Priced out of protection: Ana Santos Rutschman on the politics of vaccine distribution

Should countries attempt to get dibs on a COVID-19 vaccine for their own citizens, even if it comes at the expense of more vulnerable populations in other countries? Ana Santos Rutschman, a law professor who specializes in health law and emerging health technologies, asks this question in her June 25, 2020 essay published in The Conversation. Her analysis of how governments are jockeying to sign pre-purchase agreements with vaccine manufacturers demonstrates the danger of nationalist policies for global health.

Ana Santos Rutschman–"How ‘Vaccine Nationalism’ Could Block Vulnerable Populations’ Access to COVID-19 Vaccines," The Conversation, 17 June 2020

 

1. Rutschman introduces the concept of “vaccine nationalism.” Explain this term in your own words. According to Rutschman, what are the major problems with vaccine nationalism for developing countries, for the process of vaccine development, and for global public health?
   
2. Rutschman argues that even though the U.S. is a major world power and can secure vaccine pre-purchase agreements, U.S. citizens might still be unable to get the COVID-19 vaccine. How is this possible? Who would be most likely to be left out, and how is this connected to the structure of the U.S. health care system? What are other ways vaccine manufacturers might be able to secure profits in lieu of high prices to the consumer?
3. In the final section of her argument, Rutschman sketches out a naysayer argument, explaining the benefits of pre-purchase agreements to manufacturers. Identify where in the text you see her using templates from Chapter 6 to plant this naysayer and make a concession while still standing her ground. What do you think? What role should international institutions play in determining who gets access to vaccines, and what might be a good model for distributing vaccines? Use a template from Chapter 4 to respond to Rutschman’s proposal.
4. Rutchsman states, “Nationalism is at odds with global health priorities.” Her argument comes at a time when nationalist movements are growing across the world, from Brexit in the UK, “America First” slogans in the U.S., and the Hindu National Party in India. Explain what nationalism is in your own words (you might check out historian Jill Lepore’s 2019 essay about the distinctions among “nationalism” and “patriotism”). What are the fundamental principles of nationalist movements, and how are they “at odds” with the global health challenges we face? Why does this matter? Compose a response to the “so what?” and “who cares?” questions for Rutschman’s argument against nationalism, using templates from Chapter 7.

Comments

[Anna P.]

1). Vaccine nationalism, to me, is one country’s focus on securing a needed vaccine for their population without thinking of other countries that may not be able to afford such an agreement. In other words, a country is able to use purchasing power and negotiate with vaccine manufacturers to set aside a specific number of doses for their population within the country before access is available to all countries.
In Rutschman’s article I agree with her main argument that a major problem with this act is that it causes an imbalance in the global public health setting. Developed countries securing vaccines for their own population first, hurts underdeveloped countries because they lack the money to engage in such purchasing agreements. As a result, developing countries are then unable provide their population with basic medical necessities, worsening conditions of diseases within their population, such as the COVID-19 virus.
Furthermore, future vaccine development is hurt by vaccine nationalism due to the fact that many countries partake in the creation of vaccinations for the world. In my opinion, making it harder for developing countries to gain access to necessary vaccines leads to future issues in creating vaccines. These countries may not want to partake in the effort of developing a future needed vaccine, despite having the means to, knowing that they won’t have the purchasing power to make it available to their population.
With an outlook on equal global public health, I support Rutschman’s opinion that a system should be in place to make vaccines both accessible and affordable to all countries during a crisis such as a pandemic. Developed countries that are able to secure doses just for their population should take initiative and lead in the effort to make vaccines available to all populations, not just their own.

[Gage Chapman]

I agree with you Anna, vaccine nationalism is dangerous. Rutscham's opinion is one that I favor as well, although I do understand the mentality of the countries doing this. It is good that the countries are thinking of their people, but not allowing other countries to buy vaccines as well is inherently selfish. I'm not surprised the United States was one that was trying to secure vaccines for their citizens only,
unfortunately.

[bri]

Debates of this kind are often futile without larger reform. In her essay the author talks about how it is unjust for countries to reserve certain amounts of vaccines for themselves, but this is the nature of capitalism. The issue isn’t strictly that countries hoard vaccines, it is also that companies singlehandedly develop vaccines and those companies need money and when given money they owe a product. The solution is not as simple as the author is making it out to be. Everybody is forced to act due to systems that are already in place.

[Grace Bradford]

I understand where Rutschman is coming from and I agree with what I understood. When she talked about vaccine prices in the US it hit close to home because I am type one Diabetic and underinsured, so my family struggles to get me the supplies I need. The fact that the vaccine can only be produced by certain companies and the fact that there is race for the vaccine inflates the prices. That is how it is for Diabetes supplies companies; they have a monopoly on the products so that people who need it to live are forced to pay extreme prices. The COVID vaccine can suffer from this, too. This is a deadly disease and a vaccine is necessary, but once again the poor are being treated as the enemy or as if they are less deserving because they can’t afford it. Anna mentioned that big countries claiming the vaccine before under developed countries plays into this. These major world players are once again taking from the poor and leaving them with no option but to stay oppressed.

[Travis B]

I agree with these previous comments, I don't think its necessarily selfish for a country to try to secure vaccines but I think an issue arises when underdeveloped countries can't purchase them for their own citizens. I like what was said about countries not wanting to help in production of a vaccine because they may not have money to even purchase the vaccine when made available.

[Sarah]

In Rutschuman's article, I agree that vaccines should more be accessible to countries that may not be able to afford such things. As Rutschuman's mentions in this article, "If COVID-19 vaccines are not made avaialable affordably to those who need them, the consequences will likely be disproportionately severe for poorer or otherwise vulnerable and marginalized populations." In making this comment, she warns us that there will be consequences for those countries that may not be able to afford the vaccines, only because countries who do obtain the vaccines are not willing to sell them at a reasonable and affordable price.I agree with the author in that vaccines need to be more accessible to those who may need it most, but may not be able afford it.

[Treylon Crawford]

I agree with almost everything you say Anna, the only thing I disagree with you saying is when you say that it will lead to problems in creating future vaccines. In my opinion, I think that it will help speed up the process of creating vaccines. Because of vaccine nationalism countries rush to buy any and all vaccines. So it will give a huge incentive for the private sector and public sector to rush to create a vaccine in the prospect of profits. Now, this rush could also create some other problems of safety and reliability, but it does speed up the vaccine production process.

[Tiffani Cannon]

I also agree with you Anna. I found your idea of vaccine nationalism interesting and I thought you made a very good point. The point you made of how a country doesn't think of whether or not other countries are able to afford the vaccine is extremely true, in my opinion. Most of the time countries only focus on making themselves better. However, I feel that if countries work with each other to better the world, everyone will be happier.

[Merick JOhnson]

I would say I mainly agree with Anna’s response to her Rutschman’s article. She brings up a lot of good points that are simple, but are written and developed well. If smaller countries want the vaccine they should have access to obtain it. It’s an interesting topic that has been around for awhile.

[Charli Hinton]

Overall, Rutschman’s article makes a compelling point that if there isn't a system in place to keep the balance,smaller countries will suffer. Vaccine nationalism is not a good idea for many reasons. The first reason is that developing countries are unable to provide for their people basic medical needs,along with this they are out of the loop with everyone else. If unfair passing and paying for the vaccine happens then there will be an unbalance that would not be beneficial to the world as a whole. Second, if this happens now then there will inevitably be more pressing and urgent problems in the future. So to conclude, I would agree with Rutshman's stance that there needs to be a system setup to make sure there are checks and balances, that way there won't be divided between countries and vaccines.

[Chance Eaton]

Anna, I agree with your claim that this idea of ¨vaccine nationalism¨ is consequently hurting underdeveloped counties that do not have the power or the money to secure such vaccines for their populations. And to add to this, the idea of purchasing power among countries on the topic of securing vaccines is really interesting to me. More developed countries have more ¨purchasing power¨ and therefore are able to gain access to more resources-including vaccines. However, I don't think that this will change. There will always be countries that have more money and more of this ¨purchasing power¨ and will most definitely take advantage of it to get some advantage, especially that in health advances in this particular case.

[Sarah M.]

Such a great comment, Chance! I agree with you and Anna in the aspect that "vaccine nationalism" does hurt undeveloped countries. Countries worldwide all have different economies. Some countries are more fortunate than others and are more developed. It is a very interesting concept. I thought it was interesting how in the article, the author explained how Vaccine Nationalism is not a new topic; it has been happening for years. If the problem is as big as the essay explained, why has nothing been done to solve it?

[Annie McArthur]

In response to Rutschuman’s essay on the nationalism of vaccines, Sarah makes a great comment. She emphasizes the importance of the availability of vaccines, particularly regarding covid19 as an example. By making this comment she relates the point of author Rutschuman more personally to the reader since covid19 is something that has affected the entire world. I agree with her statement that the vaccines should be available to everyone in this world at reasonable prices. It should not be a profitable business, but rather a charitable factor to help this world.
Anna P. also makes an interesting response to Rutschuman’s essay. In reference to Rutschuman’s claim that the greatest issue is the imbalance in our global health, she argues that as a solution to this we should take more initiative in distributing vaccines to the more poverty stricken countries first, rather than our own wealthy countries. While I agree with the fact that we should make these vaccines available to impoverished countries at a reasonable price to improve the welfare of our country, I would disagree with her opinion that they should receive them first. I think that the leaders o our country have a duty to our country and people first, then to help others. You cannot water a flower from an empty bottle. If we neglect ourselves in the pursuit to help others, eventually we won’t be able to and we will be right down there with those countries.

[A Hartshron]

I agree with Anna´s response about how developed countries have a higher advantage than underdeveloped countries. The authors point is well taken. Like her, I agree that is it unfair and an imbalance to the global public health setting. It is sad and scary that these disadvantaged countries do not have the opportunity to provide their country with basic health necessities. And like Anna says, it is worsening conditions of diseases within their population, especially COVID-19 virus.

[Jace]

Like the author, Anna believes that there should be a global system in place that allows all countries to work together to create effective and affordable vaccines for all countries. I agree with this idea. Smaller countries who do not have the means of creating their own vaccines should not be given the "leftovers". Those countries are affected by diseases too. If all countries work together, vaccines will be created faster and cheaper.

[Tia Turley]

As Ana Rutschmam mentions in this article, "I believe that developed countries should pledge to refrain from reserving vaccines for their populations during public health crises." Then Anna P. furthers this argument by replying that it is unfair to developing countries to have vaccine nationalism because they have a more challenging accessibility to the vaccine itself. I agree that this is unfair and that everyone should have an equal chance and opportunity for the vaccine.

[Avery Owen]

I do agree with many of your points, Anna. I agree that vaccine nationalism is very dangerous. I think it is selfish for countries to take credit for a vaccine that is not theirs. Furthermore, I agree with your point that a vaccine does not belong to one country, as it is almost impossible for all developers of a vaccine to be from one country. However, I wonder if those of less developed countries are more at risk for specifically COVID-19? If their countires are less densely-populated, could it make more sense to provide countries with greater populations the vaccinations first? This is not to say that only one country (such as the U.S.) should get the vaccines first, however, maybe a judgement should be made to determine the most at risk areas, and the vaccine could be distributed based on that. Essentially, I am saying that I agree with your response to this essay.

[Noelle Sampson]

In reference to Anna P.’s comment, I would say that I agree. She says, “I support Rutschman’s opinion that a system should be in place to make vaccines both accessible and affordable to all countries during a crisis such as a pandemic.” Although many argue that as long as the United States has received Covid-10 relief and vaccines then we are fine, I would say that it does not solve the problem. Even if the US becomes Covid free, there would still be no traveling, not to mention those other countries would still be traveling. Therefore, I agree with Anna because we would only receive true relief if it happened to all countries.

[Bradon Sweeney]

As Anna mentions in this article, "Developed countries that are able to secure doses just for their population should take initiative and lead in the effort to make vaccines available to all populations, not just their own." I agree with this statement because I feel like everyone that wants a vaccine should be entitled to one, in order to ensure their safety. I agree with the fact that it seems selfish for the countries who are able to afford it to take the doses themselves,leaving the populations who can not afford it to worsen.

[Drei Loudon]

I agree with Anna. Vaccine nationalism is the practice of securing a much needed vaccine for the benefit of only one country. Often, it excludes smaller or under developed countries from getting the vaccine. If the practice of vaccine nationalism continues, it could result in further issues between countries, tensions rising, and the diminishing of smaller country's opportunities to receive the help they need. In order to defeat the pandemic, we had to come together and stay quarantined for the health and safety of those around us. This same principle of unity has to apply here as well. We will only successfully defeat this as one world. We cannot be divided.

[Cordon Dell]

I agree with Anna as well when she says the rich countries take everything while the more poor countries are left to fight over the scraps. I agree that the bigger countries are in the wrong by doing this when they keep it all for themselves, but if they buy it and then distribute to underdeveloped countries, then it is okay. The pre-purchase agreement is an investment in the vaccine and when it is finished the vaccine is the payback. I also agree that by the bigger countries continuing the vaccine nationalism is worsening the gap between the rich countries and the poor. It is taking away the smaller countries opportunities to grow because the population is overall less healthy without vaccines.

[Tayla B.]

I agree with Anna P. when she describes how much vaccine nationalism hurts other countries, especially underdeveloped populations. Like Anna, I think it is certainly selfish if countries secure vaccines in a way that makes them unavailable for other countries. However, I find that she makes the solution seem too simple, because as Ana Rutschman mentions in her article, "vaccines do not typically generate a lot of sales compared to other medical products" (Rutschman). She goes on to say how purchase agreements can be an incentive for companies to manufacture vaccines which are clearly something that are important to be produced. The problem encountered here is how to have a system that regulates vaccines (making them accessible and affordable) without getting rid of the incentive for companies to even produce them.

[Taylor]

I agree with Anna’s comment, considering her stance that if a country were to take dibs on a vaccine then other countries may suffer that don’t have the money or the science to solve the problem concerning viruses, and in this case the Coronavirus. In making this comment, Anna warns that being selfish in this way is going to make things worse. I hadn’t thought of this before for the reason of the way we live. A lot of people are selfish and don’t think of others also, so this is a problem, especially when we can help. The vaccine should be available to all countries during a global pandemic. There are underdeveloped countries that can’t provide their citizens with a vaccine or a solution, which is sad, and it is even worse because there are people who can help. If only one country had an accessible vaccine then there would be no traveling to other countries like some people do. For the safety of all humankind, there should be an equal chance for everyone to get vaccinated, however the most at risk should be given the first chance. Anna not only tells us her stance on this issue but includes how it could be solved. The thing that Anna may have overlooked is that in order to “survive” we have to be selfish sometimes. When you think about it, people do this all the time. It is similar in this situation because while giving opportunities to everyone is great, it isn’t completely realistic.

[Kasia Maxfield]

I agree with your response Anna. Vaccine nationalism is a very big problem that has been going on for a long time. I find it particularly interesting that you pointed out how a country doesn't think of whether or not other countries are able to afford the vaccine. I find this statement to be extremely true. Bigger countries with more money are quick to buy the vaccine without even thinking about other people. This issue especially affects undeveloped countries as they do not have many resources needed to get vaccines. I think that anyone who wants the vaccine should be given that opportunity, regardless of where they may live. Therefore, I agree with Anna in saying that by developed countries securing the vaccine first it unfortunately hurts the less developed countries.

[Sophie]

I agree with Anna's comment as well. Vaccine nationalism can impact smaller countries drastically because they are not able to receive them as well as other countries. I feel that everyone that is in need of vaccines should be able to have the opportunity to receive it, but that is not the case.