Numerous poorer countries around the world are anxiously waiting to see if the multilateral Covax program will deliver the coronavirus vaccines they need to stop the pandemic – even though some wealthy countries are on immunization.
The scheme was set up in June by Gavi, a vaccine alliance with the goal of increasing access to immunization in poor countries; the Coalition for Epidemic Preparedness Innovations (CEPI); and the World Health Organization. It aims to ensure the fair distribution of vaccines worldwide, initially by providing 2 billion doses to participating countries by 2021.
At least two-thirds of those doses go free to 92 lower-income economies, and Covax says it’s on track to hit the target.
But more than two months after Western countries started vaccinating their populations, Covax has yet to deliver its first doses, leaving many poorer countries without vaccines to start vaccinations.
“Covax is lagging behind because they didn’t have the purchasing power to come to the table while the others were busy closing deals,” said Jenny Ottenhoff, senior policy director for the ONE Campaign against global poverty.
While the UK has given 21 doses per 100 inhabitants and the EU has given 4.2, Bangladesh has only administered 0.02, Myanmar 0.007 and Algeria 0.00007, according to the latest data from the Financial Times. Many African countries have not yet seen a single shot.
The widening gap is a stark symbol of the challenges Covax has faced in trying to make theoretical support for the idea of a global vaccination urge a reality. While most advanced economies have backed Covax, those same governments have subsequently fought against manufacturers’ coveted vaccine deliveries scheme.
Covax beneficiaries, such as Nigeria, appreciate the program’s ambition but agree that it is struggling. “We recognize that Covax is working hard in an environment where wealthier countries buy vaccines,” said Dr. Faisal Shuaib, director of the National Primary Health Care Development Agency in Nigeria, Africa’s most populous country.
Covax was initially envisioned as a single clearinghouse for the world’s vaccine orders, from which all countries, rich and poor, would purchase their doses.
But almost immediately, rich and middle-income countries tried to strike their own bilateral deals when nationalism outstripped multilateralism. Some observers say this was inevitable and suggest that Covax could have progressed faster and more efficiently had it accepted that reality earlier.
“It’s good that Covax is here, but some parties were too optimistic or naive about a multilateral solution to the pandemic,” said an international health expert, who asked not to be named due to the sensitivity of the topic.
It also meant that Covax remained open to wealthy countries, allowing countries like Canada to take doses from the Covax jar, while also placing their own vaccine orders directly with manufacturers.
Despite criticism that such “double immersion” diverts further supplies to developing countries, Covax argues that the involvement of high-income countries as vaccine buyers is critical to achieving its ambitions to serve poorer states.
“For Covax to succeed on the scale of its ambition, it is important that Covax serves both groups, with the money from participants who self-finance proving vital to enabling us to close deals with manufacturers,” said Gavi .
Gavi is “optimistic” that Covax will start delivering vaccines in February. As such, confidence in the plan can turn a corner.
In Rwanda, Health Minister Dr. Daniel Ngamije said he expected the first batch of an order of 996,000 doses of the Oxford / AstraZeneca vaccine to arrive within weeks, along with several doses of BioNTech / Pfizer.
He added that Covax had promised to deliver 7 million doses by the end of the year – more than enough to immunize 25 percent of the 13 million people in Rwanda with the two-dose vaccine. “So far it works,” he said of the program.
Covax announced last week that it should deliver 337.2 million doses worldwide by June, with the pace accelerating in the second half of the year.
Covax will rely heavily on the Oxford / AstraZeneca vaccine, especially over the next six months. In contrast, it has purchased only a smaller number of two of the other most advanced vaccines from BioNTech / Pfizer and Moderna, both of which use mRNA technology and have proven highly effective against coronavirus.
Seth Berkley, Gavi’s CEO, said Covax partners were concerned about the price of mRNA vaccines, the initial lack of availability and the need to store them at very low temperatures. “We may end up buying more of those doses,” he said. “The challenge will be how to lower the price, how to improve stability.”
Covax hopes that its 2021 target will be enough to ensure that at-risk and vulnerable people around the world, as well as primary health workers, are vaccinated by the end of the year – at least 20 percent of the world’s population. “With the right funding, it may be possible to deliver more – possibly 27 percent,” said Gavi.
Soumya Swaminathan, WHO’s chief scientist, said she was confident Covax would “deliver” but said it was clear that initial doses would be “limited” due to global competition for scarce supplies.
“We need to make sure that most at-risk groups get the vaccine around the same time or around the world, instead of vaccinating your entire country before you’re willing to think about it,” she said.
An impending discussion is how wide Covax’s reach should be in the long term. Ultimately, providing vaccines to a vast majority of the world’s 7.8 billion people would still require a hefty injection of money and perhaps years to fully deploy.
“If the problem is, what we have to do is just vaccinate 100 percent of the people on Earth, that’s going to take a while,” Berkley said. “But I don’t think we know.”