Viral Sovereignty, Vaccine Diplomacy, and Vaccine Nationalism: The Institutions of Global Vaccine Access

The COVID-19 pandemic has triggered a global vaccine race. Distributive questions about which countries will receive scarce doses and under which conditions pervade international law and diplomacy. This Article is the first to describe the phenomena that have driven the development of international vaccine-sharing mechanisms, identify the international organizational forces that explain the phenomena, and explain how international organizations may facilitate international cooperation before, during, and after global crises. This Article explores the longstanding dissociation between global public health imperatives and nationalist responses to pandemics within the frameworks of “vaccine nationalism,” “viral sovereignty,” and “vaccine diplomacy.” The Article then considers two international agreements indicative of an interest in international collaborations, division of gains from trade, and sustained governance structures—the 2011 Pandemic Influenza Preparedness Framework, and the 2020 COVAX Vaccines Pillar of the ACT Accelerator. The recurrence of these legal arrangements suggests that, to save the transaction costs generated by repeated development of ad hoc structures that centralize vaccine distribution, a permanent facility may be developed. One possibility for such a facility is the Pandemic Influenza Preparedness Framework, adapted to become an all- or most-pathogen-sharing international organization. A second possibility, which gained some momentum during the COVID-19 pandemic, is a Pandemic Treaty establishing the terms under which pandemic vaccines will be developed and shared in the future