Is COVID-19 vaccine nationalism corruption?

International Anti-Corruption Day highlights: Is COVID-19 vaccine nationalism a case of corruption?  

Only about a year ago, the World Health Organization approved the first COVID-19 vaccine for emergency use, fuelling hopes that it would soon help beat the pandemic. However, what started as hope for a global and joint response hasn’t benefited everyone equally. Very early on, vaccine nationalism led high-income countries to hoard enough doses to vaccinate their populations several times over. The spread of new variants such as Delta and Omicron have demonstrated that the pandemic is far from over – and high-income countries are now rushing to administer booster shots for non-risk groups in an attempt to protect against the new variants. 

At the same time, the majority of risk groups – including the elderly and health care workers – in low- and middle-income countries (LMICs) have not even received their first dose; a trend the WHO has warned risks exacerbating inequities in global vaccine access, giving the coronavirus a boost by enabling it to mutate more often as it replicates and spreads faster among unvaccinated populations. 

On the occasion of International Anti-Corruption Day on 9 December, Transparency International Sweden and The Swedish Anti-Corruption Institute hosted an event at the Swedish Chamber of Commerce in Stockholm exploring corruption in several sectors, including protection against retaliation for whistle-blowers and how companies operating in complex markets can tackle corruption.  

The event also hosted a discussion on how corruption and inequitable vaccine access is hindering the success of the global COVID-19 vaccination campaign with speakers Anna Mia Ekström, clinical professor in infectious disease epidemiology at the Karolinska Institute and an expert member of the WHO-COVAX Independent Allocation of Vaccines Group (IAVG) for global COVID-19 vaccine allocation; Maurice Nyambe, executive director of Transparency International Zambia; and Jonathan Cushing, head of Transparency International’s Global Health Programme. The session was moderated by Transparency International Sweden’s Chair Ulrik Åshuvud. Here are some of the main takeaways from the discussion about COVID-19 vaccines.

High-income countries must do more for vaccine equity

Transparency International defines corruption as “abuse of entrusted power for private gain” and starting off the COVID-19 vaccine session, Ulrik Åshuvud, Chair of Transparency International Sweden, explained how corruption is “affecting development and democracy, as well as the ongoing efforts to respond to the pandemic and the fulfilment of the Sustainable Development Goals.”

The term “No one is safe until everyone is safe” was meant to spread public awareness about the importance of COVID-19 vaccine doses being shared globally and immediately. Yet, many countries have not acted accordingly. As of 15 December, an average of 66.33% of individuals in high-income countries have been vaccinated, compared to only 9.02% in low-income countries, according to the UNDP’s global dashboard for vaccine equity. These numbers hide even worse disparities between countries – the Democratic Republic of Congo, for example, has vaccinated less than 1% of its population with at least one dose while Canada has vaccinated 82% of its population with at least one dose. In Sweden, 85% of the population has received at least one dose of COVID-19 vaccine.

Ekström highlighted that the main bottleneck for ensuring equitable distribution of vaccines has so far been the shortage of supplies fuelled by high-income countries bypassing COVAX in “the queue” and instead creating direct, bilateral agreements with manufacturers – making it difficult for COVAX to predict and allocate the number of vaccines it will get. 

For countries without bilateral agreements with manufacturers – mainly LMICs – this has meant a very irregular and limited supply of vaccines. Contrary to the initial objective of distributing vaccines equitably across the world, COVAX has instead become dependent on donated doses.

According to Ekström, unequal access to vaccines means that there are now five times more booster doses being distributed to already fully vaccinated populations in high-income countries than there are primary [first] doses being distributed to unvaccinated populations in low-income countries. “It doesn’t get any better” [as the vaccine roll out continues] she said.

But Ekström was optimistic as supplies of vaccines [to LMICs] have been increasing dramatically over the past months. The main issues will hopefully be around improving the absorption capacity of countries and to ensure vaccine demand increases. More resources will be needed to train the necessary health personnel to administer the vaccines and to support public vaccination campaigns, she said.

An equitable access to COVID-19 vaccines is needed not only to prevent the direct health effects of the virus, but also the indirect consequences caused by the fear and lockdowns –which have pushed more than 160 million people into extreme poverty, Ekström concluded.

Mistrust in government and misinformation fuel hesitancy

“The issue of vaccines in Zambia elicits a lot of passionate debate,” said Transparency International Zambia’s executive director Maurice Nyambe, who joined the event via livestream from Zambia. The issue has become very polarized, with one side of the population strongly opposing the vaccines and the other being very pro-vaccines – each group passionately defending their position, he explained. 

A lot of the vaccine hesitancy is fuelled by political connotations, as well as mistrust in the government. Opposition leader Hakainde Hichilema – who initially ran on an anti-vaccine platform – won the contested presidential election in August this year. Since stepping into power, his party has changed their position to becoming pro-vaccines, a shift that has given rise to mistrust from many Zambians according to Nyambe.

Initial results from a survey carried out by Transparency International Zambia showed that vaccines remain a polarizing issue and that more awareness raising is needed in order to address some of the myths and misconceptions, said Nyambe. The survey also looked at people’s main sources of information, with half of respondents saying television was their main source of news, whereas about 20% said they got most of their information from social media. “With social media comes quite a big risk of misinformation so we want to look at this in our analysis,” he added.

Long-term corruption creates distrust – something we see play out in a crisis like this, according to Ekström, “you can’t build trust in a short time and suddenly expect people to trust.” Many undemocratic governments have taken outrageous measures, including strict lockdowns and curfews in the name of public health. In reality, they were implemented for political reasons rather than for science-based health reasons, she explained. “We need to build trust long term and that’s one of the lessons learned from this pandemic.”

Corruption creates barriers for vaccination among the most vulnerable 

Transparency International’s Head of Global Health, Jonathan Cushing, highlighted that “we see a situation now where high-income countries are delivering booster doses, but the reality for many people in the world is very different.” 

One of his key messages was that transparency and equity within countries has looked very different – from accusations of nepotism in Sweden and many other countries around the world to demands for bribes for vaccination in Uganda. The amounts being requested for bribes in relation to SEK or Euro are quite low, but put in relation to the daily wages in for example Uganda, the bribes are quite high, Cushing explained. 

The low supply of vaccines in LMICs has created a situation where people are willing to use personal connections to access vaccines. As vaccine mandates are increasing, Transparency International has also received reports of people attempting to by-pass the system by paying for vaccine certificates without having been vaccinated in order to be able to return to work and making a livelihood. This can be due to shortage of vaccines or due to vaccine hesitancy. In early December, the WHO Europe Director, Dr Hans Kluge, told a press conference that vaccinations should not be made mandatory “if you haven’t reached out first to the communities.” 

Short-notice vaccine donations make equitable allocation harder

Some countries are choosing to directly donate earmarked doses to specific LMICs – and exclude others from receiving them – sometimes based on political reasons, explained Ekström. “We would of course prefer that contracts are transferred directly to COVAX so that we can distribute [vaccines] according to need and make sure that the countries lagging behind can at least reach 10% or 20% [vaccination rates] before we start topping up countries that have fairly high rates,” she said.

The main issue with donated doses is that they often have a short shelf life. Too often, high-income countries that have procured more doses than they can absorb end up donating doses that are close to expiring. The receiving country gets little to no notice before having to distribute them – often across health systems that are understaffed and under-resourced – making equitable distribution almost impossible.

Bangladesh, Zambia, and Uganda – the three countries where Transparency International’s Global Health Programme works – all attempted an equity based roll out to start with, but later faced challenges in continuing to target those most in need.

“One common denominator across the three countries is that officially or unofficially, the equity-based principles of distribution have largely been abandoned. It’s now very much a first-come first served approach,” Cushing said. This is driven in part by the short shelf life of doses and the lack of doses. In order to not waste doses that are about to expire, many countries are forced to simply distribute them around the airports where they arrive.

Transparency International Sweden’s Chair Ulrik Åshuvud ended the session by asking the audience to consider the question “Is the delay in distributing vaccines equally around the globe to be seen as corruption in itself?” Referring back to Transparency International’s definition of corruption he asked, “is it abuse of entrusted power for your own country’s gain?”

You can catch up on the full discussion here (the COVID-19 vaccine session can be found at one hour 55 minutes and 34 seconds).