《环球时报》刊发全文

“疫苗民族主义”与多边主义

部分因为北半球秋冬季节普通流感频发，多数经济体的新冠疫情尚未得到有效控制，各国边境管控仅能有限度放宽，世界因此对已经取得重大进展的疫苗寄予厚望。但疫苗不是一般性产品，从研发到三期临床试验证明安全、有效后，在紧急使用阶段还需进一步优化，得到相关经济体的医药管理机构批准使用后才能量产、广泛接种以实现群体免疫。

目前已经向世界卫生组织（WHO）报备的在研疫苗有40多款，其中已进入第三期临床试验的9款中有4款是中国企业研发的。任何一款准疫苗距离成功进入使用阶段都要有一个过程，一些准疫苗难免被淘汰。

研制、生产一款疫苗的经济和技术投入极高，产能必须以质量保障为前提。而这种质量保障又以其先期试验人群的健康安全保障需求为前提，这决定了仅有少数经济体能做到自研自用。所以，一些经济体采取了在研发阶段与他国合作（包括准备入市产品的分装、运输）；另一些经济体则因没有疫苗自研或参与研发的机会，需要通过国际采购才有机会获得产品供其民众接种使用。WHO的疫苗预先认证为国际采购提供了技术性参考。

基于全球新冠疫苗供应剂数的不确定性，以及与有接种需求人口之间的庞大差额，获批产品推出初期出现供需短缺是难免的。WHO连同全球免疫联盟（GAVI）、由盖茨基金会资助成立的流行病防范创新联盟（CEPI）在今年9月发布的”新冠疫苗实施计划”（Covax Facility）列出的目标，是在2021年末有20亿支疫苗可供中低收入经济体使用。参与该计划的经济体有望满足其20%的人口接种需求。

当下，在科技上有研发能力、经济上有支付能力的发达经济体，“疫苗民族主义”是普遍性选择。虽然到目前为止还没有获批使用的疫苗，只有“准疫苗”或者说可以批准紧急使用的产品，多个发达经济体已经通过与疫苗研发企业签订预先订购合同的途径，为满足本国的疫苗使用需求做准备。据称，美国、英国、欧盟和日本已经锁定了13亿支潜在新冠疫苗的使用权。

疫苗分配的可及性仅是世界面临的挑战之一。如果以同物同价为原则分配新冠疫苗，对多数中低收入经济体而言将处于可望而不可即的窘境。其实，包括普通疫苗在内，这些经济体的可支付性挑战一直存在。GAVI由疫苗生产者组成，它将无力自研自用的经济体按照人均收入水平分类，一部分需要全额支付，另一部分则可得到有补贴的低价疫苗。

“新冠疫苗实施计划”是一种多边主义安排，被其推出者称为“自巴黎气候协定以来最具雄心的国际合作”。该计划的出现，表明疫苗作为国际卫生公共品的理念得到了认可。开发者和使用者通过销售计划谈判，而相互进行利益保护。

必须看到，“疫苗民族主义”行为有历史先例。例如在2009-2010年的H1N1病毒疫情应对过程中，少数发达经济体选择了以研发和支付能力为基础而抱团互助，甚至囤积疫苗，等本国接种需求充分满足后才开始谋划向其他经济体推出。但此时疫情已经基本结束，因此出现了疫苗过剩。可见，“疫苗民族主义”是一把双刃剑。

我们还要看到，新冠疫情是百年不遇的全球性挑战，在疫苗需求强劲的情形下，保障并扩大本国疫苗生产，且对疫苗针剂、包装和注射器生产所依赖的材料的全球性流通设置限制，这种可能性是无法排除的。这也是“疫苗民族主义”的表征之一。毕竟，疫苗产品的跨国流通也是国际经贸竞争的载体之一，背后涉及品牌、经济和政治等产品衍生利益的博弈。

现实世界中，公共卫生是地缘政治和经济博弈的领域之一。疫苗的采购若是以产品的国别属性为核心指标，那将是“疫苗民族主义”的另一种形式。那种不以疫苗与接种人群所需的病理学原理匹配为采购政策指针的做法，有违基础医疗常识，也许能博得一时的政治运作收获，但实质上是对其国民不负责任。

根据业已公布的“新冠疫苗实施计划”，中国在单价方面因人均收入水平处于中等偏高阶梯而不会得到特别照顾。即便如此，在这一计划中，中国将有机会成为产品的供应方和采购方，特别是在国内产能不足以满足需求的情形下。作为供应方，加入集体谈判可节约双边谈判所需的人力和物力。

新冠疫苗的多边主义安排，不可简单化地理解为与“疫苗民族主义”形成对抗。特别是在应对新冠疫情的挑战中，病毒的传播不分国籍、不认国界，也不认经济体和个人支付能力的差距。尽可能多的经济体尽可能早地得以通过疫苗接种而实现群体免疫，不同经济体之间的经贸和人员往来就有望尽快恢复常态。所以，在疫苗的实施方面践行多边主义也是维护自身公共安全的一种举措。事实上，包括欧盟成员国在内，不少经济体在选择双边预购安排的同时，也加入了多边实施计划。         

新冠病毒的病原学机理尚未被科学界发现。未来对新冠疫苗的需求，会不会像非典疫情过后那样消失，也是未知数。总而言之，“疫苗民族主义”和多边主义之间在进行着一种竞赛。多边计划有利于为未来可能出现的多种情景做准备。

文章转载自环球网

《马尼拉时报》刊发文章全文

Cross-national accessibility of Covid vaccines: Nationalism vs multilateralism

Around the world, great hope is placed on vaccines as an instrument for dealing with the year-long Covid-19 pandemic. With the winter flu season in the more populous northern hemisphere and many societies still struggling with containing the spread of the virus, loosening of international travel restrictions continues to be limited, which in turn hampers the world’s return to normalcy.

Much progress has been achieved in the search for vaccines. Yet, vaccine production necessitates a constant process of refinement through research, clinical trials and gathering of data to prove the vaccines’ safety and effectiveness. Only upon approval by national health authorities can a vaccine be mass-produced and then made available for mass inoculation, with the eventual goal of realizing mass immunity.

Around 40 candidate vaccines are registered with the World Health Organization (WHO), with nine of them — four of which by Chinese vaccine developers — in the third and final clinical trial phase. For any of these products to successfully reach the state of mass use, there is still a scientific process to complete. Some inevitably are to be eliminated.

Production of a vaccine is a demanding endeavor in terms of financial and technological inputs. Quality assurance is a necessary precondition, which must result from proven health safety and effectiveness on human participants in the development process. Only a few countries have the resources to produce vaccines to meet demand for immunization of their own populations.

Accordingly, some countries opt to partake in vaccine development initiated in other countries, including bottling and transportation. Some other countries will have to procure from the available international pool of successful vaccines. The WHO’s vaccine prequalification offers a technical reference for such procurement.

Globally, gaps between demand for vaccines and available dosages are a predictable reality, at least in the initial stage, partly because of uncertainty a producer faces in marketable doses of a product. To address this foreseeable challenge, the WHO, in collaboration with the Global Alliance of Vaccines and Immunization (GAVI) and the Coalition for Epidemic Preparedness Innovations (CEPI) offered the Covax Facility arrangement. The facility envisions making available two billion doses of Covid vaccines for use in middle- and low-income developing countries, covering some 20 percent of their total populations.

Against the odds, vaccine nationalism is a common choice of action by developed countries equipped with the scientific and technological capacity as well as financial resources to cover the associated costs. Although no vaccine has yet received approval for use, with only candidate vaccines that meet technical standards for emergency use, several developed country governments have signed advance purchase agreements with vaccine- developing corporations to satisfy future needs of their respective domestic populations. The United States, Great Britain, European Union member states and Japan are said to have secured right to 130 million doses of potential Covid vaccines.

Accessibility is but one of the many challenges the world is facing in vaccine distribution. If Covid vaccines are sold at market price levels, most low-income and some mid-income countries will encounter the predicament of affordability. To be fair, though, even with commonly available vaccines, affordability is a long-standing challenge for developing economies. GAVI, an alliance of vaccine producers, addresses the matter by dividing developing country beneficiaries into two categories, with one having to pay full costs and the other subsidized prices.

The Covax Facility is a multilateral arrangement. Its proponents champion it as the biggest effort at international cooperation since the Paris climate agreement. Emergence of the arrangement manifests acceptance of treating international health as a public good, which China champions. Product developers and users negotiate through the platform to realize the goal of mutual protection.

Vaccine nationalism, meanwhile, has its historical precedent. To deal with the H1N1 pandemic 2009-2010, a small number of developed economies chose to bond with each other on the merit of research and paying capabilities, with a few even hoarding successful vaccines. Developing economies were offered the product only after deployment needs had been met in developed ones, by which time the pandemic had come to an end. There resulted in a surplus and waste of vaccines. As such, vaccine nationalism can be a double-edged sword.

Covid-19 is an entirely different challenge, unprecedented in one century. Economies will be tempted to ensure and expand domestic capacities of vaccine production. But a scenario cannot be ruled out whereby curbs are imposed on global movement of materials for vaccine ingredients, packaging and injection. That will be another form of vaccine nationalism. After all, cross-national flow of vaccine products is a component of international competition in trade and investment, which comes with its share of frictions and conflicts over product branding and extended economic and political interests.

In the real world, public health is a sphere in which geopolitically motivated maneuvering takes place. Procurement of a vaccine, when a product’s nationality becomes a core choice factor, can become yet another manifestation of vaccine nationalism. For a procurement decision to be made without due regard for scientific facts behind pathobiology would be against common sense in therapeutic terms. It might earn some momentary gains in political maneuvering but amount to irresponsibility toward citizens so affected.

According to publicized information, in the Covax Facility, China is not going to receive preferential treatment when it comes to per unit price of participating vaccines，reflecting the fact that its per capita income is in the upper level of middle income economies. But China stands to have an opportunity to function as both a product supplier and purchaser under the platform, especially in the event of domestic products falling short of meeting demand. As a supplier, joining group negotiation can help save time and human resource input that comes with relying on bilateral channels.

A multilateral arrangement for Covid vaccine distribution, meanwhile, should not be viewed as a confrontation with acts of vaccine nationalism. The prevailing Covid-19 challenges are such that the spread of the virus pays no regard to an individual’s nationality, nation-state boundaries, or gaps in aggregate or individual capacity to afford a product. The sooner and the more societies reach the stage of herd immunity through effective immunization by vaccination, the greater for realization of hope for trade and travel to restore normalcy among different economies. In this sense, practices of multilateralism in vaccine access and affordability are also in line with protecting an economy’s own public health security.

As a matter of fact, including members of the European Union, many economies have opted to join multilateral vaccine arrangements, in addition to pursuing bilateral means of product acquisition.

The world’s search for etiological origins of the Covid-19 virus is still under way. Whether future demand for a Covid vaccine will evaporate like that in the wake of the SARS pandemic in 2002-2003 remains unknown as well.

All in all, the world is witnessing a race between vaccine nationalism and multilateralism. Being part of a multilateral arrangement is one way to prepare for multiple future scenarios.

文章转载自Manila Times