Access,to,COVID-19,Vaccine,and,Its,Distribution:The,Responsibility,of,State,and,International,Organization
Liza Shahnaz,Zainal Abidin Muhja,Ade Cici Suciati
With the current development of the COVID-19 vaccine within two years of the outbreak， science has scored a remarkable milestone. US pharmaceutical companies， such as Pfizer， Moderna， Oxford/AstraZeneca， and Novavax have led the global race to mass-produce the most effective vaccine against COVID-19， followed by Russia and China. However， developing countries still cannot afford the U.S.-made vaccine on a large scale， which is currently considered the most effective. The challenge now is to make all these vaccines quickly， reasonably， and equally accessible to people worldwide. While rich countries have bought vaccine doses， low-income countries are still under-resourced. The development of distribution and access to vaccines is worrying， considering that many countries may find it difficult to buy or make their vaccines， so cooperation between governments and international institutions is needed to solve the problem. This study analyzes how countries and international institutions as the prominent legal subjects in international law work together to achieve equitable and fair distribution and access globally following international law.
Keywords：
access and distribution to COVID-19 vaccine， state responsibility， international organization
Introduction
The COVID-19 pandemic is considered a major catastrophe in the history of humankind （UNAIR News， 2020）. On March 11， 2020， the World Health Organization （WHO） declared the disease outbreak due to the COVID-19 coronavirus a global pandemic. He stated that this status was due to positive cases outside China， increasing rapidly worldwide， with total deaths reaching more than five million people and 265 million people infected with this virus （Worldometer， 2021）. Furthermore， COVID-19 has continued to infect humans until today. On that basis， WHO asks countries to take urgent and aggressive action to prevent and contain the spread of the COVID-19 virus. In its development， the COVID-19 disease outbreak has spread to 221 countries since it first emerged in Wuhan， China.
With the characteristics of its speedy spread among humans， coupled with the very high mobility of humans and across national borders， this virus becomes even more dangerous. Based on data from Worldometer， the United States is the country with the highest number of patients in the world. This global pandemic requires states and international institutions to quickly adapt and find solutions in developing vaccines for this easily mutated virus. Almost all countries compete to get vaccines to meet everyones needs. This is because vaccines are needed to improve the situation in countries. Hence， countries compete in securing vaccine stocks for their citizens. Some countries are even willing to provide free vaccines for their citizens， including Indonesia.
The International Labor Organization （ILO） stated that giving a vaccine equivalent to the COVID-19 vaccine has a positive impact on the countrys economic growth. On the other hand， according to WHO， unequal access to a COVID-19 vaccine can destroy economic life and have disastrous moral consequences. The ILO analyzed the impact of the COVID-19 pandemic on the global labor market and found that last year the world economy lost up to 8.8% or equivalent to the loss of 255 million permanent jobs. ILO President Guy Rider recommended that international support be given to low and middle-income countries with fewer financial resources to launch vaccines and promote economic recovery. The International Chamber of Commerce Research Foundation （ICCRF） also voices the same opinion. In detail， the ICCRF analyzed that if the wealthiest countries were fully vaccinated， while only half of the poorest countries， this could cause global economic losses of up to USD 9.2 trillion. Nearly half of those losses will be in the wealthiest countries. Therefore， the international community has the right to obtain assurance from the State and international organizations on adequate health services and is entitled to protection as an inherent right. This protection must also guarantee everyone around the world. Based on these matters， this study analyzes the enforcement of international legal obligations according to the 1966 International Covenant on Economic， Social， and Cultural Rights concerning global distribution and access to the COVID-19 vaccine.
Literature Review
COVID-19 Pandemic
Currently， people worldwide continue to be affected by the coronavirus disease 2019 （COVID-19）， the fifth pandemic after the flu pandemic of 1918 （Suara， 2020）. Within months， the COVID-19 outbreak has caused crises in various countries worldwide. The first reported positive case of COVID-19 was on December 31， 2019， in Wuhan City， Hubei Province， China. The market in Wuhan was then closed， and people experiencing similar symptoms were quarantined. On January 3， 2020， a total of 44 patients with symptoms of Pneumonia were reported to WHO by the Chinese state authorities. Of the 44 reported cases， 11 people are seriously ill， while 33 are stable. In addition， approximately 700 people who were in contact with suspected patients， including more than 400 hospital workers， were quarantined. As special PCR testing was developed to detect infections， 41 people in Wuhan were found to have the SARS-CoV-2 coronavirus， two of whom were husband and wife， one of whom had never been to the market， and three were members of a family who worked in a fish shop. As a result， the death toll rose on January 9 and 16， 2020. Confirmed cases outside mainland China were found in Thailand， Hong Kong， Vietnam， Japan， South Korea， Singapore， Taiwan， and the United States.
The World Health Organization （WHO） explains that coronaviruses （CoV） infect the respiratory system. This viral infection is called COVID-19. Coronaviruses cause illnesses from the common cold to more severe diseases such as Middle East Respiratory Syndrome （MERS-CoV） and Severe Acute Respiratory Syndrome（SARS-CoV）. Current evidence suggests that the virus spreads mainly between people who are in close contact with each other， typically within a short range. A person can be infected when droplets containing the virus are inhaled or come directly into contact with the eyes， nose， or mouth （WHO， 2020a）.
International Law
International law consists of rules and principles governing the relations and dealings of nations with each other， as well as the relations between states and individuals， and relations between international organizations. Public international law concerns itself only with questions of rights between several nations or nations and the citizens or subjects of other nations. In contrast， private international law deals with controversies between private persons. These controversies arise out of situations which have a significant relationship to multiple nations. In recent years， the line between public and private international law has become increasingly uncertain. Issues of private international law may also implicate issues of public international law， and many matters of private international law have substantial international significance. International law includes the basic， classic concepts of law in national legal systems （statutes， property law， tort law， etc）. It also includes substantive law， procedural law， due process， and remedies. The major substantive fields of international lawinclude international security law， international economic law， international criminal law， international environmental law， diplomatic law， international humanitarian law， and international human rights law.
Sources of International Law
Customary law and conventional law are primary sources of international law. Customary law results when states follow certain practices generally and consistently out of a sense of legal obligation. Recently the customary law was codified in the Vienna Convention on the Law of Treaties. Conventional international law is derived from international conventions and may take any form that the contracting parties agree upon. These contracting parties， however， may not violate the rules of international law. International agreements create laws for the parties of the deal. International conventions are treaties signed between two or more nations that act as international agreements. A treaty is a binding agreement between nation-states that forms the basis for international law. Authority for the enforcement of these treaties is provided by each signing partys adherence to the treaty. Conventions generally have built-in mechanisms to ensure compliance， such as inspection procedures. These treaties also include methods to enforce non-compliance， such as economic sanctions. Outside of internal tools， states could resort to external enforcement methods through other escalations， including military action threats.
Customary law and laws made by international agreements （such as those passed by the United Nations） have equal authority as international law. Private or public parties may assign higher priority to one of the sources by agreement. General principles which are common to systems of national law can be a secondary source of international law. There are situations where neither conventional nor customary international law can be applicable. In these cases， a general principle may be invoked as a rule of international law.
Subjects of International Law
Traditionally， individual countries were the main subjects of international law. However， individuals and non-state international organizations have increasingly become subject to global regulation.
Right to Health Under International Law
Under international law， there is a right not merely to health care but the much broader concept of health. Because rights must be realized inherently within the social sphere， this formulation immediately suggests that determinants of health and ill-health are not purely biological or “natural”， but are also factors of societal relations. Thus， a rights perspective is entirely compatible with work in epidemiology that has established social determinants as fundamental causes of disease. The first notion of a right to health under international law is found in the 1948 Universal Declaration of Human Rights. The UN General Assembly unanimously proclaimed a common standard for all humanity. The Declaration sets forth the right to a
standard of living adequate for the health and well-being of himself and his family， including ... medical care and ... the right to security in the event of ... sickness， disability... or other lack of livelihood in the circumstances beyond his control.
The Declaration does not define the components of a right to health；
however， they both include and transcend medical care.
The right to health was included in the International Covenant on Economic， Social， and Cultural Rights（ICESCR）. Article 12 of the ICESCR explicitly sets out a right to health and defines steps that states should take to “realize progressively”， “the maximum available resources”， and the “highest attainable standard of health”. The reference to a “highest attainable standard” of health， taken from the World Health Organization constitution， builds in a reasonableness standard. The state has a role in leveling the social playing field concerning health；
however， some factors are beyond the states control. Furthermore， the highest attainable standard will evolve in response to medical inventions and demographic， epidemiological， and economic shifts. In addition to the ICESCR， a wide array of international and regional treaties recognizes health as a rights issue. These reflect a broad consensus on the content of the norms. A review of the international instruments and interpretive documents clarifies that the right to health as enshrined in international law extends well beyond health care to include essential preconditions for health， such as potable water and adequate sanitation and nutrition.
Methodology
Legal research is a scientific activity based on specific methods， systematics， and thoughts；
it also aims to analyze a particular legal phenomenon. A deep analysis is conducted on a legal factor to seek a solution to problems that may occur. There are two types of legal research：
socio-legal research and normative legal research. Socio-legal research considers the law a social phenomenon with a structural approach （Wignyasoebroto， 1993）. This type of research is relevant to assessing the relationship between law and society to determine the implementation of law in the community；
hence， it is frequently referred to as “law in action”. On the other hand， normative legal research is also known as a doctrinal method （Amiruddin， 2004） or a study of documents that use secondary data as sources， such as existing regulations and court decisions and doctrines （Santoso， 2005）. Normative legal research is an appropriate tool to evaluate legal philosophies， theories， principles， or substances of positive legal orders；
therefore， it is commonly referred to as “law in books” （Shahrullah & Syarief， 2015， p. 311）. This study adopts a normative legal approach to evaluate the scope and material provisions in international regulations related to the issue. In addition， this research also adopts descriptive analysis， which aims to describe juridical symptoms that occur in society.
Result and Discussion
Law can be a facilitator and a stumbling block to global health， equity， and justice. Where the law is being utilized as a mechanism to permit or restrict equal global access to COVID-19 vaccines， the impact of legal determinants of health on the COVID-19 pandemic is clear. Governments are trying to use the law to gain priority access to future vaccines through Advance Purchase Agreements （APAs） with vaccine makers， which is part of the barriers to equal entry. These bilateral legal agreements can benefit a country. Still， given the uncertain viability of individual COVID-19 vaccine candidates and the global spread of SARS-CoV-2， APAs are a risky bet that erodes international cooperation. Importantly， bilateral legal arrangements like this are likely to exacerbate inequality and potentially lengthen the pandemics duration.
On the other hand， multilateral legal agreements could pave the way to global health security and justice by reinstating international solidarity norms， committing to global equitable vaccine access initiatives， and laying the groundwork for a post-pandemic era based on multilateralism and cooperation. COVID-related queries about the allocation of vaccines have prioritized disadvantaged people and health care and vital professionals for equitable distribution within countries. On the other hand， Justice necessitates taking into account the equitable distribution of vaccines among countries. WHO proposes distributing pandemic influenza vaccines procured through contracts with manufacturers to nations based on public health risk and needs under the Pandemic Influenza Preparedness （PIP） Framework—the only worldwide legal mechanism for the equitable global distribution of vaccines. In a pandemic with a limited quantity of available vaccines， however， public health needs alone are unlikely to lead decisions， particularly in the early stages of vaccine distribution， when supply would be limited， and demand will be similarly high across many countries.
Furthermore， unlike pandemic influenza， COVID-19 does not have an international legal instrument agreed to by all WHO member nations. There is also no formal international agreement on how COVAX Facility （or alternative platforms） vaccines should be distributed. The World Health Organization has developed a proposal for a Global Framework to Ensure Equitable and Fair Allocation of COVID-19 Products， highlighting how a global access mechanism would distribute risk and maximize equitable allocation between countries；
however， the legal process and form for the adoption of such a framework has not been publicly proposed.
Despite the lack of a specific international agreement for COVID-19 vaccines， 171 countries are already bound by the International Covenant on Economic， Social， and Cultural Rights （1966） to take steps， individually and through international assistance， to realize the right to health and the right to benefit without discrimination from scientific research and its applications. In the context of COVID-19， respecting， safeguarding， and achieving these rights would entail ensuring that COVID-19 vaccinations are available， accessible， acceptable， and of good quality in all countries.
Multilateral commitment is required to avoid an additional legal risk stemming from vaccine nationalism， such as applying government export prohibitions， which might render multilateral and some bilateral APAs ineffective. During the 2009 H1N1 influenza pandemic， governments in HICs worked with vaccine makers to limit vaccine exports until domestic needs were addressed. As a result， vaccine nationalism in the place of manufacture may embargo or requisition vaccinations， slowing worldwide distribution. Any international governance platform for COVID-19 vaccines， whether the COVAX Facility or a new mechanism， would succeed only if there is global momentum and commitment to global equitable COVID-19 vaccine access， especially from HICs. Despite this， several HICs are now driving the proliferation of bilateral APAs， entrenching nationalism， and directing vaccine distribution in the future. Countries will meet in November 2020 for the second phase of the pandemic segmented WHA. This summit could be the last chance for all countries to approve an international instrument and agree on a COVID-19 vaccine mechanism before they become available.
Conclusion
The COVID-19 reaction has proven to be the worlds greatest challenge in centuries， and it can only be met if nations are willing and able to collaborate. Unfortunately， despite the need for global cooperation， governments have hurried to develop nationalist legal agreements to hoard potential vaccines while separating the world in ways that will prolong the pandemic threat. Although global health coordination and universal vaccine availability remain challenging， international health law can help build global unity in the face of this common peril by securing equitable access to a promising new vaccine now.
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