COVID-19 Vaccines: A Tale of Infrastructure Disparity and Vaccine Nationalism

Illustration of COVID-19 vaccines. Photo: Pixabay

After almost a year of development and clinical trials, Coronavirus Disease (COVID-19) vaccines are being approved by regulatory bodies around the world and many countries are already starting to administer the vaccines to the populace. Hailed as the biggest vaccination program in history, the COVID-19 vaccines represent the biggest hope to end the pandemic and the return to normality. However, despite this glimmer of hope, there are some hurdles that need to be overcome for the success of this massive vaccination program. Two of the hurdles are the infrastructure inequality for vaccines distribution between developed and developing countries, and the vaccines nationalism phenomenon. These issues are some of the main reasons why some countries opted to acquire vaccines that are not yet known about their effectiveness and efficacy. 

The Pfizer and Modena COVID-19 vaccines are two of the leading vaccines that were already approved for use and distributed by some countries. Both vaccines are made using a newer technology called messenger RNA (mRNA) and need to be stored in very low temperature, with Pfizer vaccine around -70 degrees Celsius, while Moderna vaccine need to be stored at -20 degrees Celsius and can stay stable in refrigeration units between 2 to 8 degrees Celsius for 30 days (Miller, 2020). Another issue with the COVID-19 vaccine was the hoarding of doses by rich and developed countries in a phenomenon called “vaccine nationalism”. According to the People’s Vaccine Alliance in a Deutsche Welle article, rich nations have bought 54% of the total stock of the world’s most promising vaccines, despite being home to just 14% of the global population (Deutsche Welle, 2020).

The infrastructure requirement for these vaccines have proved to be problematic, especially for developing or poor countries. These vaccines need to be distributed in a cold chain system, which requires the establishment of refrigeration units for distribution. This is a challenging task in developing and poor countries, as cold chain equipment is often unreliable due to equipment failures, power outages and an unreliable electricity grid (De Boeck et al., 2018). Inadequate equipment will lead to wasted vaccines, and the low temperature requirement for the Pfizer and Moderna vaccines can likely result in wasted vaccines due to spoilage. Hence, cold chain logistics for vaccination in developing or poor countries are frequently not at the level required to support a successful immunization program, much less the enormous scale required for effective COVID-19 vaccination (Ksoll et al., 2020). 

This issue is also compounded by the remoteness of many parts of the world and also the spotty infrastructures in these locations. This requirement coupled with inadequate infrastructure in many developing and poor countries made the Pfizer and Moderna vaccines only suitable for large wealthy countries that have the resources to implement a well-developed cold chain, and that means huge parts of the world currently can’t get a COVID-19 vaccine (Ford & Schweik, 2021). These issues raise equity and social justice concerns of the COVID-19 vaccination program. Therefore, it is safe to expect that many developing or poorer countries will opt for other vaccine candidates that can be maintained at standard refrigeration temperatures. Oxford-AstraZeneca’s COVID-19 vaccine is one of the most promising candidates for standard refrigeration temperature vaccines, with Sinovac and Gamaleya’s vaccines being the alternatives. 

Even if cold chain storage wasn’t a problem, developing and poor countries still had to deal with the issue of vaccine nationalism. Vaccine nationalism as defined by Adam Kamradt-Scott (2020) is when governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries. According to a World Economic Forum article, the richest nations have secured billions of doses of COVID-19 vaccines, while many developing and poor economies struggle to access supplies (Kretchmer, 2021). As stated from the data compiled by National Public Radio, the United States has claimed around 2,6 billion doses of vaccines, while the European Union has claimed around 2 billion doses (Doucleff, 2020). 

This hoarding of vaccine doses has attracted several backlashes from around the world. Jamaican Prime Minister Andrew Holness said the hoarding caused many poorer countries to wait months for doses to be available, with Jamaica might not receive vaccines until around April (Wyss & Stenovec, 2021). World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus said this kind of selfish attitude by wealthy countries will bring “catastrophic moral failure” to the world, and the poorest countries will take most of the brunt (TRT World, 2021). According to a research report by RAND, vaccine nationalism could have negative consequences on how well the COVID-19 global pandemic is managed and contained. The report suggests that vaccine nationalism cost the global economy up to $1.2 trillion a year in GDP terms, and physical distancing measures will continue to affect key sectors of the global economy negatively (Hafner et al., 2020). To alleviate the risk of vaccine nationalism, GAVI has created COVID-19 Global Access (COVAX) initiative to ensure equal access to the COVID-19 vaccines.

The scientific advancement that brought the COVID-19 vaccines for humanity was indeed something that warranted celebration. However, this celebration of advancement shouldn’t make us ignore the difficulties that lie ahead. The infrastructure disparity between countries and vaccine nationalism are two of the many difficulties that lie ahead for the success of arguably the biggest and most ambitious vaccination program in history. Inadequate infrastructures led some to question about the equity and social justice concerns of the COVID-19 vaccination program, especially when some if not many of the approved vaccines could only be distributed in countries with robust infrastructures. Concurrently, the vaccine nationalism phenomena also shed more lights on how rich and developed countries oppress underprivileged countries by hoarding millions or even billions of vaccine doses for their own use. 

Underprivileged countries which consist primarily of developing or poor countries would then have to wait longer for doses to be available to them—while at the same time, they are the ones who usually took the brunt of the COVID-19 pandemic. It was true that the WHO called for global solidarity and GAVI to create the COVAX initiative in order to provide equal access for COVID-19 vaccines, however, just like any other multilateral efforts, the success rests on the willingness and commitment of the participants to look beyond their self-interest. Therefore, as citizens of the world, we have the moral obligation to ensure equity and justice to all human beings, regardless of who they are and where they are.


De Boeck, Kim et al. (2018). Vaccine distribution supply chains in developing countries: A literature review. Working Papers of Department of Decision Sciences and Information Management, Leuven

Deutsche Welle (2020, 09 Desember). Coronavirus: Rich countries hoarding COVID vaccines, campaigners warn. Deutsche Welle.

Doucleff, Michaeleen (2020, 03 Desember). How Rich Countries Are ‘Hoarding’ The World’s Vaccines, In Charts. National Public Radio.

Ford, T. & Schweik, Charles M. (2021, 4 January). The cold supply chain can’t reach everywhere – that’s a big problem for equitable COVID-19 vaccination. The Conversation.

Hafner, Marco et al. (2020). COVID-19 and the cost of vaccine nationalism. RAND Corporation

Kamradt-Scott, Adam (2020, 08 September). Why ‘vaccine nationalism’ could doom plan for global access to a COVID-19 vaccine. The Conversation.

Kretchmer, Harry (2021, 06 Januari). Vaccine nationalism – and how it could affect us all. World Economic Forum.

Ksoll, Christian et al., (2020). Temperature Controlled Logistics: Essential for Health and Growth. International Finance Corporation.

Miller, Korin (2020, 18 Desember). What Are the Differences Between the Pfizer and Moderna COVID-19 Vaccines? Here’s What We Know So Far. Health.

TRT World (2021, 18 Januari). WHO: World to experience ‘moral catastrophe’ over vaccine hoarding. TRT World.

Wyss, J. & Stenovec, T. (2021, 09 January). Jamaica Accuses Rich Nations of ‘Hoarding’ Covid-19 Vaccines. Bloomberg.

Maula M. Haykal adalah Mahasiswa Sarjana Hubungan Internasional Universitas AirlanggaDapat ditemui di Instagram dengan nama pengguna @maulahk

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