ABSTRACT
COVAX is a multilateral risk-sharing mechanism for pooled procurement and equitable distribution of COVID-19 vaccine globally. International pandemic response coordination requires buy-in from nation-states and donors. However, vaccine equality has been set back by the prioritizing, not just vaccination of wealthy country populations but also predatory vaccine nationalism, excessive vaccine hoarding, prioritization of commercial and economic interests, and, even more problematically, the emergence of political gain from vaccines through vaccine diplomacy. This chapter traces the evolution of multilateral responses to COVID-19, specifically COVAX, and its capture by political and economic interests, highlighting the key point of failure of COVAX; without binding agreements or rules-based norms to ensure that vaccine equality is enshrined as a principle, multilateral responses are held hostage to national self-interest, and vaccines become politicized and a soft power tool. The chapter concludes that multilateral responses based on assumptions that powerful or wealthy countries will behave within certain boundaries that would not directly compete with or undermine COVAX aims are a fallacy. There is no clear path that will lead to a new framework for equitable access to vaccines for all, but controlling for national self-interest in global public health is the priority.
