BY DR. SETH BERKLEY, Medical doctor, infectious disease epidemiologist & CEO of Gavi, The Vaccine Alliance

COVID-19, it’s now clear, did more than create the worst global health crisis in a century, alongside a major economic crisis. It also sparked a massive global trust crisis. The fault lines it generated have rippled far beyond familiar and important issues, such as vaccine hesitancy or lack of faith in the counsel of policymakers and experts. They have exposed a gaping trust gap at the very core of our modern international order.

Dealing with crises that spill easily across national borders, such as pandemics or the consequences of climate change, requires effective global solutions. No country is safe unless all are safe. And yet, according to recent research published in Nature Medicine, at least 1.3 million lives were lost that could have been saved during the first critical year, when COVID-19 vaccines initially became available, had they been shared more equitably across the globe. This is a damning indictment of how self-interest prevailed.

But if the world can’t come together at a time when millions of people are dying, then how can we trust governments, businesses and citizens to do the right thing when confronted with similar crises in the future? The cold hard truth is that we can’t. During any kind of global disaster, even with the best will in the world, governments understandably put the protection of their citizens first.

The proper response is not despair but realism. Since national self-interest is certain to prevail in future crises, the way to obviate that is to put in place global solutions that will automatically work in everyone’s best interest — and do so long before disaster strikes.

Consider the case of COVAX, which I co-founded. This multilateral effort was created in the early days of the COVID-19 crisis to prevent a potential repeat of what happened during the last pandemic in 2009 when a small number of wealthy nations bought up almost the entire global supply of H1N1 swine flu vaccines, leaving little for the rest of the world. COVAX was deliberately designed to benefit every signatory, which is why 190 countries representing 90 percent of the world’s population joined the effort.

Remember, at the start of the pandemic, it wasn’t clear if it would be possible to produce safe and effective vaccines against COVID-19 quickly enough. Even governments with the resources to negotiate bilateral deals with manufacturers faced a high risk that those deals might prove useless if those vaccines didn’t succeed. For them COVAX represented an insurance policy, and a potential a back-up source of vaccines. For the rest of the world, it was simply a lifeline. And to ensure that lifeline was there, COVAX included a mechanism that removed the financial barriers to securing equitable access.

Did it work? Up to a point. As it turned out, we got dozens of vaccines, not one, and in record time. To date, COVAX has shipped close to 1.9 billion doses to 146 economies, of which close to 1.7 billion — or roughly 90 percent — have gone to people in the 92 lower-income countries, who would have otherwise struggled to get vaccinated.

But where science delivered, self-interest hindered. The sheer scale of the vaccine hoarding we subsequently witnessed, compounded by export restrictions imposed by countries on vaccines and the components needed to make them, all conspired to create huge bottlenecks in the global vaccine supply. This created those delays in getting them to lower-income countries, which caused that tragic and unnecessary loss of lives.

Had COVAX been created and fully funded before the pandemic, much of this could have been avoided. Valuable time was lost mobilizing this new organization and raising the billions of dollars it needed, putting it at a disadvantage in securing doses from manufacturers. Also, while COVAX worked because it was built on global health networks that were already in place, with no at-risk contingency funding or surge capacity already built in, receiving agencies like Gavi, were stretched to the limits, hampering our impact.

Here again, one key way to shore up trust and improve responsiveness in a crisis is to prepare well in advance. Many, including myself, have long argued that we ought to have the vaccines we need ready before pandemics appear. Even if we don’t know the precise nature of the threat, it is possible to carry out much of the R&D and some of the human trials on potential candidate vaccines ahead of time, and then tweak them when we know precisely which virus we are dealing with, much as we do with seasonal flu vaccines.

Given that self-interest and competing national priorities are not about to disappear, whatever advance solutions we devise must be capable of working, even in the most hostile geopolitical environments. When it comes to pandemics, one way to achieve this will be to expand regional vaccine manufacturing, particularly across the African continent.

Such expansion can help reduce the impacts of vaccine hoarding and export restrictions and ensure that all countries have regional access. With climate change, we will need similar regional models and widely dispersed supply chains to ensure that future global solutions don’t leave the world’s poorest and most vulnerable citizens behind.

What’s not in doubt, sadly, is that such solutions will be needed. Even as COVID-19 continues to spread, the risk of further pandemics is increasing, with a 2 percent chance of one occurring in any given year. That prospect will only be made worse by the rebounding effects climate change will have on public health.

To cope we must continue to build global approaches. But above all, we need global approaches that can work in a world where low trust and strong nationalist responses are sure to go hand-in-hand. Building those approaches in advance, with proper respect for the persistence of self-interest, is the best way to create solutions that will serve everyone.

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