As Leigh Phillips notes in Jacobin, it does not seem that efficacy of vaccine distribution seems to correlate well to any dominant political system. Countries that have done well in vaccine distribution include the United States, the United Kingdom and Israel, while countries that have been much slower in distributing vaccines include Canada, much of the European Union and east Asian states such as China, South Korea, Japan, Taiwan and Vietnam.

In some of the latter cases, it should be noted that vaccine distribution is less pressing given the small number of cases still active in those countries, such as in China and Vietnam. Nevertheless, on the surface it seems that more explicitly “capitalist” states such as the US have done a better job at vaccine rollout than more centrally-coordinated states such as China and Vietnam, or even states with supposedly more socialized medicine such as Canada.

This seems to cut across the results that we might expect, given that a more centralized state would seem to have an easier time coordinating a vaccine rollout than otherwise. Phillips argues that dichotomizing healthcare systems into capitalist and socialized is too reductive, and that Canada’s failures in vaccine distribution have nothing to do with the fact that their healthcare system is free at the point of service, but rather due to decades of privatization.

To start, Canada has no domestic capacity for vaccine production, due to the privatization of medical manufacturing facilities in the 1980s. These tie into larger trends of global consolidation of vaccine manufacturers, leading to a situation where the only (private) vaccine manufacturers in Canada are headquartered elsewhere, and the government certainly has no control over the decision-making processes of these corporations. Merely analyzing medical infrastructure purely from the standpoint of public access misses the extent of privatization (or not) that happens at all other levels, especially as it relates to research and development, and manufacturing.

The problem for the European Union, on the other hand, seems to come from the fact that their process of medical regulation, overseen by the European Medicine Agency, must harmonize the internal regulations of over a couple dozen member states of the EU.

The Food and Drug Administration (FDA), which would handle vaccine regulation in the United States, is much more command-and-control. The European Union’s authority is actually quite diffuse, as it simultaneously needs to maintain the sovereignty of all of its member states. This is not unlike the problem of federalism or states’ rights in the United States, which could cause problems for nation-wide programs such as questions regarding the safety and distribution of a vaccine, but thankfully the Food and Drug administration has federal oversight and autonomy in this respect.

For vaccine rollout for the European Union, it was necessary to be approved by every member state before it could be distributed, which delayed the process, rather than allowing a single body to assert control over the situation.

In this sense, it is the lack of centralization and governmental or institutional power that has led to poor vaccine distribution in the EU. The EU also merely does not have the power to intervene in the market, unlike the UK which negotiated more closely with vaccine producers.

Clearly, the solution is more bureaucracy, more state power, in order to ensure a more efficacious vaccine distribution program.

Finally, suffice to say that public development and production of the vaccine would have been even more efficient than private development and production. It would have also sidestepped the issue of governments or governmental entities negotiating separately with each vaccine manufacturer, the current disparities between richer and poorer countries and their ability to purchase vaccines. As Matt Stoller has pointed out, the success of “vaccines for all” distributed for free, is perhaps the best case for Medicare for All that has actually been instituted in the United States in the recent past. However also need to fight privatization at every other level of the medicinal supply chain, not only at the point of service.