Thread by @MMKavanagh

Our NEW @Global_Policy article out as #PandemicAccord negotiators meet: "Vaccine Politics: law & inequality in COVID" shows COVAX failed b/c of a model misaligned with politics.Not $.Not tech.
Same approach,better funded ≠ equity next pandemic
🧵thread onlinelibrary.wiley.com/share/author/S…

I write w/@Renu_Singh_ about why the dominant law&policy paradigm proved incapable of securing equity.
Political analysis necessary to design effective pandemic response.
Greater use of law, inter-state negot, and intl agreements can engage intl & domestic political forces 2/16

Well before a vaccine had been developed there was an unprecedented moment where heads of state and global leaders pledged they would ensure equitable access to a not-yet-created medical countermeasure. But of course... 3/16

…those efforts failed to ensure anything approaching equity. A yr after vaccines registered, 9 bill doses delivered, only 1% to low-income countries. 1 in 4 African health workers were vaxed but 72% of entire W European pop had been. COVAX reached >half goal of 2b doses 4/16

Why did equity efforts fail? We trace development of 2 competing law & policy paradigms. 1 focused on voluntary measures (little use of legal mechanisms), norm entrepreneurship, and aggregating demand (COVAX). Unit of debate/sharing was doses. 5/16

An alternative paradigm proposed by Southern leaders focused on openness, sharing technology instead of doses, & on use of law and agreements between states to compel sharing of tech to produce independently in factories throughout the world 6/16

Paradigms could have been combined, mutually reinforcing. Wealthy states (e.g. US) used elements of both voluntary/demand and compulsory/tech sharing. But powerful ACT-A players had policy preferences against tech sharing/compulsory legal measures. 7/16

.@SuerieMoon et al explain the role of governments in ACT-A decisionmaking was problematically unclear; in particular, LMIC govts only appear in governance months into the effort while industry was "initially in a leading role." This mattered… 8/16
thelancet.com/journals/lance…

… it reflects govts never had a single venue where they negotiated access proposals and paradigms. In the absence of that, two paradigms grew apart, demand-focused/ voluntary action dominated and default was against use of law or legal agreements to share tech 9/16

Problem was VACCINE NATIONALISM was entirely PREDICTABLE to anyone watching domestic politics in powerful states or familiar with Intl Relations in context of existential threats.
Dominant voluntary paradigm had no viable mechanism to counter vaccine nationalism 10/16

Rising populism, Xi and Trump govern largest economies.Even in countries promising cooperation (Europe,Canada) leaders promised rapid vax for all, put in orders for many times more than needed and used their political & economic power to secure those doses. 11/16

No major state power said “our young, healthy will wait for others before we vax health workers and elderly”
No major manufacturer had an incentive to tell the richest, most powerful countries (home to their biggest markets and regulatory masters) to wait. 12/16

Lesson: Norms for sharing doses are too weak to overcome nationalism in pandemic crisis; Leaders’ domestic political incentives=against sharing doses. Instead: manufacturing in regions so all can make for “their own” & have agreement between states to share necessary tech 13/16

Some want to make this model permanent. But it failed. Not b/c there wasn’t ready financing. Or b/c of technical issues. It was missing a political analysis & the legal mechanisms necessary to address vaccine nationalism.
We must not repeat this mistake in next pandemic. 14/16

We need for more law to address known political realities:
➡️agreements between states
➡️law to compel companies to share tech
➡️use of legal mechanisms between states to (at least) complain formally when agreement to share tech isn’t fulfilled
15/16

Also: every global health initiative needs a serious political analysis…
Thanks for reading @Global_Policy
onlinelibrary.wiley.com/share/author/S…
/fin