Vaccines

Author: Nicholas Stubblefield Edited by: Nora Lewis

Suggested Citation:

Stubblefield, N., Lewis, N. (2026). Vaccines. Technology Assessment Project Case Study Library, University of Michigan. https://stpp.fordschool.umich.edu/tap-case-study-library/vaccines

Vaccines

Key Takeaways

• Technology can be used as a geopolitical and nationalistic bargaining chip, often to the detriment of less powerful and wealthy states.
• The distribution of such technology, particularly emerging technologies being rapidly developed in response to a national crisis, may prioritize national interests over the global collective good.
• Powerful states may exploit neocolonial dependencies to shift the risks of technological waste onto less powerful states, often with negative environmental impacts.

Vaccines as a Modernizing Technology

Medical experts widely consider vaccines the most important innovation, save potable water, for modern public health. Vaccines have proven an essential technology in transforming the way people adapt to and mitigate disease; in some cases, eliminating diseases altogether. Since 1914, vaccines have prevented over 40 million cases of diphtheria, 35 million cases of measles, and 103 million cases of other childhood diseases in the US alone (Rappuoli et al., 2014). Globally, vaccinations prevent 2.5 million deaths a year. Polio and smallpox infections, once notorious killers, are at a historic low, and in 1980 the World Health Assembly announced the human population was smallpox free (Centers for Disease Control and Prevention, 2024). By improving quality of life and increasing longevity, vaccines have removed barriers on the human experience and maintained open channels for social and economic interactions. Vaccines have played an important role in shaping the public health, economic, and social landscape of modernity.

Accessing Vaccines

Vaccine ownership rests almost exclusively within private pharmaceutical companies. Patent protections, both at the state and international levels, grant these companies broad control over vaccine supply, distribution, and pricing, thereby placing important public health questions in private hands (Frankel, 2023). Supply and pricing power allows pharmaceutical companies to decide which diseases to vaccinate and which to ignore. Some diseases lack the potential for substantial investment return, so, without profit incentive, private companies opt against vaccine development (Frankel, 2023). The discrimination with which these companies choose which diseases merit vaccines has led to a new category of illnesses called "neglected diseases." "Neglected diseases" are typically tropical sicknesses affecting populations in low- and middle-income countries (World Health Organization, n.d.-a) . Left to the whims of corporate interest, global public health suffers.

Private-public partnerships are not uncommon in vaccine development; however, government involvement places greater scrutiny on the patent model and the private company's exclusive right to profit. Astra Zeneca's COVID-19 vaccine was developed at Oxford University using public monies. Oxford then commercialized its product through Astra Zeneca, forfeiting the public investment in the vaccine to a total private ownership (Frankel, 2023). These private-public models offer significant financial windfalls to the private side while requiring little in return. Yet, when a product benefits from public investment, the returns are not funneled back to the source of that money: citizens.

Avenues do exist to circumvent private patent protections, but they are seldom used. During a severe public health crisis, state governments can suspend patent protections to allow third parties to produce the vaccine without the patent holder's permission (Council on Foreign Relations, n.d.). Governments call this practice "compulsory licensing," and the World Trade Organization (WTO) has codified it to varying degrees at both domestic and international levels (World Trade Organization, 2017). While compulsory licenses are an institutional check to broaden vaccine access and lower discriminatory costs during public health emergencies, countries are extremely reluctant to use them because of influential industry opposition (McMahon, 2020).

The COVID-19 pandemic saw a resurgence of the perennial public health versus patent rights debate, and illustrated the narratives companies use to justify private vaccine control. In October of 2020, India and South Africa, acting as representatives of the world's low- and middle-income countries, applied for a COVID vaccine patent waiver through the WTO. The two states argued that any effective response to the pandemic would have to be prompt and equitable, ensuring fast global herd immunity. Patent rights, and even the piecemeal logistical steps of compulsory licensing, would create barriers to vaccine access and prevent critical immunization; therefore, a waiver on intellectual property (IP) rights for COVID vaccine technology was required until the pandemic ended (World Trade Organization, 2020). The waiver met significant resistance from both private and state parties alike. Pharmaceutical companies responded with the typical messaging that waivers undermine the profit motivations which drive innovation. Additionally, companies and governments claimed vaccine technology-sharing posed national security risks and could provide foreign competitors with guarded state secrets (Council on Foreign Relations, n.d.). Innovation and security narratives are frequent tactics used to justify vaccine patent protections.

Failures in International Cooperation: COVID-19 Vaccine Access

Today's legal protections for patents and deference towards IP ownership have proven counter-productive for tackling global health emergencies. During the COVID-19 pandemic, experts urged a cooperative global response to achieve worldwide herd immunity and definitively suppress the spread of the virus. This medically advised strategy necessitated an equitable vaccine rollout. The World Health Organization (WHO) and two other international agencies (Gavi and CEPI) responded to this need by forming COVAX, a multilateral effort to vaccinate high risk people and health workers in every country (World Health Organization, n.d.-b). To work, COVAX required uniform cooperation across high-, middle-, and low-income states in pooling together vaccine resources. Many wealthy nations refused to play ball and instead took advantage of the COVID vaccines' private distribution model (Gonsalves & Yamey, 2021). Endowed with tremendous capital, high-income states brokered exclusive deals with pharmaceutical companies to gain first access to vaccine technology and horde supplies (Matthews, 2024).

Canada bought enough vaccines to dose its population 5 times over (Hassan et al., 2021). Britain stockpiled enough supplies to vaccinate its population 8 times over (Gonsalves & Yamey, 2021). Near the close of 2021, when the US and UK had already vaccinated over 60% of their respective populations, the world's 50 least wealthy nations (20% of human population) only had 2% of all existing vaccine doses (Hassan et al., 2021). Rather than mobilizing international cooperation to counter a global threat, wealthy states retreated inward and leveraged their resources to capitalize off the private COVID vaccine market. This private model hampered any coalition building that could have reached global herd immunity quickly and safely.

Without the financial resources to outbid wealthier countries, low- and middle-income states were dependent on donations for vaccine access. As the patent holders, pharmaceutical companies even set restrictive guidelines on vaccine exports and imports. Countries willing to donate extra doses found themselves constrained by these privately imposed restrictions. To donate, states needed written consent from the manufacturers. In this way, pharma companies could control where and when vaccine shipments were distributed, and the added logistical step came at the expense of sending shelf-stable vaccines (Barnéoud, 2022). When low- and middle-income countries did receive shipments, most delivered vaccines were already expired or at the very end of their shelf life. COVAX refused 100 million donated vaccine doses in December 2021 alone because they were unusable (Barnéoud, 2022). Nigeria discarded 1.1 million of a 2.6 million vaccine dose shipment in landfills because the doses had expired, and Malawi burned 20,000 doses of expired vaccines, further polluting the air and contaminating soil and water supplies in these places (Barnéoud, 2022; Hu & Cui, 2022). In a twist, low- and middle-income states, hopeful – and entirely dependent on – the charity of high-income states, found itself the global receptacle for unwanted and unusable vaccines. Faced with global disaster, wealthy states used their resources to secure exclusive advantages at the cost of international cooperation. These isolationist retreats against worldwide threats were facilitated by private business models that prioritized profit motivations over countering a pandemic.

Compulsory vaccinations

Since the invention of vaccines, governments have experimented with compulsory vaccination regimes to maximize vaccines' public health benefits. Massachusetts passed the United States' first compulsory vaccination law in 1810 which penalized offenders with fines and/or quarantines (McHugh, 2021). The law was largely ad hoc, and officials only enforced it during times of acute public health emergencies (McHugh, 2021). Over time vaccination requirement laws grew in popularity, and by the end of the 19th century, 13 US states required vaccination for schoolchildren, and 11 states had adult vaccine mandates (McHugh, 2021). Other countries enacted similar mandates. Britain passed a series of vaccine acts mandating vaccination between 1840 and 1853 (History of Vaccines, n.d.).

These laws were primal versions of politics mediating a new sociotechnical boundary. Vaccines had the potential to transform society, but they could not do so without being coupled to political systems. The early years of vaccine development were an experimental period for legislators and scientists alike as both groups attempted to understand their societal goals and how vaccines could realize them. As politics and technology combined, their young union experienced growing pains and was marred with unusual experimentation and state violence. In Boston, Massachusetts, board of health chairman Samuel Durgin used government resources to assemble "virus squads," motley crews of police and public health officers who forcibly vaccinated the homeless (Brockell, 2021). Violent tactics like Durgin's demonstrated how vaccines could serve as a weapon against class and status, with vaccination laws acting as proxies for imposed elitist will on other classes.

The disparate laws, ad hoc enforcements, and "vaccine vigilantism" come to a head when the US Supreme Court ruled in its 1905 Jacobson v. Madison decision that vaccine mandates are constitutional but vaccines cannot be forced on individuals (Brockell, 2021). The law came to define the legal relationship between US citizens and vaccines, and the long standing, trusted institutional procedure provided clarity and standardization to vaccines' socio-technical boundary.

As the prevalence of compulsory vaccine laws rose in the US and across the rest of the world, so too did public opposition. British citizens formed anti-vaccination leagues during the mid-19th century in protest. These groups were politically and motivationally diverse. Middle-class reformers argued vaccine mandates were government encroachment on individual liberty and autonomy. The leagues also included working class members who saw vaccine mandates as a form of class warfare, an extension of wealthy elitist subjugation (Durbach, 2000). As the relationship between society and vaccines has been better codified in government decisions like Jacobson v. Madison, anti-vaxx groups have increasingly framed their struggle as challenges to expertise and state encroachment on individual liberties.

Relevance to Advanced Nuclear Energy

The vaccines case deals with the global distribution of a technology, and we wanted to examine how this might map on advanced reactors as a technology that will also be globally distributed, principally from high-income and middle-income nations to other low- to middle-income nations. Just as vaccine distribution rapidly responds to national or global health crises, advanced nuclear technology is seen by proponents as a response to the rapidly developing climate crisis. This urgency framing, combined with the neocolonial underpinnings of both forms of technology distribution, make these two technologies ripe for comparison.

Key References

Council on Foreign Relations. (n.d.). The debate over a patent waiver for COVID-19 vaccines: What to know.

Gonsalves, G. & Yamey, G. (2021, May 17). The Covid-19 vaccine patent waiver: A crucial step towards a 'people's vaccine'. BMJ, 373.

Frankel, S. (2023, February 28). COVID-19, vaccines and international knowledge governance on trial. Queen Mary Journal of Intellectual Property, 12(4), 441–469.

References

Barnéoud, L. (2022, April 4). The huge waste of expired Covid-19 vaccines. Le Monde.

Brockell, G. (2021, April 1). Smallpox 'virus squads' and the mandatory vaccinations upheld by the Supreme Court. The Washington Post.

Centers for Disease Control and Prevention. (2024, October 23). History of smallpox.

Council on Foreign Relations. (n.d.). The debate over a patent waiver for COVID-19 vaccines: What to know.

Durbach, N. (2000, April 1). 'They might as well brand us': Working-class resistance to compulsory vaccination in Victorian England. Social History of Medicine, 13(1), 45–63.

Frankel, S. (2023, February 28). COVID-19, vaccines and international knowledge governance on trial. Queen Mary Journal of Intellectual Property, 12(4), 441–469.

Gonsalves, G. & Yamey, G. (2021, May 17). The Covid-19 vaccine patent waiver: A crucial step towards a 'people's vaccine'. BMJ, 373.

Hassan, F., Yamey, G. & Abbasi, K. (2021). Profiteering from vaccine inequity: A crime against humanity? BMJ, 374.

History of Vaccines. (n.d.). Vaccine timeline.

Hu, Y. & Cui, F. (2022, January 5). What's the use of west-donated COVID-19 vaccines to Africa when millions of doses expire? Global Times.

Matthews, D. (2024, October 4). Coronavirus: How countries aim to get the vaccine first by cutting opaque supply deals. The Conversation.

McHugh, J. (2021, December 12). First U.S. vaccine mandate in 1810 launched 200 years of court battles. The Washington Post.

McMahon, A. (2020, December 8). Patents, private governance and access to vaccines and treatments for Covid-19. Journal of Medical Ethics Blog.

Rappuoli, R., Pizza, M., Del Giudice, G. & De Gregorio, E. (2014, August 26). Vaccines, new opportunities for a new society. Proceedings of the National Academy of Sciences, 111(34), 12288–12293.

World Health Organization. (n.d.-a). Control of neglected tropical diseases.

World Health Organization. (n.d.-b). COVAX.

World Trade Organization. (2020, October 2). Waiver from certain provisions of the TRIPS agreement for the prevention, containment and treatment of Covid-19. (IP/C/W/669).

World Trade Organization. (2017, January 23). WTO IP rules amended to ease poor countries' access to affordable medicines.

Photo: A nurse prepares a vaccine as COVID-19 vaccinations begin in Ghana under the COVAX rollout. Nana Kofi Acquah - Blink Media / World Health Organization, CC BY-SA 3.0 IGO, via Wikimedia Commons.