The relative obscurity of this vaccine program belies its critical role in the global fight against Covid-19. COVAX is arguably the most important acronym of 2021. With vaccination nationalism rearing its ugly head, the best – perhaps the only – gamble is to get billions of doses to low- and middle-income countries.
COVAX is an entity led by a coalition that includes the Vaccine Alliance known as Gavi and the World Health Organization (WHO), and is funded by donations from governments, multilateral institutions and foundations. Its mission is to buy coronavirus vaccines in bulk and ship them to poorer countries that cannot compete with rich countries in winning contracts with the major pharmaceutical companies.
It has secured nearly 2.3 billion doses for distribution this year. Of that total, 1.8 billion must be made available to 92 of the world’s poorest countries, most of which (1.3 billion) are free.
Gavi has extensive experience in providing vaccines to populations in need – it has helped vaccinate half of the world’s children against other diseases, such as polio, meningitis and typhoid fever. But the Covid-19 campaign is overshadowing those programs.
Shipments of coronavirus vaccines via COVAX will begin this month and increase in the second half of the year. Countries in Latin America and the Caribbean will be among the first to receive approximately 35 million doses of Pfizer-BioNTech and AstraZeneca vaccines by the end of June.
Countries must submit a detailed plan for how to treat and distribute the shot – any country that has joined the program is eligible for a vaccine. Some countries fund their own share of the vaccines to be delivered through COVAX, but 92 countries are eligible for heavily discounted or free shipments.
The Pan American Health Organization (PAHO) says there will be no distinction between countries that pay for the vaccines and countries that receive them for free.
So far, only two vaccines have been approved for distribution through COVAX – made by Pfizer-BioNTech and AstraZeneca – but Gavi says it will need as many vaccine candidates as possible to achieve its goal, “once they get approval from a strict regulatory body. authority and / or prequalification by WHO. “
Southeast Asia will receive 695 million doses and Africa 540 million doses by the end of 2021, according to Gavi. According to the WHO, parts of the Middle East, Afghanistan and Pakistan should receive 355 million doses by December. PAHO says it plans to distribute 280 million doses to America by the end of the year.
Several countries in Eastern Europe, including Ukraine and Moldova, are also eligible for subsidized COVAX supplies.
More than a billion of the required doses are likely to be produced by the Serum Institute of India (SII), the world’s largest vaccine producer, at a cost of approximately $ 3 per injection, thanks to the collaboration of Gavi, the Bill & Melinda Gates Foundation and SII.
The great if
It’s an impressive effort, but hardly enough. To begin with, ‘secured’ means not obtained. Gavi himself warns that there is “a great deal of if, with uncertainties about the country’s capacity, funding and readiness.” Governments must submit detailed plans to show they can distribute the doses they receive and identify areas where they need help.
The logistics involved are daunting. The UN Children’s Fund – which will be one of the main distributors – is seeking to double its transport capacity this year so that it can move 850 tons of Covid-19 vaccines per month.
A bigger hurdle COVAX faces: money. It has raised more than $ 6 billion so far, but it is trying to “raise another $ 2.8 billion by 2021 – $ 800 million for research and development, and at least $ 2 billion for vaccines for low-income countries,” a spokesman for Gavi told CNN.
Major donors to date have included the UK ($ 750 million), the European Union (nearly $ 600 million) and Canada ($ 250 million). The Biden administration has pledged to rejoin COVAX, which the Trump administration has boycotted.
Nguyen said that “without a concerted effort, low-income countries will be left behind because of restrictions on their financial capabilities.”
Even if the target of 2.3 billion doses is reached, the vast majority of people in low-income countries will have to wait until at least 2022. Gavi himself predicts that vaccines distributed through COVAX will reach 27% of the population of low-income countries. year.
That will depend on a massive ramp-up of the program in the second half of 2021. WHO officials expect that only 3.3% of the population of low-income countries will have been vaccinated by the end of June. India, Pakistan and Nigeria will receive the most doses, respectively, 97.1 million, 17.1 million and 16 million doses, according to COVAX.
In the case of India, that allocation would cover less than 4% of its population. Latin America and the Caribbean should receive adequate doses through COVAX for nearly 20 million people by the end of June, but the region has a population of 500 million.
In contrast, many rich countries are aiming to have their entire population vaccinated by the last quarter of 2021. In Germany, Chancellor Angela Merkel has set a target on September 21 that every adult should be offered a vaccine.
Some middle-income countries in the COVAX program hedge their bets and opt for a hybrid approach that includes direct purchases from vaccine manufacturers. Colombia and several Balkan countries signed bilateral deals pending COVAX.
The African Union has also entered the market, securing 670 million doses of various vaccines in addition to the COVAX program.
‘Me first’
The biggest challenge to global coverage is a ‘me first’ attitude that has been criticized by global health officials. WHO Director General Tedros Adhanom Ghebreyesus says bilateral agreements effectively raise vaccine prices for everyone.
“Many countries have bought more vaccines than they need,” Tedros said in January. “We are now facing the real danger that even if vaccines give hope to people in rich countries, much of the world will be left behind,” he said.
It was not correct, he added, that younger, healthy adults in rich countries could get the vaccine earlier than health workers and older people in poorer countries, especially as new variants of the virus emerged.
Gavi told CNN, “Every time a new bilateral deal is struck, it reduces the potential supply to COVAX, so we continue to urge manufacturers and governments to support our work.”
The longer it takes to vaccinate worldwide, the greater the chance that new varieties will flower. However, Gavi told CNN that his partner – the Coalition of Epidemic Preparedness Innovations – is investing in the “ next generation ” vaccine candidates, which will give the world additional options in the future to get Covid-19 under control.
If, as is commonly expected, the coronavirus vaccine is an annual requirement, the pressure on stocks will not abate. Long before most of the developing world is vaccinated, people in rich countries can get their second annual dose.
Tedros’ comments are echoed by Dr. Seth Berkley, CEO of Gavi, who criticized a sense of “vaccine panic” in wealthier countries.
“We will only be safe everywhere if we are safe everywhere,” he said.
History is not encouraging. Tedros recalls the H1N1 epidemic in 2009, when developed countries monopolized early stocks of vaccines.
Going further back, Africa only received life-saving antiretroviral treatments several years after they became widely available in the developed world, even as the continent was facing catastrophic death rates from HIV / AIDS.
The director of the Africa Centers for Disease Control and Prevention, John Nkengasong, says the Covid-19 approach needs more urgency.
“We need a 60% [vaccination] target within two years, “in Africa, he said. Otherwise, he warned,” the virus will be endemic to our communities. “
Tedros has used stronger language. Unless COVAX is given the resources it needs, the world will face a “catastrophic moral failure,” he said.