“Vaccine Multilateralism” – Singapore’s approach towards fair and equitable access for COVID-19 vaccines

by Ambassador Umej Bhatia, Permanent Mission of Singapore Blog, Blog, By invitation, By invitation, Uncategorized

Just a year ago the threat of a global pandemic was treated as a theoretical possibility, the subject of scenario planning or fiction. Pandemic preparedness was expressed in words but not as much in deeds. Today after taking over 1.5 million lives globally, COVID-19 has become a brutal reality-check for us all. It has transformed our societies, impacted the world economy and changed our everyday life. Besides its drastic public health and socio-economic impact, the pandemic has also accelerated isolationist sentiments, eroding support for a rules-based multilateral system precisely when we need it most.

Recent positive news on several COVID-19 vaccine candidates offers light at the end of the tunnel. However, we still have a long way to go. Critical uncertainties include the duration of immune response, the efficacy of the vaccine candidates among vulnerable segments of the population and cold chain requirements.  There are still many ways in which the global situation can take a turn for the worse, especially if the international community fails to band together to tackle the pandemic collectively. The key area in which we must collectively commit to is the fair and equitable distribution to COVID-19 tools, especially vaccines. “Vaccine multilateralism” can be the base for us to build back better our frameworks of international cooperation to adequately meet the COVID-19 challenge and confront other “problems without passports”.

As a densely populated city state, Singapore is particularly vulnerable to the effects of COVID-19. From the health perspective, a pandemic like COVID-19 could decimate our population given our high urban density. 15% of our residents are over 65, which puts them at greater risk. Singapore acted swiftly and decisively after the early days of the pandemic to prevent the situation from getting out of hand and overwhelming our health systems. We put in place international travel restrictions, required the use of face masks in public, had extensive testing and a “circuit breaker”, which was a period of strict domestic restrictions aimed at disrupting community transmissions. We are now fortunately in a relatively stable situation, with community transmissions brought down to an almost negligible level.

Despite our domestic success, the reality is that countries do not exist nor thrive in hermetically sealed bubbles. As a small island state, Singapore is highly economically dependent on global markets and international trade which have been severely disrupted by the COVID-19 pandemic. The pandemic and ensuing global economic slowdown had a brutally accelerated trickle-down effect, affecting livelihoods of people all around the world, including in Singapore. It made clear just how connected we were and that no one can overcome this disease or mitigate its impact alone.

Singapore recognised this fundamental principle early on. We championed a coordinated international response to COVID-19 led by global health actors, whether multilateral such as WHO, or multi-stakeholder like Gavi, the Vaccine Alliance or the Coalition for Epidemic Preparedness Innovations (CEPI). Chief among the various international workstreams has been the effort to identify safe and efficacious COVID-19 vaccines, an important tool that would pave the way out of the acute phase of this pandemic. While all governments and leaders naturally seek to prioritise the safety of their citizens, with COVID-19 no one is safe until everyone is safe. For vaccines to truly be an effective tool against the pandemic, all in need must have fair and equitable access. This is why Singapore’s Prime Minister, Mr Lee Hsien Loong, urged countries to forge partnerships under the rubric of what he termed “vaccine multilateralism” in June 2020 during the Global Vaccine Summit. Prime Minister Lee’s call has helped to shape the global conversation around ensuring equitable access to COVID-19 vaccines.

While the concept of “vaccine multilateralism” is simple, it is a paradigm shift from the way the issue of vaccine access has been treated in the past. In 2009, high-income countries snapped up almost all of the vaccines doses for H1N1 vaccines, and some even put in place policies to prevent export of doses if they were manufactured locally. This left the rest of the developing world vulnerable to the H1N1 pandemic. When excess doses were eventually released or donated, the critical phase of the pandemic had already fizzled out. It was a case of too little too late, and a clear demonstration that for global health issues, this “pay to play” model was fundamentally flawed. We have to move away from vaccine nationalism, which is a short-term solution to a long-term issue, or vaccine diplomacy based on political considerations, and embrace “vaccine multilateralism”, which presents a sustainable way for the world to tackle this pandemic. As the saying goes, if you want to go far, go together. And as WHO Director General Dr Tedros has said: “No-one is safe until everyone is safe”.

When the WHO first announced the ground-breaking Access to COVID-19 Tools (ACT) Accelerator initiative in April 2020, one of the key principles underpinning the work of its various pillars was to ensure fair and equitable global access to COVID-19 tools. Singapore was an early supporter of the COVAX Facility, which was established under the vaccines pillar of the ACT Accelerator as the flagship global mechanism to secure fair and equitable access to COVID-19 vaccines for all countries, regardless of income level or development status. We founded the informal Friends of COVAX Facility (FOF) group, which we co-chair with Switzerland, to catalyse discussions about the COVAX Facility and generate a significant body of support among self-financing countries. The FOF has been a sounding-board for the Facility’s implementing partners, Gavi and CEPI, and has been closely involved in the co-creation of the Facility so that it could be a truly universal mechanism.

We are heartened to see that the world has overwhelmingly embraced the COVAX Facility as the global mechanism for access to COVID-19 vaccines. The Facility now has 189 participants, which covers an estimated 90% of the global population.  This demonstrates that almost all countries are committed to the idea of fair and equitable distribution. To advance global solidarity, Singapore has also committed a US$5 million contribution to the COVAX Advance Market Commitment (AMC), which supports 92 low and lower-middle income countries’ access to the COVAX Facility’s portfolio of vaccines. We are also honoured to have been invited to be a member of the ACT Accelerator’s Facilitation Council, in our capacity as Chair of the Forum of Small States. This allows us to ensure that the perspectives of small states are taken into account in deliberations about access, which is important given our unique set of challenges and circumstances. This pandemic also presents a special opportunity for us to strengthen our multilateral institutions, such as the UN and the WHO, to tackle the next pandemic far more effectively.

Without banding together as a global community, COVID-19 will continue to ravage communities and control our lives.  Committing to “vaccine multilateralism” will keep us on the right track as the beginning of the end of this pandemic appears in sight. We cannot ease off just yet, but must continue fighting this pandemic together with solidarity, science and solutions.  Let us work together to give our COVID-19 front-line fighters the tools, and they will finish the job.


Featured image: ‘Meeting between Singapore’s Permanent Representative to the UN at Geneva Ambassador Umej Bhatia (L) and Switzerland’s Ambassador for Global Health Nora Kronig Romero (R) which led to launch of the Friends of COVAX Facility’, June 2020, Permanent Mission of Singapore to the United Nations and other International Organisations at Geneva

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