Vaccine diplomacy in the European Union

Vaccines against coronavirus offer hope after a year of fear and uncertainty. However, global demands far outstrip production capacity. The high demand has resulted in countries using the production of vaccines to advance their own interests and exploiting jabs to strengthen regional ties, whilst enhancing their own global status.

Russia and China have been using vaccines as an opportunity to develop meaningful relationships and to increase their influence all over the world. In response, India has also been donating vaccine supplies to regional neighbours, challenging China’s efforts at regional dominance. In another instance, the United States has promised to send Canada and Mexico a total of 4 million doses of the AstraZeneca vaccine. But where is Europe in all that? Even if the European Union is now a major coronavirus vaccine exporter, it is still dealing with delivery issues and other unexpected problems to secure enough vaccines for its own citizens.

Is unity strength?

To date, four safe and effective vaccines have been authorized for use in the EU: BioNTech Pfizer, Moderna, AstraZeneca and Johnson & Johnson. The latest is the new single-dose vaccine which is supposed to speed up the vaccination process in the second quarter of 2021. The EU has also reached agreements to buy Sanofi-GSK and CureVac once clinical trials are completed.

Yet, the European Commission’s strategy of joint vaccine procurement has been accused by national leaders of being too bureaucratic, limiting and slow. Although the EU has managed to get lower prices, higher accountability for pharmaceutical companies and vaccine shots for the whole Union, this has come with delays in delivery and rising tensions among the Member States, lagging behind the United Kingdom and the United States. 

In other regions, China and Russia are sending out more than 60 percent of their doses to other countries. Russia is providing free vaccines to 13 states, and China has already donated doses to almost 50.  For the EU, managing the market power and authority of 27 Member States means moving slower. Before placing an order, the Commission has to wait for each country to accept the contract. Some countries, frustrated by these dynamics, simply made the purchases on their own, whereas  Germany has already warned it may follow Hungary’s path and buy the Sputnik V vaccine. 

The Commission has sacrificed speed for solidarity and coherence in the process. This joint approach has helped smaller Member States get vaccines faster than on their own but also slowed down larger countries such as France and Germany. Thus, it has risked widening the existing divisions within the EU. Despite the risk, France has firmly defended working together as a block. Most EU countries have fully vaccinated only 5% of their populations since the EU’s strategy has not secured enough supply so far. Fortunately, the delivery problems are being solved and progressively reversing this trend. 

Still a long way to go

At the beginning of the year, the pharmaceutical company AstraZeneca announced that, due to production problems, it would not be able to deliver EU member states the expected number of doses of its vaccine, as were agreed upon in January. This news generated huge tensions between the European Commission and the British-Swedish pharmaceutical, which has/had been breaching the agreed delivery times for months. Due to these delays, the EU will receive only 130 of the 300 million doses convened with AstraZeneca in the first half of 2021. This revealed that the way out of the crisis would be complex, which raised questions about countries’ capacity to negotiate over a limited vaccine supply collectively.

Additionally, several countries are currently suspending the use of AstraZeneca over isolated reports of blood clotting issues developing after vaccination. The European Medicines Agency (EMA) has confirmed the ‘possible link’ between this vaccine and the clots but recommend the jab for all age groups. Even if the EMA and diverse national authorities keep insisting that the benefits outweigh the risks, countries such as France and Germany decide to alleviate the risk by vaccinating with AstraZeneca only people above 55 or 60, while Denmark has suspended the vaccine rollout altogether. 

The social climate must also be taken into account. In Spain, the poor and chaotic communication strategy around AstraZeneca’s vaccine has generated mistrust among the population. In Madrid, two out of three people summoned in April to receive a dose of the coronavirus vaccine did not show up at the vaccination centre.

On the distribution side, the EU is also facing some challenges and controversies. There is an emerging dispute on whether the vaccines are being distributed fairly among the EU-27: five EU countries have already complained of unequal treatment. In this context, the ‘vaccine war’ with the United Kingdom over the AstraZeneca production continues. The EU has accused the UK of grabbing more doses than it was agreed upon and threatened to block the company from exporting to the UK if it does not meet its supply obligations. Since then, escalated tensions with the Union’s former Member have cooled down. 

EU initiatives and the COVAX Facility

For the fight against the virus, the EU has contributed €1.4 billion under the Coronavirus Global Response, which was launched by the European Commission to ensure universal access to affordable vaccination, treatment and testing. €1 billion comes from Horizon2020, of which €350 have been dedicated to supporting coronavirus vaccine development. Prior to that, over €650 had been invested in vaccine research and innovation, building on previous programmes’ efforts.

In the context of vaccine diplomacy, the EU has all eyes on COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, a framework for global collaboration launched by the WHO, the European Commission and France in April 2020. COVAX is co-managed by three partner agencies: The Vaccine Alliance (Gavi), the Coalition for Epidemic Preparedness Innovations (CEPI) and the WHO. The initiative aims at accelerating the development, production and equitable access to tests, treatments and vaccines. It is a risk-sharing mechanism that provides security for manufacturers and investors and reduces the risk of countries failing to secure access to a viable vaccine. The COVAX facility aims to purchase 2 billion doses by the end of 2021, including at least 1.3 billion doses to be exported to low and middle-income countries, ensuring that vaccines are available worldwide. The EU’s contribution to the initiative comes from the Member States, the European Commission and the European Investment Bank.

COVAX supports the research and development of new vaccines by investing and negotiating prices with pharmaceutical companies. Countries of all income levels can participate in the COVAX Facility, either in a self-financing capacity or through a separate financing instrument (the Gavi COVAX Advance Market Commitment). Self-financing countries will be guaranteed enough vaccines to protect up to 20% of their population, depending on funding availability. Additionally, wealthy economies will pay more to subsidize those that have fewer resources.

Although the first doses are already being exported to Africa and Asia, some countries do not have the resources to distribute the vaccines throughout their territory from the large urban centres where they are concentrated. Fridges, health worker training and fuel for the delivery trucks would need a large sum of additional funding. Moreover, even if the COVAX target is met, it would still fall short of the level of immunity that would be needed to end the pandemic (at least 70% of the global population, according to the WHO). However, two billion doses are still going to be crucial to protect health workers, the elderly and the vulnerable in a great number of countries.

The road ahead

Fortunately, in Europe, vaccines are not being allocated by wealth or power but by prioritising countries and people who need it most. However, countries clearly have an interest in vaccinating their most vulnerable populations first. While some parts of the ‘developed world’ are purchasing more doses than are needed to vaccinate their entire populations, countries in Africa and Latin America are only beginning their vaccination campaigns. Even if COVAX is a good initiative, it remains under-funded and aims to donate an insufficient number of vaccine doses to the target countries.