20.Global access to covid-19 vaccines is deeply unequal. As of September 2021, more than 78 percent of vaccines administered have gone to high and upper-middle income countries, which make up about 48 percent of the total global population. Some 22 percent have gone to low and lower-middle income countries, which make up the other 52 percent of global population. Low-income countries, which make up approximately 9 percent of global population, have received just 0.32 percent of all vaccines (see graph). This risks undermining global health security and exacerbating broader inequalities—and the full impact is not yet known. There are particularly worrying shortfalls in delivering vaccines to vulnerable populations such as refugees, displaced people, and those in conflict zones or areas under the control of non-state armed groups. A strategy that solely focuses on vaccinating UK nationals and ignores the need to vaccinate people around the world will be self-defeating. No nation is a hermetically sealed unit, least of all the UK, which rightly prides itself on its connections with every nation in the world. That is why the best defence against this and any future pandemic will have to be waged on a global basis.
21.In December 2020, the FCDO told us that “vaccine nationalism” could undermine efforts to bring the pandemic under control:
Countries only focusing on domestic vaccines needs and increasing population coverage as quickly as possible (before others can vaccinate highest risk groups) may limit the potential to have greater impact on the pandemic. [ … ] an equitable distribution of a first 2 billion vaccine doses to high-risk populations globally could avert 62% of COVID-19 deaths, compared to only 33% of deaths averted if focused on only high-income countries.
22.However, the UK only donated its first vaccines overseas in July 2021, when 86 percent of its adult population had already received a first dose. Many other high-income countries have taken a similar approach, vaccinating large majorities of their own population before sending vaccines abroad. This was criticised by many of our witnesses, and we heard evidence that delay in ensuring equitable access to vaccines could damage UK interests by harming its diplomatic relationships, undermining international security and the multilateral system. However, Jeremy Hunt argued that it would have been difficult for the UK to share doses before its own population was vaccinated:
it is unrealistic in a pandemic to ask an elected Government to give vaccines abroad when you still need them at home. [ … ] Whether it is right or wrong is a different question, but that is the reality in an emergency like a pandemic in a democracy.
When we put this to Minister Morton, she said she did not “see it as an either/or”.
23.The UK has been a major donor to COVAX, a multilateral scheme meant to ensure equitable global access to covid-19 vaccines. The UK pledged the world’s fourth-largest donation, £548 million, to the part of the scheme that funds vaccines for lower-income countries. COVAX aims to offer doses to cover 20 percent of the population of participating countries in its initial phase. However, it has been held back by shortfalls in vaccine availability, due in part to high-income countries such as the UK buying up supplies. As of April 2021, the UK had distributed roughly the same number of vaccines domestically as COVAX had across the entire world. The UK and other wealthy countries have also purchased doses through COVAX, drawing on its limited supply.
24.The pandemic was a blow to global trade, as governments scrambled for medical goods and vaccines, imposing tariffs and export bans. As the chief executive of India’s Serum Institute has put it: “almost every country now wants to set up local manufacturing so that it never has to scramble for vaccine again.” We heard evidence calling for greater efforts to improve vaccine manufacturing capacity around the world through measures such as technology transfer and a vaccine patent pool. The WHO head has praised the UK-backed Oxford-AstraZeneca partnership for its efforts to increase vaccine production around the world through agreements with producers in India and elsewhere. The US, France and others have backed the idea of a patent waiver for covid-19 vaccines, along with the head of the WHO. The FCDO told us that it was not clear that this step would increase access to vaccines, and that the measure risked undermining the intellectual property framework’s ability to respond to future crises.
25.However, some witnesses told us that the traditional approach to intellectual property did not apply to the covid-19 vaccines, as they had received heavy public subsidies: “We are essentially paying twice for these vaccines: we are paying for the research and development, and we are paying to purchase the vaccines.” We received evidence arguing that the UK and other governments had done too little to ensure that research they funded would be accessible and affordable. The Independent Panel recommended that technology transfer and commitment to voluntary licensing should be included in all agreements where public funding is invested in research and development.
26.While the UK and many other Western countries have been slow to send vaccines overseas, others have used “vaccine diplomacy” to gain global influence. Among those that sent significant quantities of vaccines abroad through bilateral sales or donations in the first half of 2021 are Russia, China, India and Israel. China has pledged to provide 2 billion doses abroad, contrasting itself with “some countries that have said they have to wait for their own people to finish the vaccination before they could supply the vaccines to foreign countries.” China has focused on countries of strategic importance, and is reportedly using vaccine supplies to pressure countries that have strong relations with Taiwan. Of the 72 countries to which China has pledged donations, all but two are reportedly participants in its Belt and Road infrastructure initiative. Russia has also offered vaccines in large quantities—it claimed to have the capacity to provide 700 million doses overseas in 2021, though it is falling short on delivery. Recipients include countries in Africa and Latin America, as well as some in Europe. Moscow is using vaccines to pitch itself as a technological great power, filling the gap where the West has fallen short, and to exploit divisions in Europe, according to analyst Mark Galeotti. This trend risks undermining UK soft power, according to analyst Yanzong Huang, by creating a perception of Western countries practicing “vaccine nationalism” while Russia and China support those in need. However, shortcomings in efficacy of some Chinese vaccines, and delivery of Russian vaccines, means that these advantages are likely to be short-lived.
27.When asked his view on the Russian and Chinese use of vaccines to gain influence, the then-Foreign Secretary said: “we don’t support vaccine diplomacy, let alone blackmail.” Minister Wendy Morton told us that: “We want countries such as China and Russia to join the multilateral effort” on covid-19 vaccines. Nonetheless, of the 100 million doses the UK has pledged to donate overseas by June 2022, 20 percent will be distributed “on a strategic basis”, with the other 80 percent going via COVAX. In July, the Government announced the recipients of its first bilateral donations, including 600,000 to Indonesia, 300,000 to Jamaica and 817,000 to Kenya. We heard powerful testimony on this point from Dr Nkengasong, Director of the Africa Centres for Disease Control and Prevention:
When you go with 100,000 doses of vaccines to country X, provide it, and then you drop another 50,000 there, you create even more inequalities, tension, and frustration. True vaccine diplomacy, in our view, should be any approach where a partner or a country is supporting a region or a country to achieve its vaccination target. [ … ] Let diplomacy be used, through COVAX, so that many more countries get the doses they need.
28.When we launched this inquiry, in October 2020, it was not known whether there would ever be effective vaccines against covid-19. Today, less than a year later, all UK adults have been offered full immunisation, and 41 percent of the global population has received at least one dose. This is a huge achievement for global scientific cooperation. The UK has made an important contribution, and the UK-backed AstraZeneca vaccine is responsible for the majority of COVAX vaccinations in lower-income countries. However, these achievements are undermined by the failure to ensure anything close to global equity in access. While democratic governments have responded to the needs of their electorates, it is now time to turn our attention overseas. Promoting rapid vaccine access globally is not just morally right, but is clearly in the UK’s interest. It is necessary in order to build prosperous and healthy societies, preserve the safe travel that underpins the global economy, fend off the threat of new variants, and counter autocracies that are using vaccines to gain influence.
29.The glaring inequality in global access to vaccines has created the opportunity for autocracies such as Russia and China to seek to undermine the West and expand their influence by donating and selling vaccines. Even if these campaigns have fallen short on delivery, there is still a worrying potential to undermine UK influence overseas and harm its reputation as a force for good. We welcome the UK’s commitment to donate 100 million vaccines in the year to June 2022. However, this target falls far short of what is needed to meet the health challenge and protect British nationals from further outbreaks and variants, let alone meet our moral duty. We urge the Government to make every effort to achieve a significant increase in the speed and number of vaccines it donates through COVAX. Delays in vaccinating the world could mean irreparable damage to global health security, widening inequalities, undermining lower-income country health systems, and increasing the disease burden in the parts of the world that can least afford it. The UK should ensure that any bilateral donations are planned and timed to give real, sustainable and predictable support to other countries’ vaccination campaigns, rather than transferring small quantities that do more for the image of the donor than for the recipient. While a strategic approach may be appropriate for some foreign aid, lower-income countries in particular need predictable, needs-based vaccine supplies—this matters to us all. Ensuring there is low infection is key to ensuring there are few variants. In response to this report, the FCDO should set out a list of the countries that have and will receive bilateral donations from the UK, with dates, quantities, and the factors that went into each decision. The response should set out the FCDO’s role in selecting these countries, how this is coordinated with other Departments, and how it links to the objectives set out in the Integrated Review. We recommend that the Government sets out its strategy for delivering the vaccine to particularly vulnerable groups, including displaced people.
30.To defeat covid-19, and tackle future pandemics, a wider range of countries need the ability to produce vaccines. The production of AstraZeneca by India’s Serum Institute offers a good model for technology transfer to build this capacity. Many national leaders have backed the call for a temporary waiver on intellectual property for covid-19 vaccines. We recommend that the Government pursues a wide range of means to bring about greater manufacturing capacity in lower-income countries, including through expanded technology transfer schemes. In its response to this report, the Government should set out the steps it is taking to transfer vaccine technology to low- and middle-income countries, and its goals in terms of increasing global vaccine production.
31.UN agencies have jointly warned that the spread of falsehoods around covid-19 constitutes an “infodemic”. Those promoting false information include hostile state actors. China has spread disinformation on covid-19 since the early days of the outbreak, in an attempt to deflect blame for its role as the starting place of the virus. More recently, both Russia and China have sought to undermine trust in vaccines produced in the West and promote their own products. Minister Morton told us that the UK had raised the issue of vaccine misinformation in talks with Russia, but that it had not done so with China.
32.Access to accurate, trusted and locally relevant information is crucial to fighting health misinformation around the world. This depends on robust and independent media outlets. The previous Foreign Affairs Committee called on the Government to do more to defend global media freedom. One of its recommendations was to extend funding of the BBC World Service. While the Government announced an additional £8 million in May to tackle disinformation and improve digital engagement, the longer-term funding of the service remains unclear, pending the 2021 Spending Review.
33.Deliberate misinformation about the safety of vaccines is not only irresponsible—it costs lives. Tackling state-backed falsehoods on covid-19 should be an integral part of the Government’s global health security strategy. To promote global access to covid-19 vaccines and bring the pandemic under control, communities around the world need access to reliable information about immunisation, delivered in a format that is accessible and inspires trust. This requires strong local media outlets. The FCDO should lead on efforts to counter health misinformation internationally. In particular, it should target support to independent local media outlets in regions at risk of high levels of vaccine hesitancy. The Government should give the BBC World Service long-term funding to tackle fake news, with a focus on strategic locations such as Russia and China.
42 , Our World in Data, accessed 9 September 2021; , accessed 9 September 2021
43 For example, the International Monetary Fund has said that the main fault line in the global economy in the coming years would be between countries with high and low vaccination rates.
, Sky News, 27 July 2021
44 International Committee of the Red Cross () para 10–11; STOPAIDS, on behalf of the Missing Medicines Coalition, Global Justice Now, Just Treatment, Students For Global Health UK, Doctor Mohga Kamal-Yanni () para 9.2.14.
45 Foreign, Commonwealth and Development Office () para 23 iv
46 , FCDO, Department of Health and Social Care, The Rt Hon Sajid Javid MP, and The Rt Hon Dominic Raab MP, 28 July 2021
, Coronavirus (COVID-19) in the UK, accessed 29 July 2021
47 , Associated Press, 14 August 2021
48 Including: [Dr John Nkengasong]; [Mark Eccleston-Turner]; Médecins Sans Frontières (MSF) (); STOPAIDS, on behalf of the Missing Medicines Coalition, Global Justice Now, Just Treatment, Students For Global Health UK, Doctor Mohga Kamal-Yanni () para 9
49 [Dr John Nkengasong]; [Mark Eccleston-Turner]
50 [Rt Hon Jeremy Hunt MP]
51 The Minister told us “no one is safe until everybody is safe, so yes, it is important that we vaccinate our citizens here at home, but the Prime Minister has been very clear about equitable access”.
, [Wendy Morton MP, Minister for European Neighbourhood and the Americas]
52 , Prime Minister’s Office, 10 Downing Street and The Rt Hon Boris Johnson MP, 11 June 2021
53 WHO, 12 January 2021
54 [Mark Eccleston-Turner]; [Dr John Nkengasong]; STOPAIDS, on behalf of the Missing Medicines Coalition, Global Justice Now, Just Treatment, Students For Global Health UK, Doctor Mohga Kamal-Yanni () para 4.2
55 [Mark Eccleston-Turner]
As of 8 April 2021, the UK had administered some 38 million doses domestically, while COVAX had shipped 38 million globally. The scheme has since overtaken the UK—in early September 2021, COVAX had shipped some 243 million doses globally, while the UK had distributed 92 million doses at home.
, WHO, 8 April 2021; , Coronavirus (COVID-19) in the UK, accessed 9 September 2021; , GAVI, accessed 9 September 2021
56 , Associated Press, 14 August 2021
57 , The Guardian, 14 February 2021
However, historian Niall Ferguson told us that: “The notion that we can all be self-sufficient and make our own MRNA vaccines is a complete fantasy”, due to the difficulties of manufacturing in many parts of the world.
58 [Kiran Mazumdar-Shaw]; [Mark Eccleston-Turner]; University College London ()
59 , WHO, 15 July 2021
The FCDO told us: “AstraZeneca has at least a dozen manufacturing partnerships globally, including voluntary licensing agreements like the one with SII [The Serum Institute] in India. […] There is certainly a model there that can be expanded and rolled out.”
[Darren Welch, Director of Global Health, FCDO]
60 , Dr Tedros Adhanom Ghebreyesus, WHO, 7 March 2021; , Politico, 10 June 2021
61 , 6 May 2021; [Wendy Morton MP, Minister for European Neighbourhood and the Americas; Darren Welch, Director of Global Health, FCDO]
62 [Mark Eccleston-Turner]
As MSF put it: “With millions of pounds of public money going into R&D for future COVID-19 medical technologies, it is critical that the final products are sold ‘at cost’. Pharmaceutical companies must not be allowed to profiteer from public funding when governments are forced to buy back the products whose development they initially funded.”
Médecins Sans Frontières (MSF) ()
63 According to MSF: “UK public funding agencies currently have no clear policies in place directing their grantees to ensure effective technology transfer, open-sharing or licensing of COVID-19 medical technologies.”
Médecins Sans Frontières (MSF) ()
See also: [Kiran Mazumdar-Shaw, Mark Eccleston-Turner]; Results UK () part 2; STOPAIDS, on behalf of the Missing Medicines Coalition, Global Justice Now, Just Treatment, Students For Global Health UK, Doctor Mohga Kamal-Yanni () para 7.6
64 The Independent Panel for Pandemic Preparedness and Response (IPPPR), , May 2021, p 55
65 According to one analysis: “China, India, Israel, and Russia, the four countries that have taken a global approach to vaccine diplomacy—i.e., providing vaccines to at least ten countries on three continents or more—have largely done so in alignment with their national and strategic interests.”
, ThinkGlobalHealth, 4 June 2021
66 According to the NYT, it is not known whether these are donations or sales.
, New York Times, 6 August 2021
67 , Associated Press, 20 May 2021
68 As one witness put it: “Venezuela and Paraguay have a relatively high mortality rate, but comparably less vaccine supply from China, in part because of the relationship with Taiwan.”
See also: , BBC News, 7 April 2021
69 , ThinkGlobalHealth, 4 June 2021
70 , Foreign Policy, 24 June 2021; , BBC Monitoring, 29 July 2021; , Carnegie Endowment for International Peace, 3 August 2021
71 , [Mark Galeotti]
72 [Yanzhong Huang]
73 As analyst Mark Galeotti put it: “countries like Russia, and indeed China, think that, to an extent, they can buy loyalty with these kind of programmes. At best, they can rent it for a short period of time.”
[Yanzhong Huang, Mark Galeotti], [Rt Hon Jeremy Hunt MP]
74 , Reuters, 11 June 2021
75 [Wendy Morton MP, Minister for European Neighbourhood and the Americas]
76 Covid-19 Vaccines: Global Distribution, HC Deb, 20 July 2021, [Commons Chamber]
77 , FCDO, Department of Health and Social Care, The Rt Hon Sajid Javid MP, and The Rt Hon Dominic Raab MP, 28 July 2021
78 [Dr John Nkengasong]
79 , Joint statement by WHO, UN, UNICEF, UNDP, UNESCO, UNAIDS, ITU, UN Global Pulse, and IFRC, 23 September 2020
80 Foreign, Commonwealth and Development Office () para 23.v; , FCDO and The Rt Hon Dominic Raab MP, 24 March 2021
81 Viral immunity: The FCO’s role in building a coalition against COVID-19, First Report of Session 2019–21, , 6 April 2020, para 4–5; [Yanzhong Huang]
82 We heard evidence that these disinformation campaigns vary between those that are state initiatives from the beginning, and those that are started by autonomous actors and later endorsed by the state.
[Mark Galeotti], [Yanzhong Huang]; , Politico, 19 November 2020; . It’s Backfiring., New York Times, 25 January 2021
83 , 28 July 2021
84 Internews Europe ()
85 , Twenty-First Report of Session 2017–19, 4 September 2019 para 35
86 According to the Government: “The FCDO has guaranteed World2020 funding until September 2021. Funding beyond that is currently being discussed in the context of the 2021–2022 Spending Review”.
, FCDO, 12 February 2021
See also: , 13 July 2021