The International Trade Law Review: Laws of Vaccine Nationalism
'Hardship builds character', or so the old saying goes. But the covid-19 pandemic has shown that hardship is more likely to reveal a person's character than build it. Since the onset of the pandemic, the shortage of personal protective equipment (PPE) and vaccines quickly led to export restrictions around the world.
At the centre of this are the restrictions introduced by countries that hosted vaccine research and production, namely the European Union (EU), the United States (US) and the United Kingdom (UK), and China and Russia. These countries relied on different legal grounds to control supply and secure prioritised access – often in contradiction to the equitable distribution that their heads of governments were advocating in public.
This chapter focuses on the race to secure vaccines through export restrictions and advance purchase agreements (APAs) and examines the legal significance of this. The manner in which the three market economies (the EU, the US and the UK) prioritised their own citizens has opened up a debate on 'vaccine nationalism'. Trade law cannot curb vaccine research or the policies and practices that have proliferated during the pandemic. Ultimately, compliance with World Trade Organization (WTO) law did very little to assure an equitable outcome as its rules were not designed for this purpose.
II Diverging legal basEs with similar outcomes
The legal approach to vaccines was often an extension of the measures taken for PPE. Shortages led to unprecedented competition to secure supplies. US federal agencies resorted to extraordinary extrajudicial measures and allegedly acted outside their territories to seize shipments intended for other countries.2 Some EU governments seized shipments of PPE destined for their neighbours,3 leading to Brussels exercising its supranational competence over the internal market to ban internal export restrictions,4 but imposing an export authorisation scheme for non-EU countries instead. Similarly, in January 2021, the EU introduced the Vaccine Exports Temporary Transparency and Authorisation Mechanism, which stipulated that authorisation was required from the EU to export covid-19 vaccines. The mechanism was aimed at pharmaceutical companies that used plants inside the EU to fulfil contractual obligations under their APAs with third countries.5 The authorisation measure was justified as a necessary response to the lack of transparency surrounding vaccine exports outside the EU, implicitly blaming the APAs for the shortages in Europe.6
Meanwhile, the Trump administration in the US issued a series of executive orders7 invoking the emergency authority under the Defense Production Act (DPA) of 1950, which has continued under the Biden administration.8 The DPA allows the President to seize direct control of domestic industries, which the Trump administration used to prevent hoarding and exportation and to force an increased production rate of critical supplies. Although the DPA is not a formal export restriction, it empowers the executive branch to directly control private production assets. Thus, the Biden administration used the authority to order two Merck facilities to produce a vaccine created by its competitor, Johnson & Johnson.9
Meanwhile, the UK restricted the export of vital drugs and medicines, requiring wholesale dealers and marketing authorisation holders to ensure continued supply for UK patients.10 The measures effectively created an export ban as no country had domestic surpluses to export.
In contrast, China did not impose any export restrictions on its vaccine production, and its producers (e.g., SinoPharm and SinoVac) became the primary suppliers for the developing world. Russia introduced temporary export control measures relating to PPE – effective from March 2020 to June 2020 – but did not impose any export restrictions on its Sputnik V vaccine. In addition to the strong incentives China and Russia have to supply their vaccines, the state trading in the pharmaceutical sector in these jurisdictions makes executive control redundant. SinoPharm and Gamalaya (producer of Sputnik V) are also wholly state-owned entities.
III Export restrictions under WTO
Under WTO law, quantitative restrictions on exports are governed under Article XI of the General Agreement on Tariffs and Trade (GATT). However, the EU, the UK and the US have explicitly or implicitly justified their measures through references to the exceptions contained under the second paragraph of Article XI, in addition to the general exceptions in Article XX and the national security exceptions in Article XXI.
Article XI prohibits Members from introducing or maintaining any form of quantitative restrictions, including export prohibitions or restrictions other than duties, taxes or other charges. However, the exceptions contained within the same Article (XI:2) exempt measures for critical shortages of essential products if those measures are temporary. While covid-19 vaccines are inarguably essential products,11 case law also envisages a situation where shortages are no longer critical (i.e., if hoarding occurs) or the measures are no longer deemed temporary.12
Article XX grants general exceptions from commitments if they are deemed necessary, which is understood to mean that the least trade-restrictive measures available must be used.13 In any case, export authorisations are no longer necessary if they lead to hoarding. In addition, case law has established a two-tier test.14 The first test determines whether the objective of the restriction is covered by the catalogue of exceptions within Article XX (in this case, the exception of 'necessary to protect human, animal or plant life or health'). The second test is applied to determine whether the restriction arbitrarily discriminates between countries where similar conditions apply. Thus, if the restriction discriminates between WTO Members with similar availability of vaccines (through preferential exemption from the Member's export restrictions to its neighbouring countries), it would fail the second test. The question of whether a country has signed APAs is materially relevant, such as in the case of the EU seizure of shipments to Australia.
The US use of the DPA invokes the security exception under Article XXI, ipso facto. The exception has been invoked in recent disputes, including Russia – Measures Concerning Traffic in Transit, on the embargo against Ukraine;15 United States – Certain Measures on Steel and Aluminium Products,16 on Section 232 tariffs on steel and aluminium; and Saudi Arabia – Measures Concerning the Protection of Intellectual Property Rights,17 on embargoes against Qatar. These cases concluded that Article XXI grants the Member the discretion to protect its self-defined essential security interests, but the discretion is subject to conditions. The burden of proof continues to rest with the Member invoking the exception.
A discussion on the legality of the security exception depends on whether the pandemic qualifies as an 'emergency in international relations'. The DPA provides that national security rests on the ability of the domestic industrial base to 'supply materials and services for the national defense and to prepare for and respond to military conflicts, natural or man-caused disasters, or acts of terrorism'. In the case of a dispute, the US must thereby prove that the pandemic threatened its ability to defend itself.
In conclusion, the gravity of the circumstances and porousness of the three grounds for exception leaves enough flexibility for the EU, the US and the UK to impose export restrictions – at least to the point that they are not hoarding or can prove equal treatment.
IV Law and politics of advance purchase agreements
The EU, the UK and the US (and every high-income country) negotiated private contracts with several potential vaccine developers, even before it was certain that the research would yield any results. As a result, advance purchases were much more significant for determining trade flows of vaccines than export bans, with the EU even arguing that APAs necessitated the restrictions.
APAs are often negotiated in the development phase and bind governments to purchase a specific number or percentage of doses of a potential vaccine at a pre-negotiated price if (and only if) it enters the manufacturing stage. There are obvious risks with APAs for both buyers and sellers18 – buyers cannot evaluate the scientific challenges in the early stages, and the seller may underestimate the costs required.19 The pricing hazard is evident for covid-19 vaccines: the AstraZeneca-Oxford vaccine (which is sold on a non-profit basis) was sold at US$0.82 per dose in its first APA with the UK (signed before development) and was later adjusted to US$14.62 in its APA with Australia.20
APAs (and their private contract-based model) are inherently different from the traditional grant-based research funding operated by the EU and many other countries. Nevertheless, they are a well-established instrument to incentivise private research through public procurement. For example, during the 2009 H1N1 pandemic, APAs were used so prevalently that vaccine manufacturers were unable to commit 10 per cent of their vaccine production for UN aid agencies due to pre-existing commitments under APAs with high-income countries.21
The UK concluded several APAs, diversifying their risks among alternative methodologies. It notably secured 100 million doses of the AstraZeneca-Oxford vaccine as early as May 2020,22 and over 300 million doses were procured through APAs. Given the uncertainty regarding the success of its projects, the UK could have ended up with no vaccines. Similarly, the UK may have purchased a considerable surplus if several projects yielded satisfying results. It also provided considerable support and infrastructure to researchers, de facto bankrolling some developments.23
The US signed its first APA with AstraZeneca days after the UK signed its APA, buying up to one-third of the first batch.24 The US also made several investments in the development and manufacturing of different experimental vaccines through what has become known as Operation Warp Speed. Public investments were made into the Sanofi-GSK, BioNTech-Pfizer, Novavax, Moderna, Johnson & Johnson and AstraZeneca-Oxford vaccines.25 In addition, the US government provided support through research funding and upgrading plants (even acquiring capacity from competitors) to scale up production and procure necessary equipment.26
A multi-country bloc such as the EU could not organise its purchases as quickly as the UK and the US,27 signing its first APAs in August 2020. A matter of great dispute (albeit of lesser relevance for trade law) was the clause in the EU APAs that stipulates that vaccine manufacturers should make 'best reasonable efforts' in supplying the vaccines,28 leading to prior contractual commitments (with the UK and the US) taking precedence.
In conclusion, APAs reward early-stage risk-taking in a manner that EU subsidies were not accustomed to. In addition, the EU typically relies on its market size, and not its speed, for negotiation leverage and commercial bargaining power. The EU signalled its intent to impose export restrictions unless the manufacturers fulfilled their obligations under their APAs with the EU before delivering to other countries,29 eventually seizing 250,000 doses of the AstraZeneca-Oxford vaccine destined for Australia,30 which had signed its APA after the EU.
V Absent multilateral leadership
In light of the US policy of America First and the US's retreat from multilateralism, the EU was arguably the only viable source of global leadership and coordination in 2020. Perhaps in an attempt to prevent the kind of situation brought about by a lack of PPE, the President of the European Commission, Ursula von der Leyen, made multiple statements on vaccines as 'universal, common good',31 advocating a globally coordinated and non-market driven approach. The EU also initiated a donor conference, with more than 40 countries pledging €7.4 billion.32 On this occasion, President von der Leyen, President Emmanuel Macron of France, Chancellor Angela Merkel of Germany and Prime Minister Justin Trudeau of Canada reiterated that a vaccine was 'a unique global public good of the 21st century. Together with our partners, we commit to making it available, accessible and affordable to all.'33
The European message was unequivocal: the EU would be the guarantor of universal access to vaccines. The principal beneficiary of the multilateral funding was the COVAX facility, co-organised by Gavi, the Vaccine Alliance (a public-private partnership), the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations. The EU – via the European Commission and the European Investment Bank, its regional development bank – has donated approximately €500 million to COVAX, equivalent to 1 billion covid-19 doses.34 In addition, some individual Member States, including Spain, Sweden and Portugal, pledged bilateral donations,35 later joined by Germany, Italy and France, bringing the total amount of contributions from the EU to €26 billion by April 2021.36
However, only France committed to donating vaccines rather than just funds by pledging 105,600 doses, with another 500,000 to be delivered later.37 Similarly, the UK contributed £548 million to COVAX but did not commit to donating vaccines.38 The US, China and Russia joined COVAX at a later stage.39 The US's initial refusal to join COVAX was rooted in its withdrawal from the WHO.40
In sum, the EU leadership on vaccines largely translated into fundraising, with very few vaccines actually being distributed. Vaccine shortages were not a matter of funding shortages as there were no vaccines to procure. By the end of May 2021, COVAX had shipped just 77 million vaccines to 127 countries,41 amounting to single doses for less than 1 per cent of the global population. Moreover, the EU announced that the bloc would not share its vaccine supplies with COVAX until there was a 'better production situation in the EU',42 and faced considerable criticism for it. The EU had also signed APAs and demanded prioritisation before other APA signatories, even seizing shipments. The EU response to the criticism builds on the fact that it had exported 34 million doses to 31 countries.43 However, these exports were exclusively shipments organised by vaccine manufacturers to the UK and other high-income countries to fulfil their APAs, rather than doses purchased and organised by Member State governments for developing countries.
The Biden administration announced at the G7 Summit in June 2021 that it would donate 80 million surplus doses, mostly through COVAX,44 reaffirming the centrality of US leadership for multilateral order – or perhaps merely pointing to the root of the problem. In addition to the vaccines distributed by the private sector in the EU, the US and the UK, the WHO has approved the use of Chinese SinoPharm and SinoVac vaccines for distribution within COVAX. China's Ministry of Foreign Affairs announced that it would provide 10 million doses to COVAX,45 which were delivered on 1 June 2021.46 In addition, China has bilaterally delivered more than 350 million doses to the developing world, primarily in the Asia-Pacific region and Africa, in addition to vaccine production assistance.47
Others have turned to Russia for vaccines. Sputnik V has been authorised in Latin America (Argentina, Mexico, Guatemala, Honduras, Guyana, Bolivia and Venezuela), across Africa (with 300 million doses pledged with financing to the Member States of the African Union),48 eastern Europe (Hungary, Serbia), the Middle East (Iran, the Palestinian territories and the United Arab Emirates) and former Soviet states (Belarus, Armenia and Turkmenistan).49
Statements from African and South East Asian leaders indicate a positive reception of Russian and Chinese vaccines, and 'as good as any other vaccines invented by the Americans or the Europeans',50 implying that the West is no longer an exclusive source of innovation. The Indonesian Ministry of Health's covid-19 vaccination spokesperson, Dr Siti Nadia Tarmizi, stated: 'We are not waiting for a better vaccine because we do not know when it will arrive.'51 This demonstrates how the emerging powers quickly filled the leadership vacuum left by America First and Europe's ineptitude.
The multilateral efforts in late 2020 to mid 2021 provide a lifetime's worth of lessons for trade negotiators, which will inform the debate on how governments can cooperate in the face of a global pandemic.
First, the exceptions that rendered the WTO rules ineffective were not due to a flaw or oversight; in fact, they are a part of the intentional design. Articles XI, XX and XXI of the GATT provide for carefully balanced and negotiated outcomes. Their exceptions were specifically designed for exceptional circumstances; however, this accounted for one Member facing an emergency that necessitates exceptional measures – not a global pandemic where nearly every able Member will impose such measures, creating conspicuously suboptimal outcomes.
Moreover, the WTO disciplines are greatly concerned with trade distortion caused by monopolistic behaviour that displaces supply from other countries – and much less to do with market failures brought on by monopsonic buyers, where a government attempts to displace other people's demand for a globally scarce good. Similarly, trade disciplines are, by and large, indifferent to delays, advance purchases or the sequencing of supply.
Yet the order we deliver the vaccines in is a matter of life and death, which determines who stands at the front or the end of the queue to the lifeboats. While the exceptions in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have widely been debated and criticised by some WTO Members and non-governmental organisations, the export restrictions by the largest producing countries remained relatively unchallenged – which is a remarkable paradox.52 Hoarding and some export restrictions (which arbitrarily blocked shipments to some countries) might have been challenged in the WTO under different political circumstances.
If GATT exceptions made trade law irrelevant, the proliferation of APAs transformed the subject entirely, from public international law to contract law. On the surface, the bilateral APAs concluded by the EU, the UK and the US prevented a more globally balanced distribution of vaccines and eroded collaboration between countries,53 potentially even prolonging the pandemic.54 The United Nations Secretary-General, António Guterres, criticised the APAs as 'side deals' that 'undermine access to all people in the world'.55
Ultimately, even contract law was trumped by politics: the EU took the political decision of not sharing vaccines with developing countries,56 and seized APA shipments destined for countries considered lower down in the pecking order.57 If vaccine nationalism was a political necessity in the West, at the other end of the spectrum are China and Russia, for whom vaccine diplomacy was good statecraft. China and Russia may or may not gain long-term strategic allies through their donations. Nonetheless, they were successful in highlighting that liberal democracies are not necessary to bring the vaccine to Asia, Africa and Latin America. President Xi Jinping of China has proclaimed that Chinese vaccines are a global public good58 – but they are not a multilateral public good. China and Russia proved they could assist developing countries without cooperating with COVAX or any multilateral institution that is dominated by the West.
The emergence of China and Russia as vaccine producers leads to the concluding point on leadership. The Director-General of the WHO, Tedros Adhanom Ghebreyesus, made a pertinent point on vaccine nationalism: 'Whilst there is a wish amongst leaders to protect their own people first, the response to this pandemic has to be collective.'59 The response should perhaps have been collective, but leadership in times of crisis is rarely exercised collectively. Europe failed to seize its moment under America First because of its inability to take transactional risks, pre-empt or swiftly respond to the unilateral action of others, and provide actual leadership outside of publicity and cash contributions.
The APAs were arguably less criticised ethically (if not also legally), except by the EU. Meanwhile, both the US and the EU imposed production or export controls that raised new questions pertaining to WTO exceptions. The vaccine policies of the EU, the UK and the US were not measured by lawfulness alone, however, but also by public expectation: by resorting to vaccine nationalism, albeit very reluctantly, the EU failed to live up to its own public messaging and the expectations it had set for other world powers. But the long-term lesson observers draw from this reversal is not about Europe. In fact, the true lesson is about multilateral rule-based order, which did not turn out to be a viable solution to a global existential crisis.
As the pandemic may result in more carve-outs from WTO rules, it could be said that hardship builds neither law nor character.
1 Hosuk Lee-Makiyama the director of the European Centre for International Political Economy. The author thanks Faith Tigere Pittet for her able research assistance.
3 Mölynlyke (2020). French export ban for face masks lifted. Retrieved from https://www.molnlycke.com/news/news-archive/french-export-ban-for-face-masks-lifted/.
4 Commission Implementing Regulation (EU) 2020/402 of 14 March 2020 making the exportation of certain products subject to the production of an export authorisation (2020) OJ L77/1. Retrieved from https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:L:2020:077I:FULL&from=EN.
5 Including AstraZeneca, Pfizer-BioNTech, Moderna, Janssen Pharmaceuticals, CureVac, Sanofi Pasteur and GlaxoSmithKline Biologicals, and Novavax.
6 The European Commission (2021). Questions and Answers: Transparency and authorisation mechanism for exports of COVID-19 vaccines. Retrieved from https://ec.europa.eu/commission/presscorner/detail/en/qanda_21_308.
7 Presidential Memorandum (2020). Memorandum on Allocating Certain Scarce or Threatened Health and Medical Resources to Domestic Use. The White House. Retrieved from https://trumpwhitehouse.archives.gov/presidential-actions/memorandum-allocating-certain-scarce-threatened-health-medical-resources-
8 The Defense Production Act of 1950, as amended [50 U.S.C. § 4501 et seq.]. Current through P.L. 115-232, enacted Aug. 13, 2018.
9 The White House (2021). Remarks by President Biden on the Administration's COVID-19 Vaccination Efforts. Retrieved from https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/03/02/remarks-by-president-biden-on-the-administrations-covid-19-vaccination-efforts/.
10 Restrictions on parallel export and 'hoarding' of medicines under regulation 43(2) of the Human Medicines Regulations 2012. Retrieved from https://assets.publishing.service.gov.uk/media/5d95b627ed915d08f0f326a8/letter-to-wda-holders.pdf.
11 The General Agreement on Trade and Tariffs. Article XI: General elimination of quantitative restrictions. Retrieved from https://www.wto.org/english/res_e/publications_e/ai17_e/gatt1994_art11_gatt47.pdf.
12 Panel Reports, China – Measures Related to the Exportation of Various Raw Materials, WT/DS394/R, Add.1 and Corr.1 / WT/DS395/R, Add.1 and Corr.1 / WT/DS398/R, Add.1 and Corr.1, adopted 22 February 2012, as modified by Appellate Body Reports WT/DS394/AB/R / WT/DS395/AB/R / WT/DS398/AB/R, DSR 2012:VII, p. 350.
13 The doctrine was first adopted in the Panel Report United States – Section 337, L/6439 and upheld since.
14 Appellate Body Report, United States – Standards for Reformulated and Conventional Gasoline,
WT/DS2/AB/R, adopted 20 May 1996, DSR 1996: I, 3; and Appellate Body Report, United States – Import Prohibition of Certain Shrimp and Shrimp Products, WT/DS58/AB/R, adopted 6 November 1998, DSR 1998: VII, 2755.
15 Panel Report, Russia – Measures Concerning Traffic in Transit. WT/DS512/7 adopted 29 April 2019. Retrieved from https://www.wto.org/english/tratop_e/dispu_e/cases_e/ds512_e.htm.
16 Request for Consultations – United States – Certain Measures on Steel and Aluminium Products,
17 Panel Report, Saudi Arabia – Measures Concerning the Protection of Intellectual Property Rights,
WT/DS567/R (adopted 16 June 2020).
18 Phelan, A.L et al. (2020). Legal agreements: barriers and enablers to global equitable COVID-19 vaccine access. The Lancet Journal. 396 (10254), 800-802. Retrieved from https://www.thelancet.com/article/S0140-6736(20)31873-0/fulltext.
19 Kremer, M. et al. (2015). Briefing note on advance purchase agreements. DFID Health Resource Systems Resource Centre. Retrieved from https://www.heart-resources.org/wp-content/uploads/2012/09/Briefing-note-on-APC.pdf.
20 Ackermann, A.C. et al. (2021). COVID19 vaccines advance purchase agreements tracker: insights on pre-orders and prices. HIS Markit. Retrieved from https://ihsmarkit.com/research-analysis/covid19-
21 Phelan et al (2020).
22 Lem, P. (2021). AstraZeneca boss says faster UK vaccines due to contract terms. Research Professional News. Retrieved from https://www.researchprofessionalnews.com/rr-news-europe-innovation-2021-1-
23 Pharmaceutical Technology (2020). UK providing funding support for Covid-19 vaccine programme. Pharmaceutical Technology News. Retrieved from https://www.pharmaceutical-technology.com/news/uk-covid-19-vaccine-funding/.
24 Aakash et al. (2020). U.S. secures 300 million doses of potential AstraZeneca COVID-19 vaccine. Reuters News. https://www.reuters.com/article/us-health-coronavirus-astrazeneca-idUSKBN22X0J9.
25 Herper, M. (2020). Sanofi and GSK land $2.1 billion deal with U.S. for Covid-19 vaccine development and 100 million doses. Stat News. Retrieved from https://www.statnews.com/2020/07/31/operation-warp-
26 Bondoc, B.D. and Hills, B.J. (2021). United States: Vaccine Production And State Intervention In The U.S. Morrison and Forrester LLP. Mondaq News. Retrieved from https://www.mondaq.com/unitedstates/government-measures/1053928/vaccine-production-and-state-intervention-in-the-us.
27 Smout, A. and Blamont, M. (2020). Britain secures 60 million doses of Sanofi/GSK coronavirus vaccine. Reuters News. Retrieved from https://www.reuters.com/article/health-coronavirus-britain-vaccines/britain-secures-60-million-doses-of-sanofi-gsk-coronavirus-vaccine-idINKCN24U0IG?edition-redirect=in.
28 European Commission (2020). EU APA with Pfizer. Retrieved from https://ec.europa.eu/info/sites/default/files/redacted_advance_purchase_agreement_biontech-pfizer_0.pdf; European Commission (2020). EU APA with Curevac. Retrieved from https://ec.europa.eu/info/sites/default/files/curevac_-_redacted_advance_purchase_agreement_0.pdf; European Commission (2020). EU APA with Astra Zeneca. Retrieved from https://ec.europa.eu/commission/presscorner/detail/en/ip_21_302.
29 DW (2021). EU warns AstraZeneca of export ban if bloc not supplied first. DW News. Retrieved from https://www.dw.com/en/eu-warns-astrazeneca-of-export-ban-if-bloc-not-supplied-first/a-56937185.
30 Fleming, S. and Brunsden, J. (2021). Italy blocks shipment of Oxford/AstraZeneca vaccines to Australia. Financial Times. Retrieved from https://www.ft.com/content/bed655ac-9285-486a-b5ad-b015284798c8.
31 European Commission (2020). Statement by President von der Leyen at the joint press conference with other leaders, organised by the WHO, on the call for global action against the coronavirus. Retrieved from https://ec.europa.eu/commission/presscorner/detail/en/statement_20_741.
32 Peel, M. (2020). EU-led coronavirus funding drive nears initial €7.5bn target. Financial Times. Retrieved from https://www.ft.com/content/9dd4fbea-93c0-4631-ab0a-6734e948d170.
33 The global response: Working together to help the world get better. 3 May 2020, Brussels. Retrieved from https://ec.europa.eu/commission/presscorner/detail/en/AC_20_795.
34 Gavi (2021). Team Europe contributes €500 million to COVAX initiative to provide one billion COVID-19 vaccine doses for low- and middle-income countries. Retrieved from https://www.gavi.org/news/media-room/team-europe-contributes-eu500-million-covax-initiative-provide-one-billion-covid-19.
35 Apelblat, M. (June 2021). EU vaccines: Millions of doses exported to rich countries, less to poor countries. The Brussels Times. Retrieved from https://www.brusselstimes.com/news/eu-affairs/168606/eu-vaccines-
36 European Council (2021). EU's international solidarity during the COVID-19 pandemic. Retrieved from https://www.consilium.europa.eu/en/policies/coronavirus/global-solidarity/.
37 Gavi (2021). Algeria, Angola, Benin, Botswana, Cameroon, Comoros, Congo DR, Côte d'Ivoire, Eswatini, Ethiopia, Ghana, Guinea, Guinea-Bissau, Kenya, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, The Gambia, Togo, Uganda and Zambia (June 2021). Retrieved from https://www.gavi.org/covax-vaccine-roll-out.
38 UK government (June 2021). UK meets £250m match aid target into COVAX, the global vaccines facility. Department of Foreign Affairs. Retrieved from https://www.gov.uk/government/news/uk-raises-1bn-so-
39 Lawler, D. (2020). Vaccine initiative now covers almost entire world, but not U.S. or Russia. Axios. Retrieved from https://www.axios.com/covax-initiative-vaccines-china-joins-trump-russia-26dce1f3-1b81-47af-8b7d-199900a928f3.html.
40 Rauhala, E. and Abutaleb, Y. (2021). U.S. says it won't join WHO-linked effort to develop, distribute coronavirus vaccine. The Washington Post. Retrieved from https://www.washingtonpost.com/world/coronavirus-vaccine-trump/2020/09/01/b44b42be-e965-11ea-bf44-0d31c85838a5_story.html.
42 DW (2021). Coronavirus: EU 'not ready' to share COVID vaccines with poorer countries. DW News. https://www.dw.com/en/coronavirus-eu-not-ready-to-share-covid-vaccines-with-poorer-countries/a-56944274.
43 Supra note 36.
44 The White House (2021). Fact Sheet: Biden-Harris Administration Unveils Strategy for Global Vaccine Sharing, Announcing Allocation Plan for the First 25 million Doses to be Shared Globally. Retrieved from https://www.whitehouse.gov/briefing-room/statements-releases/2021/06/03/fact-sheet-biden-harris-
45 Bridge (2021). Four Months After China's Joining of COVAX: Progress Amid Uncertainties. Retrieved from https://bridgebeijing.com/blogposts/four-months-after-chinas-joining-of-covax-progress-amid-uncertainties/.
46 Xinhua (2021). 1st batch of Sinopharm's COVID-19 vaccine to COVAX rolls off production line. CGTN Africa News. Retrieved from https://africa.cgtn.com/2021/06/01/chinas-sinopharm-covid-19-
47 Ministry of Foreign Affairs of the Peoples Republic of China (2021). Foreign Ministry Spokesperson Wang Wenbin's Regular Press Conference on June 2, 2021. Retrieved from https://www.fmprc.gov.cn/mfa_eng/xwfw_665399/s2510_665401/2511_665403/t1880861.shtml.
48 African Medical Supplies Platform (2021). African Union member states accelerates online pre-orders as AMSP adds 300 million Sputnik V doses to its COVID 19 vaccine portfolio. Retrieved from https://amsp.africa/african-union-member-states-accelerates-online-pre-orders-as-amsp-adds-300-million-sputnik-v-doses-to-its-covid-19-vaccine-portfolio/.
49 The Associated Press (2021) Russia's Sputnik V Covid vaccine appears effective, study finds. NBC News. Retrieved from https://www.nbcnews.com/news/world/russia-s-sputnik-v-covid-vaccine-appears-effective-
study-finds-n1256448; Smith, A. (2021). Russia and China are beating the U.S. at vaccine diplomacy, experts say. NBC news, p. 1. Retrieved from https://www.nbcnews.com/news/world/russia-china-are-
50 Ratcliffe, R. (2021). Philippines and Indonesia back Chinese Covid Jabs despite efficacy doubts. The Guardian. Retrieved from https://www.theguardian.com/world/2021/jan/14/philippines-and-indonesia-
52 Gostino, L.O. et al (2019). The Legal determinants of health: harnessing the power of law for global health and sustainable development. The Lancet, 393, 1857–1910.
53 Phelan et al (2020).
55 12 March 2021. UN chief blasts vaccine nationalism, hoarding, side deals. AP News. Retrieved from https://apnews.com/article/antonio-guterres-nationalism-coronavirus-pandemic-united-nations-economy-75435e6f15c33c1ac3c48048ffdd2ea7.
56 DW (2021). EU warns AstraZeneca of export ban if bloc not supplied first. DW News. Retrieved from https://www.dw.com/en/eu-warns-astrazeneca-of-export-ban-if-bloc-not-supplied-first/a-56937185.
57 Fleming, Brunsden (2021).
58 Wheaton, S. (2021). Chinese vaccine would be 'global public good,' Xi says. Politico News. Retrieved from https://www.politico.eu/article/chinese-vaccine-would-be-global-public-good-xi-says/.
59 Khan, A. (2021). What is 'vaccine nationalism' and why is it so harmful?. Al Jazeera News. Retrieved from https://www.aljazeera.com/features/2021/2/7/what-is-vaccine-nationalism-and-why-is-it-so-harmful.