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Duke Medical Ethics Journal

Vaccine Hoarders: How Vaccine Nationalism Has Led to Inequity and Possible Solutions

By: Pranav Kannan

Undoubtedly, the subject of vaccines has risen to the forefront of public attention for the past few years -- and there is a reason why. Almost 80% of all Americans have at least obtained a single dose of the COVID-19 vaccine, and this number continues to grow through the Biden administration’s campaign to distribute the booster [1]. Yet, Americans have been blindsided by the abundance of resources at their disposal -- marginalized, lesser developed countries still face challenges obtaining initial vaccine doses and have completely altered their economic and healthcare structure. Studies present that 62% of the global population has received one dose of the vaccine, however, this statistic does not reveal the reality. Data from the New England Journal of Medicine determined that only 11% of all people in low income countries have been vaccinated in comparison to the 90% vaccination rates in wealthier nations [3]. 

Clearly, wealthier nations outcompete smaller countries for medical resources which has led to the stockpiling of valuable resources. This issue, called vaccine nationalism, poses a dangerous threat to the equitable distribution of inoculations. This will have disastrous impacts not only for lesser developed countries, but also for the global economy. Through the examination of such determinants due to vaccine nationalism, solutions can be proposed to effectively increase equity and safety


There is a fine line for a government to obtain vaccines for its nation to survive versus the deception and hoarding of valuable, limited goods during a global pandemic. Unsurprisingly, this issue has not been only seen during the COVID-19 pandemic. In 2009, there was fear over the limited production of the H1N1 vaccine for lesser developed countries and so the UN reached out to Australia who demanded their local production sites the government’s domestic amounts before shipping extras outward [4]. Such issues have cultivated international health policy initiatives like the International Covenant on Economic Social and Cultural Rights (ICESCR). Unfortunately, ICESCR was written in a way that lacks jurisdictional restrictions which catalyzed

unethical practices such as vaccine nationalism forward [4]. These backward steps have resulted in certain regions, such as sub-saharan Africa, struggling both with economic and healthcare instability. During the COVID-19 pandemic, the poverty and food insecurity rate increased dramatically, and medical supplies were insufficient and inadequate with short expiration dates. These measures severely impacted the trust between the government and citizens leading to more violence in sub-saharan countries. Healthcare systems were scrambling due to the lack of resources such as in areas of Africa, like Somalia, which had only one hospital in the whole country handling all COVID-19 cases. Not only did the government and healthcare systems worsen, but also education -- in South Africa, around 750,000 children dropped out of school during the pandemic which was almost three times the amount before the pandemic began [5]. It is evident that vaccine nationalism has completely disrupted lower income countries and will continue to cause immense challenges to governments and its citizens in the near future.  globally. 

Yet, this behavior is a double edged sword -- wealthier nations will still face pressing threats to the health of their citizens. In early 2021, new COVID-19 variants emerged in Brazil and Bangladesh which cultivated the emergence of other viruses and potent mutations in COVID-19. These variants continue to spread across the world and have the opportunity to mutate into vaccine-resistant strains. Challenges resulted such as the difficulty in detection of the Omicron variant wave in COVID-19 test kits. Thus, in order to control the Pandemic, we must have a ‘communal immunity’ to reduce transmission rates -- which means more equitable sharing of vaccines globally [4]. The lack of resources shared will ultimately lead to strained international relationships, which would decrease the level of surveillance and global health measures created by high-income countries in efforts to protect their citizens. This will eventually create other global health crises with the possibility of pandemics in our near future. Clearly, vaccine nationalism presents a superficial solution for economically developed countries, however, unmasking the issue reveals its harm to both the marginalized and wealthy nations. 

We must develop solutions to global healthcare inequities

not only to end this pandemic but foster faster collaboration

and response to future outbreaks. The WHO has already set

up a program called COVAX which has aimed to distribute

more vaccines to lower income countries. Disappointingly,

the lack of resources and aid given to the COVAX initiative

led to its limiting purchasing power, allowing wealthier

countries to beat out the WHO when procuring

inoculations. These international political actors control the

vaccine market, and sidelined the WHO from achieving a

more equitable initiative. This situation could be solved

through a stronger, democratic style of governance in the

WHO which will dictate all global health measures so that

health equity decisions are not controlled by just the

politically elite member states[6]. A new style of

governance will lead to all members of the WHO sharing

their concerns about public health crises -- thus establishing effective communication and solutions with marginalized countries. Nonetheless, the WHO also needs a more robust system to tackle vaccine inequities. Utilizing a US health policy initiative -- PEPFAR -- or the President's Emergency Plan for AIDS Relief, which focuses on data analysis, equitable distribution, workforce development, future preparedness, and development of future vaccines and drugs [2]. PEPFAR was incredibly successful as it garnered bipartisan support and bolstered the workforce to train in treating HIV/AIDS. Evidently, augmenting PEPFAR on a global scale should be a potential plan of action for the WHO’s fight on COVID-19 and vaccine inequities [2]. Ultimately, our answers to vaccine nationalism lie in our many past successes against large scale disease outbreaks -- it is up to us to comprehend and adapt policies that create a healthier world. 









MUMBAI, INDIA - APRIL 8: A public notice hangs outside a vaccination centre notifying shortage of vaccines, in Mahim, on April 8, 2021 in Mumbai, India. (Photo by Satish Bate/Hindustan Times via Getty Images)

There are plenty of possible solutions to vaccine nationalism for COVID-19, but eventually this funnels back to misguided knowledge of global health. Vital medical devices should not be recognized as a market good but rather public good [2]. We must change our perspective on the amount of influence commercialization can have on the role of vaccines, especially during a pandemic. With more public awareness of issues surrounding inequities due to the large wealth gaps between countries, we can shift to a more equitable world where hoarding vaccines will be a relic of the past. 

Review Editor: Rohan Gupta
Design Editor: Libby Gough

[1]: US coronavirus vaccine tracker. USAFacts. (2022, November 25). Retrieved November 27, 2022, from 

[2]: Katz, I. T., Weintraub, R., Bekker, L.-G., & Brandt, A. M. (2021). From vaccine nationalism to vaccine equity — finding a path forward. New England Journal of Medicine, 384(14), 1281–1283.  

[3]:Hunter, D. J., Al., E., Author AffiliationsFrom the Nuffield Department of Population Health, Y. Feng and F. Wang, T. L. Cowger and Others, & Mikuls, T. R. (2022, November 17). Addressing vaccine inequity - COVID-19 vaccines as a global public good: Nejm. New England Journal of Medicine. Retrieved November 27, 2022, from 

[4]:Riaz, M. M. A., Ahmad, U., Mohan, A., dos Santos Costa, A. C., Khan, H., Babar, M. S., Hasan, M. M., Essar, M. Y., & Zil-E-Ali, A. (2021, December 29). Global impact of vaccine nationalism during COVID-19 pandemic - tropical medicine and health. BioMed Central. Retrieved November 27, 2022, from 

[5]:Sub-saharan Africa: Millions denied vaccines, deepening inequality and human suffering from conflicts sum up 2021. Amnesty International. (2022, March 29). Retrieved November 27, 2022, from

[6]: Kim, H. (n.d.). We need peoples’ WHO to solve vaccine inequity, and we need it now. BMJ: Peer Reviewed Medical Trade Journal. Retrieved November 27, 2022, from

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