A health worker collects a swab sample from a shopper for the COVID-19 coronavirus testing at a makeshift testing booth at a market area in New Delhi on Dec. 19, as India surged past 10 million coronavirus cases. 

MEXICO CITY – The race to vaccinate the world against a once-in-a-century pandemic has begun in an all-too-familiar way: Every country for itself.

Rich nations have gobbled up nearly all the global supply of the two leading COVID-19 vaccines through the end of 2021, leaving many middle-income countries to turn to unproven drugs developed by China and Russia while poorer states face long waits for their first doses.

“Richer countries will be able to vaccinate ... their whole populations before vulnerable groups in many developing countries get covered,” said Suerie Moon, co-director of the Global Health Center at the Graduate Institute of International and Development Studies in Geneva.

As a result, the pandemic may continue to kill people across much of the world for years, delay a global economic recovery and eventually resurge even in nations that manage to control it in coming months through vaccination.

Experts say the inequities are the predictable result of a global health system in which money often counts more than the public good – and where vaccines are costly commercial products developed and patented by a handful of huge drug companies.

The gap in access has sparked calls for emergency measures that would allow poorer countries to manufacture and import generic versions of COVID-19 vaccines.

In October, India and South Africa asked the World Trade Organization to waive intellectual property protections for those drugs, just as it did for some medications used to treat HIV – a move credited with saving millions of lives in Africa.

Humanitarian groups that support the plan – which they have dubbed “the people’s vaccine” – warn that without it, 9 out of 10 people in dozens of poor countries will miss out on COVID-19 vaccinations next year.

“If we do nothing it’s going to be well into late 2022 or early 2023 before even half of the low-income countries are vaccinated,” said Niko Lusiani, a senior advisor with Oxfam America, the global health charity.

The proposal is opposed by the United States, the European Union and the United Kingdom – wealthy WTO members that helped finance vaccine development and argue that such innovation would be impossible without patent protection.

The U.S. government provided the vast majority of funding for development of the vaccine made by Moderna. It also struck purchase agreements – known as advance market commitments – with the drugmaker and with Pfizer while their vaccines were still being tested. Those deals reduced risk for the companies and allowed the U.S. to secure 300 million shots.

As the only vaccines currently authorized by the Food and Drug Administration, they are now being given to frontline health workers across the country.

In all, the U.S. government has confirmed deals to buy 1.1 billion doses of a half-dozen vaccines in various stages of development, according to the Global Health Innovation Center at Duke University. The United States is expected to end up with far more doses than what is needed to vaccinate every American.

Other wealthy countries have bought an additional 2.9 billion doses in bilateral deals with drugmakers.

Although there has never been such global demand for the same few drugs at the same time, pandemic nationalism is an old phenomenon.

A decade ago, during the swine flu outbreak that killed more than a quarter of a million people worldwide, the United States and other wealthy countries snatched up nearly all the available vaccine. They agreed to share a limited amount with poorer countries only after ensuring they had enough to meet their own needs.

For the poorest nations, the best chance to obtain significant quantities of vaccine in 2021 rests with an initiative called Covax.

Launched by the World Health Organization and several nonprofits, it aims to promote equitable distribution of vaccines by negotiating favorable pricing with drug companies and giving all countries – rich or poor – equal access.

Nearly every country in the world – with the notable exception of the United States – signed on, in many cases simply as an insurance policy in case bilateral deals with drugmakers fall short.

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