up to their rhetoric and respond to the pandemic from a global perspective (Brown
and Rosier, 2023; Dentico, 2021). Global cooperation had already collapsed in early
2020, when countries sealed their borders and competed savagely for limited supplies of
personal protective equipment (Moon et al., 2022: 487). Wealthy countries subsequently
eschewed the ad hoc multilateral vaccine acquisition mechanism that they had helped set
up and signed purchasing agreements directly with pharmaceutical companies, locking
up much of global supplies. They also blocked efforts at the World Trade Organization
(WTO) to waive patents temporarily, which would have permitted more vaccines to be
produced at an earlier stage of the pandemic. As a result, third and then fourth vaccine
jabs began to be widely administered in higher-income countries in 2021 and 2022, before
even 20% of the population of low-income countries, including most of Africa, had
received a single jab. By May 2021, access to the vaccine was so dramatically disparate
– and proportional to countries’ income levels – that the head of the World Health
Organization (WHO), Dr Tedros Adhanom Ghebreyesus, referred to the situation as ‘vac-
cine apartheid’ (Reuters, 2021b). He and many analysts and critics, including us, use that
expression rather than milder ones such as ‘vaccine inequity’ in order to ‘emphasise the
scope of this moral failure and make explicit comparisons to the South African system of
institutionalised racial segregation’ (Bajaj et al., 2022: 1452). States were not the only
actors responsible for those disparities. Even a representative of the global pharmaceuti-
cal industry admitted that Big Pharma had ‘dismally failed’ to ensure an equitable distri-
bution of vaccines (Thomas Cueni, Director General of the International Federation of
Pharmaceutical Manufacturers and Associations, quoted in Newey, 2021). What is more,
‘The COVID-19 pandemic has exposed how easily international cooperation and multi-
lateral agreements can dissolve’ (Happi and Nkengasong, 2022: 22).
This article seeks to explain the failure of global cooperation to ensure greater global
vaccine equity. Why, given that they were fully aware of the risks and injustice of vaccine
inequity, did governments of wealthy countries hoard doses, impede the expansion of
vaccine manufacturing and otherwise prevent equitable access to vaccines? Structural
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