(Image: Francis Kokoroko/UNICEF via AP)

As the United Nations General Assembly meetings kicked off last week, loud calls are being made for more funds for low-income and lower-middle-income countries to access COVID-19 vaccines.

Yet while access is needed, the emphasis on funding is misguided. Many poorer countries have the means to generate finance to access vaccines, and the more significant, difficult problem to solve is stopping the multilateral system from being wholly disregarded by richer countries. This system is underpinned by an international commitment to human rights and cooperation. At the moment, the rich have the choice to opt in and opt out when they like.

The inequitable access to COVID vaccines exemplifies how a lack of accountability is wrecking multilateral institutions. The supply shortages that most lower-income countries have faced have not been primarily due to lack of financial contributions to the COVAX program. They’re primarily caused by the vaccine hoarding that many higher-income countries have participated in.

But how has this vaccine hoarding even been possible?

The COVAX initiative was originally designed as a multilateral tool to ensure equitable distribution of vaccines. It ensures that COVAX participant countries provide vaccinations for up to 20% of their population — this is essential to ensure the most vulnerable in lower- and lower-middle-income countries are protected from COVID. It was not solely intended — as the popular narratives calling for increased financial donations to COVAX suggest — as a funding tool for rich countries to donate funds to poorer ones.

It is distribution, not financing, that has been COVAX’s greatest challenge.

Rather than procure vaccines through the COVAX program — which most developing countries were willing to do — many high-income countries such as the United Kingdom, and even some upper-middle-income countries such as Russia, instead opted out of the multilateral tool and employed bilateral agreements. These bilateral agreements bypassed the COVAX-led equitable distribution that would ensure vulnerable populations around the world were vaccinated first. Instead, bilateral agreements actively encouraged prioritisation of high-income countries. In a further betrayal of global solidarity, the UK was even able to negotiate conditional funding to vaccine developer AstraZeneca, ensuring its population was prioritised to receive vaccine supplies.

While the consequences of this opting out for the COVID-19 pandemic are very clear today, the fact is opting out of multilateral systems is the norm. Often, high-income countries use the excuse that they are providing finance into the UN or Bretton Woods system to opt out and do their own thing.

When it comes to trade rules, crime prevention, debt sustainability analysis and now health challenges, richer countries never actually cede sovereignty to the multilateral system. They hardly ever let the multilateral system make decisions on their citizens’ behalf for the good of the world, while poorer governments and their citizens are expected to conform to the rules — which were largely set by the rich and powerful in the first place. It is this opting out that is the true underlying cause of multilateralism’s greatest contemporary challenge.

COVID-19 is the very definition of a global crisis where the full utilisation of multilateral tools would ensure effective international collaboration and — centrally — the protection of the right to health. As laid out in the International Covenant on Economic, Social and Cultural Rights of 1976 and the general comment issued on it in 2000, the right to health specifically refers to the prevention and treatment of epidemics and obligates state parties to uphold these rights regardless of nationality or race, among other protected characteristics. Article 2.1 of the covenant applies this to a state’s citizenry and to its international assistance and cooperation.

And yet, by opting out of COVAX’s distribution mechanism and hoarding vaccines instead, rich countries are actively preventing the governments of poorer ones from ensuring the protection of the right to health of their populations.

This is no small matter. For example, due to a lack of vaccine supplies, only 4.02% of people across African countries have been fully vaccinated, while some rich countries in other parts of the world have received enough doses to vaccinate the entirety of their populations many times over. This is not just inequitable distribution of vaccines — it is a violation of the right to health of the most vulnerable people around the world.

This use of bilateral agreements to procure COVID vaccines demonstrates the dangers of participation in multilateral tools such as COVAX being optional. These tools, as well as such institutions as the UN and the World Health Organization, exist to fulfil the promise of such rights as the human right to health without discrimination on the basis of, for example, nationality. They cannot meet this intended function if states — in particular high-income ones — are able to simply opt out of their structures. By opting out, any state creates inequalities across nations and endangers the framework of rights protected in international law.

State parties — especially rich nations — benefit from participation in multilateral institutions such as UN bodies, for example through membership of the UN Security Council. As my colleagues have argued, access to these benefits ought to be predicated on state parties abiding by international human rights law, which forms the basis of these institutions.

The failure of COVAX to ensure equitable access to the COVID-19 vaccine and protect the human right to health is a lesson for the international community. It demonstrates the necessity to reevaluate the multilateral tools and institutions at the UN General Assembly.

Focusing on money is a distraction. Ensuring the effective protection of rights and protecting the world’s most vulnerable people is not about finance — it is about finding ways to prevent protectionist state behaviour that hinders international collaboration.

This is no doubt more difficult to solve than raising more dollars, pounds or yuan, but as COVID-19 shows, it is urgent and necessary.