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The COVAX Facility: the way forward to ensure equitable distribution of COVID-19 vaccines?

The distribution of COVID-19 vaccines across the globe is far from fair. High-income countries currently hold a confirmed 4.6 billion doses of vaccines, compared to 1.5 billion doses by middle-income countries and 1.3 billion doses by lower-income countries. This lack of vaccine equity in the COVID-19 response is relevant to the COVINFORM project’s focus on vulnerabilities and structural inequalities in the pandemic.

An initiative set up to battle inequities in vaccine procurance and distribution is the COVID-19 Vaccines Global Access (COVAX) Facility. This blog post discusses why equitable distribution is important and explores whether the COVAX Facility is the best way forward to ensure fair global distribution of COVID-19 vaccines.

The importance of fair distribution

First and foremost, finding a way to distribute vaccines equitably across the globe is important from a moral point of view. Indeed, the Director General of the World Health Organization (WHO) has called unequal COVID-19 vaccine policies a “catastrophic moral failure”, the price of which “will be paid with lives and livelihoods in the world’s poorest countries”.

However, there are also pragmatic arguments for a fair distribution of vaccines. In order to break chains of transmission and stop the pandemic, a substantial proportion of the global population has to be vaccinated. In an interconnected world, no country is an island, and “unless we end the pandemic everywhere, we will not end it anywhere”. Vaccinating the global population will also slow the emergence and spread of new variants.

The COVAX Facility

The goal of the COVAX Facility is to coordinate fair procurement and distribution of COVID-19 at a global level. COVAX pools funds from countries and donors to invest in a range of different vaccines and collectively negotiates with suppliers and manufacturers. By investing in a diverse portfolio of vaccines, COVAX increases the likelihood that countries have access to one or more effective vaccines.

So far, approximately 190 countries have joined the initiative, among which are about 64 high-income countries. COVAX aims to purchase 2 billion vaccine doses by the end of 2021, of which at least 1.3 billion doses will be reserved for low and middle-income countries.

The three governments donating most money to COVAX are the USA, the UK and Germany. Last month, the European Union announced that it would double its contribution to COVAX by donating an additional €500 million.

Progress and pitfalls

COVAX is widely praised for providing an equitable distribution mechanism, but it has been slow to get off the ground. By the end of March 2021, a meagre total of 32 million doses had been shipped through COVAX. Key barriers to rapid roll-out are underfunding and vaccine hoarding by high-income countries.

Many governments of high-income countries have gone around COVAX and signed bilateral agreements with pharmaceutical companies to avoid being left at the back of the queue. Some countries have even signed agreements for access to many more doses than they have citizens. For example, Canada has signed vaccine purchase deals for nearly nine times as many vaccines as it needs for its population of 37 million. If all the EU’s vaccine orders are fulfilled, it will also have a surplus of around 525 million full vaccinations.

By “gobbling up scarce global supply”, these bilateral deals effectively limit low- and middle-income countries’ access to vaccines. Delays in the production and delivery of vaccines to richer countries push back COVAX delivery dates for poorer ones. In fact, it has been projected that most lower-income countries will not be fully vaccinated until at least 2023.

A key challenge COVAX faces is that it has no power to compel states to share their vaccine surpluses. As a result, it remains at the mercy of the goodwill of individual governments and donors.

Critics have pointed out that the most effective way to achieve global vaccination coverage quickly would be to provide countries with the knowledge and infrastructure to produce their own vaccines. COVAX has been accused of failing to address the fundamental problem: unwillingness to waive intellectual property rights and to share data and technology with low-income country vaccine manufacturers.

Looking to the future

COVAX is an ambitious initiative which has helped fuel the global conversation about vaccine equity. It is certainly a step in the right direction, but additional efforts are required to achieve greater equity in the distribution of COVID-19 vaccines.

The effectiveness of COVAX could be improved by demanding of countries that they donate any excess vaccine doses to the Facility, so they can be redistributed to countries where COVID-19 is still circulating.

However, the fastest and most ethical way to ensure rapid global roll-out of COVID-19 vaccines would be to waive patent rights for vaccines and promote partnerships, technology transfers and training in vaccine manufacturing. A way of achieving this would be to force pharmaceutical companies to join the WHO’s COVID-19 Technology Access Pool (C-TAP), so that any manufacturer around the world could start producing vaccines.

It will be difficult for COVAX to deliver on the scale that is required without challenging pharma companies’ monopoly control. Leaving no one behind in ensuring access to lifesaving vaccines requires political leaders to address the inherent flaws in the global vaccine access system.


Author: Jil Molenaar



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