Many poorer countries around the world are anxiously waiting to see if the multilateral Covax program will provide the coronavirus vaccines needed to stop the pandemic – although some rich countries continue to immunize.
The scheme was set up in June by Gavi, a vaccine alliance aimed at increasing access to vaccination in poor countries; the Coalition for Innovations on Epidemic Preparedness (CEPI); and the World Health Organization. It aims to ensure the equitable global distribution of vaccines, initially by providing 2 billion doses to participating countries by 2021.
At least two-thirds of the doses will go free to 92 lower-income economies, and Covax says it’s on track to reach the target.
But more than two months after Western countries began vaccinating their populations, Covax is still not delivering its first doses, leaving many poorer countries without vaccines to start vaccinations.
“Covax is in arrears because they do not have the purchasing power to get to the table while the others were making deals,” said Jenny Ottenhoff, senior policy director at the ONE Global Poverty Campaign.
While the UK gave 21 doses per 100 inhabitants and the EU 4.2, Bangladesh administered only 0.02, Myanmar 0.007 and Algeria 0.00007, according to the latest data compiled by Financial Times. Many African countries have not seen a single moment.
The widening gap is a clear symbol of the challenges Covax faced in making theoretical support for the idea of a global vaccination project work. While most advanced economies supported Covax, the same governments then competed with the manufacturer’s coveted vaccine supply scheme.
Beneficiaries of Covax, such as Nigeria, appreciate the ambition of the program, but agree that it has struggled. “We realize that Covax is working as hard as they can in an environment where richer countries are receiving vaccines,” said Dr Faisal Shuaib, director of the National Agency for Primary Health Care Development in Nigeria, the most populous country in Africa.
For the first time, Covax was considered a cleaning industry for the world’s vaccine orders, from which all countries, rich and poor, would obtain their doses.
But almost immediately, rich and middle-income countries wanted to do their own bilateral transactions, as nationalism trumps multilateralism. Some observers believe this was unavoidable and suggest that Covax could have progressed faster and more efficiently if it had accepted reality earlier.
“It’s good that Covax is there, but some of the parties involved were too optimistic or naive about a multilateral solution to the pandemic,” said one international health expert.
It also meant that Covax remained open to rich countries, allowing countries like Canada to take doses out of the Covax pot, while also placing their own vaccine orders directly with manufacturers.
Despite criticism that such “double immersion” diverts further supplies from developing countries, Covax argues that the involvement of high-income countries as buyers of vaccines is crucial to achieving its ambitions to serve poorer states.
“In order for Covax to succeed on the scale of its ambition, it is important that Covax serves both groups, with the advance cash of self-financing participants that is very important to enable us to deal with manufacturers,” Gavi said. .
Gavi is ‘optimistic’ that Covax will start vaccinating in February. As such, confidence in the scheme could be on the verge of taking a turn.
In Rwanda, dr. Health Minister Daniel Ngamije said he expected the first order of 996,000 doses of Oxford / AstraZeneca vaccine to arrive within a few weeks, along with 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. “It’s working so far,” he said of the program.
Covax announced last week that it would have to deliver 337.2 million doses worldwide by June, with the rate rising in the second half of the year.
Covax will be very dependent on the Oxford / AstraZeneca vaccine, especially in the next six months. In contrast, he purchased only a smaller number of two other advanced vaccines manufactured by BioNTech / Pfizer and Moderna, both of which use mRNA technology and have been shown to be very effective against coronavirus.
Gavi CEO Seth Berkley said Covax partners were concerned about the price of mRNA vaccines, the initial lack of availability and the need to keep them at very low temperatures. “Maybe we will eventually buy more of the doses,” he said. “The challenge will be to lower the price point, and how to improve stability.”
Covax hopes that its target for 2021 will be sufficient to ensure that high-risk and vulnerable people around the world, as well as health workers at the forefront, are vaccinated by the end of the year – at least 20 percent of the world’s population. “With the right financing, it’s possible to deliver more – possibly 27 percent,” Gavi said.
WHO chief scientist Soumya Swaminathan said she was confident Covax would “deliver”, but said it was clear that initial doses would be “limited” due to global competition for scarce stocks.
“We need to make sure that most high-risk groups get the vaccine at about the same time or around the world, rather than vaccinating your entire country before you are prepared to think about it,” she said.
A looming debate is how extensive Covax’s range will have to be in the long run. Ultimately, the provision of vaccines to a vast majority of the world’s 7.8 billion people requires a huge further cash injection and perhaps years for full implementation.
“If the problem is, we just have to vaccinate 100 percent of the people on earth, that’s going to take time,” Berkley said. “But I do not think we know.”