Legal agreements: barriers and enablers to global equitable COVID-19 vaccine access.
Legal agreements: barriers and enablers to global equitable COVID-19 vaccine access.
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DOI：
10.1016/s0140-6736(20)31873-0
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发表时间：
2020-09-19
期刊：
影响因子：
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通讯作者：
Wang C
中科院分区：
文献类型：
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作者：
Phelan AL;Eccleston-Turner M;Rourke M;Maleche A;Wang C
法律既可以成为全球健康、公平和正义的推动者，也可以成为障碍。1在法律被用作促进或阻止全球公平获得COVID-19疫苗的机制时，健康法律决定因素对COVID-19大流行的影响是显而易见的。阻碍公平获取的障碍部分是由疫苗民族主义造成的，各国政府寻求利用法律手段，通过与疫苗制造商签订预先购买协议，确保优先获得未来的疫苗。这些双边法律协议可能符合一个国家的利益，但鉴于个别COVID-19候选疫苗的不确定成功以及SARS-CoV-2的全球传播，APAs是一场赌博，会损害国家之间的合作。重要的是，这种双边法律协定可能助长不公平现象，并可能延长大流行的时间框架。相比之下，多边法律协定可以通过重新建立国际团结规范、致力于全球公平疫苗获取倡议，并为建立在多边主义和合作基础上的大流行后时代奠定基础，从而成为恢复全球卫生安全和正义的途径。在2020年5月世界卫生大会召开之前，来自世界各地的现任和前任政治家和民间社会领导人，包括加纳总统纳纳·阿库福-阿多、巴基斯坦总理伊姆兰·汗以及南非总统兼非洲联盟主席西里尔·拉马福萨，呼吁达成一项“大胆的国际协议”，保证全球公平获得疫苗作为全球公共产品。在被截断的世界卫生大会期间通过的唯一决议承认免疫，而不是疫苗本身，是一项全球公共产品。然而，从那时起，全球法律格局已经从全球公共产品的修辞转变为主要基于民族主义的现实。据世卫组织称，有170多种COVID-19候选疫苗正在开发中。虽然这些候选疫苗中只有8种目前处于3期试验阶段，但一些富裕国家已经获得了超过20亿剂使用APAs的潜在未来COVID-19疫苗。8
Law can serve as both an enabler and a barrier to global health, equity, and justice. 1 The impact of legal determinants of health on the COVID-19 pandemic is evident where law is being used as a mechanism to enable or prevent global equitable access to COVID-19 vaccines. Barriers to equitable access are partly driven by vaccine nationalism2 with governments seeking to use law to secure priority access to future vaccines through Advance Purchase Agreements (APAs) with vaccine manufacturers. These bilateral legal agreements can be in a nation’s interest, but given the uncertain success of individual COVID-19 vaccine candidates and the global spread of SARS-CoV-2, APAs are a gamble and erode collaboration between countries. Importantly, such bilateral legal agreements are likely to contribute to inequities and potentially extend the pandemic’s time frame. By contrast, multilateral legal agreements could be the path back to global health security and justice by re-establishing norms of international solidarity, committing to global equitable vaccine access initiatives, and laying a foundation for a post-pandemic era built on multilateralism and cooperation. In the lead-up to the World Health Assembly (WHA) in May, 2020, current and former politicians and civil society leaders from around the world, including the President of Ghana, Nana Akufo-Addo, the Prime Minister of Pakistan, Imran Khan, and the President of South Africa and Chair of the African Union, Cyril Ramaphosa, called for a “bold international agreement” that guarantees global equitable access to vaccines as global public goods. 3 At the WHA, China’s President Xi Jinping stated that any Chinese vaccine developed will be a “global public good”, and contribute to “ensuring accessibility and affordability in developing countries”. 4 The only resolution adopted during the truncated WHA recognised immunisation, rather than vaccines themselves, as a global public good. 5 However, since then, the global legal landscape has shifted from a rhetoric of global public goods to a reality largely based on nationalism. According to WHO, there are more than 170 COVID-19 candidate vaccines in development. 6 Although only eight of those vaccine candidates are now in phase 3 trials, 7 some wealthy nations have secured more than 2 billion doses of potential future COVID-19 vaccines using APAs. 8