When the swine flu pandemic struck in 2009, some of the world's richest countries scrambled to get their hands on vaccines however they could. Poorer countries - among the worst affected - were pushed to the back of the queue, as Western nations signed deals with drugmakers to guarantee access to vaccines.
Australia even stopped a domestic drugmaker from exporting doses to the United States until it had immunised its entire population, while the Obama administration delayed a promise to donate vaccines to poorer countries in order to prioritise distribution in the US.
Swine flu resulted in about 18,000 confirmed deaths but one study estimates as many as 575,000 people worldwide could have died from it, including a "disproportionate" number in Africa and South-east Asia.
For many health experts, swine flu acts as a warning for the far more serious coronavirus crisis. They fear it could lead to a geopolitical fight over vaccines that would exceed the failings over swine flu. A mixture of the intense and growing rivalry between the US and China, and the related rise of nationalism and decline in multilateralism - exemplified by the Trump administration threatening to withdraw US funding from the World Health Organisation (WHO) - is making students of pandemics anxious.
"There are things that make it more problematic than in the past. It will magnify the political and economic cleavages that have been hidden from sight," says Dr Stuart Blume, emeritus professor of science and technology at the University of Amsterdam.
The hunt for a vaccine - which many experts believe is at least 12 to 18 months away - is central to global efforts to restart economies. But, like swine flu, it raises big questions about whether countries will act in their narrow self-interest or embrace a more collaborative, global approach. More than 100 potential vaccines are in the testing phase and an enormous effort costing tens of billions of dollars and using complex logistics will be needed to make and distribute the successful drugs worldwide.
European countries and the WHO are trying to keep the multilateral option alive with a series of fund-raising summits. But the US and China have been reluctant to commit, instead drafting in their militaries as well as pharmaceutical and biotech groups for what some see as a tussle for national bragging rights.
"The race to develop a vaccine is like the US and Soviet Union competing in the space race," says Mr Brad Loncar, founder of Loncar Investments, a US fund manager which runs a China-focused biotech fund. "It's like a Cold War".
RACE TO BE FIRST
Beijing and Washington are pouring huge resources into trying to be the first to develop a vaccine. US President Donald Trump has launched Operation Warp Speed, a public-private partnership that aims to make hundreds of millions of doses available in the US by the end of the year, says a government scientist involved in the project.
Dr Scott Gottlieb, the first head of the Food and Drug Administration under President Trump, says swine flu showed how the "utopian view" that countries could give a vaccine away before satisfying their local needs was unrealistic. "It's important that America has a vaccine available from an American manufacturer because what history has shown us is that in the setting of public health crises, countries nationalised their products," he adds.
In China, the race is no less intense. Four of the eight candidate vaccines in clinical evaluation, according to the WHO, come from China. Two are from the US; one is a collaboration between Germany's BioNTech, China's Fosun Pharma and Pfizer of the US, and the last is between the University of Oxford and AstraZeneca.
"Chinese officials view this not only as a matter of national pride and important for their own health, but also as a way to demonstrate superiority," says Mr Loncar. One of his funds has invested in Cansino Biologics, the first Chinese biotech company to start studying its experimental vaccine in "phase two" human trials under a partnership with a branch of the People's Liberation Army.
Dr Weidong Yin, chief executive of Sinovac, another Chinese company with a potential vaccine undergoing tests, has said it could complete phase two trials and go to production by July, according to local media. Mr Loncar adds: "Let's suppose China succeeds four months before the US. The implication of that is it helps them get their economy fully more open than the US and other areas. Also, think of it in the context of the US presidential election in November. Imagine the headline, 'Chinese People Are Getting Vaccinated', and we don't have it yet."
Many health experts agree it is short-sighted to overly focus on being first. "It's a truly global issue. The scale of manufacturing is global - you're going to run out of glass vials, APIs (active pharmaceutical ingredients); there aren't enough facilities in a single country to do this," says Ms Kalipso Chalkidou, director of global health at the Centre for Global Development, a think-tank.
The early days of the Covid-19 pandemic have left many experts fearful for what will happen when distribution of a vaccine starts. German politicians accused the US of "modern piracy" when masks produced by 3M and destined for Berlin's police force were diverted to America.
Within the European Union, there have been problems such as France seizing millions of masks belonging to a Swedish healthcare firm, sparking furious protests.
Dr Blume says one of the most worrying trends in recent decades has been "the securitisation of global health", making it as much about national security and international diplomacy as health. He adds that China could use any vaccine as a way of "announcing their international prestige" by giving it to African and Latin American countries.
SELF-INTEREST V GLOBAL INTEREST
Others are trying to back a multilateral approach. The European Commission led a donor conference last month that raised €7.4 billion (S$11.4 billion) for the development and distribution of vaccines and treatments against coronavirus, including the aim of equitable access for poorer countries. But the US, Russia, India, Brazil and Argentina stayed away from the meeting, while China sent its EU ambassador rather than a head of state or government, like the other countries did.
Much of the €7.4 billion would be funnelled through global initiatives that were set up in recent years to ease past problems with vaccines. The Global Alliance for Vaccines and Immunisation (Gavi) was founded 20 years ago by the Bill and Melinda Gates Foundation and others to help with the roll-out of vaccines globally, particularly in the poorest countries.
A separate multilateral summit in London next month is aiming to raise at least US$7.4 billion (S$10.5 billion) to develop various vaccines, including against the coronavirus. Another initiative - the Coalition for Epidemic Preparedness Innovations (Cepi), set up in 2017 to help finance vaccines against infectious diseases - is aiming to raise US$2 billion to find at least three viable Covid-19 candidates.
Experts applaud the initiatives, but many argue they are unlikely to be sufficient for the coronavirus.
"There is no global authority that has the money and the influence to direct what the private sector - the pharmaceutical industry - will do. You can have as many sentiments of altruism but the question is how you translate that into reality," says Professor David Salisbury, associate fellow at the global health programme at the think-tank Chatham House and a former chair of the WHO committee on global immunisation.
Mr Paul Hudson, chief executive of French drugmaker Sanofi which is working on two potential vaccines including one with Britain's GlaxoSmithKline, has for instance said that the US might receive first access to the drugs because it bankrolled their early development.
The WHO itself has been severely weakened by Mr Trump's threat to stop US$400 million in annual US funding for the UN body. Dr Blume calls it "one of the great losses in global health", adding: "What we have lost is a forum that had sufficient moral authority that countries felt bound by what was decided there."
FAIRER DISTRIBUTION SYSTEM
Many global health advocates are worried because there is no formal system over how to hand out vaccines and in what order. That is crucial because it is unlikely that there will be enough doses to meet global demand for a long time, perhaps years. Cepi has tried to ease those concerns by stressing equitable access for poorer countries when it finances potential vaccines, but many experts are sceptical that this will be enough to trump national self-interest.
Gavi is leading the push for a fairer, global distribution. Its chief executive Seth Berkley argued last month that the first priority for a coronavirus vaccine should be given to health workers, then countries with out-of-control outbreaks, then the elderly and those with underlying risk factors, before finally the rest of the population.
Assuming one or more vaccines are found, experts say there are broadly two possible outcomes: the world rediscovers multilateralism and works together, or there is a more piecemeal approach where every country is forced to fend for itself. There are many unknowns: Many privately speculate that a change of president in the US could lead the country to alter its position. "This would look a lot different under a president (Joe) Biden, I think," says one European official, referring to the Democratic presidential hopeful.
Ms Gayle Smith, who was involved in the US response to both swine flu and the 2014 Ebola outbreak, says: "It's a very bad time for multilateralism to be under siege. But it's the most dramatic example of why multilateralism is absolutely essential. A global plan without some of the main powers is not a global plan."
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