Vaccine nationalism occurs when a country manages to secure doses of vaccine for its own citizens or residents before they are made available in other countries. This is done through pre-purchase agreements between a government and a vaccine manufacturer. The United States has indicated on various occasions that it would like to secure priority access to doses of COVID-19 vaccine. Other countries, including India and Russia, have taken similar stances. Also, India, alongside the US and Russia, chose not to join the Access to COVID-19 Tools Accelerator, which was launched by the World Health Organization to promote collaboration among countries in the development and distribution of COVID-19 vaccines and treatments. Earlier Instance Of Vaccine Nationalism • Vaccine nationalism is not new. During the early stages of the 2009 H1N1 flu pandemic, some of the wealthiest countries entered into pre-purchase agreements with several pharmaceutical companies working on H1N1 vaccines. • At that time, it was estimated that, in the best-case scenario, the maximum number of vaccine doses that could be produced globally was two billion. The US alone negotiated and obtained the right to buy 600,000 doses. All the countries that negotiated pre-purchase orders were developed economies. • Only when the 2009 pandemic began to unwind and demand for a vaccine dropped did developed countries offer to donate vaccine doses to poorer economies. Issues With Vaccine Nationalism • Vaccine nationalism is harmful for equitable access to vaccines. It disadvantages countries with fewer resources and bargaining power and deprives populations in the Global South from timely access to vital public health goods. • Taken to its extreme, it allocates vaccines to moderately at-risk populations in wealthy countries over populations at higher risk in developing economies. Without broad access to a vaccine, these   populations will likely continue to suffer more than others, leading to unnecessary disease burden, continued economic problems and potential loss of life. • Vaccine nationalism also runs against the fundamental principles of vaccine development and global public health. With modern vaccines, there are very few instances in which a single country can claim to be the sole developer of a vaccine and most vaccine development projects involve several parties from multiple countries. • Even if that were possible, global public health is borderless. As COVID-19 is illustrating, pathogens can travel the globe and public health responses to outbreaks, which include the deployment of vaccines, have to acknowledge that reality. Conclusion If used appropriately, pre-purchase agreements can be an incentive for companies to manufacture vaccines that otherwise would not be commercialised. Institutions like Gavi use similar mechanisms to guarantee vaccines for developing countries. However, it is important that contracts should not trump equitable access to global public health goods. Hence, developed countries should pledge to refrain from reserving vaccines for their populations during public health crises. Equity entails both, affordability of vaccines and access opportunities for populations across the world, irrespective of geography and geopolitics. Thus, international institutions — including the WHO — should coordinate negotiations ahead of the next pandemic to produce a framework for equitable access to vaccines during public health crises.