01 Apr 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
Cohen, J., & Kupferschmidt, K. (2021, March 9). Countries now scrambling for COVID-19 vaccines may soon have surpluses to donate. Science | AAAS. https://www.sciencemag.org/news/2021/03/countries-now-scrambling-covid-19-vaccines-may-soon-have-surpluses-donate
Cohen, R. (2021, February 9). COVID vaccines: Rich countries have bought more than they need – here’s how they could be redistributed. The Conversation. http://theconversation.com/covid-vaccines-rich-countries-have-bought-more-than-they-need-heres-how-they-could-be-redistributed-153732
Duke Global Health Innovation Center. (2021, March 12). COVID-19 Vaccine Advance Market Commitments by Country. Launch and Scale Speedometer. https://public.tableau.com/views/COVID-19VaccineAdvanceMarketCommitmentsbyCountry_16131542122100/Dashboard1?:embed=y&:showVizHome=no&:host_url=https%3A%2F%2Fpublic.tableau.com%2F&:embed_code_version=3&:tabs=no&:toolbar=yes&:animate_transition=yes&:display_static_image=no&:display_spinner=no&:display_overlay=yes&:display_count=yes&:language=en&publish=yes&:loadOrderID=0
Emanuel, E. J., Fabre, C., Halliday, D., Leland, R. J., Buchanan, A., Tan, K.-C., & Chan, S. Y. (2021, March 9). How Many Vaccine Doses Can Nations Ethically Hoard? https://www.foreignaffairs.com/articles/world/2021-03-09/how-many-vaccine-doses-can-nations-ethically-hoard
European Commission. (2021, February 19). EU doubles contribution to COVAX to €1 billion [Text]. European Commission – European Commission. https://ec.europa.eu/commission/presscorner/detail/en/ip_21_690
Fallah, M. (2021, January 14). No country is an island: Collective approach to COVID-19 vaccines is the only way to go. The Conversation. http://theconversation.com/no-country-is-an-island-collective-approach-to-covid-19-vaccines-is-the-only-way-to-go-153200
Gavi. (2021, March). COVAX Facility. Gavi: The Vaccine Alliance. https://www.gavi.org/covax-facility
McCarthy, N. (2021, February 22). Infographic: The Governments Donating The Most Money To COVAX. Statista Infographics. https://www.statista.com/chart/24244/donations-to-covax-by-country/
MSF. (2021, February 24). MSF responds to news of first deliveries of COVID-19 vaccines through the COVAX Facility. Médecins Sans Frontières Access Campaign. https://msfaccess.org/msf-responds-news-first-deliveries-covid-19-vaccines-through-covax-facility
Ravelo, J. L. (2021a, February 22). With scarce funding for ACT-A, “everything moves slower”: WHO’s Bruce Aylward. Devex. https://www.devex.com/news/sponsored/with-scarce-funding-for-act-a-everything-moves-slower-who-s-bruce-aylward-99195
Ravelo, J. L. (2021b, March 11). Is COVAX part of the problem or the solution? Devex. https://www.devex.com/news/sponsored/is-covax-part-of-the-problem-or-the-solution-99334
The Economist. (2021, January 27). More than 85 poor countries will not have widespread access to coronavirus vaccines before 2023. Economist Intelligence Unit. https://www.eiu.com/n/85-poor-countries-will-not-have-access-to-coronavirus-vaccines/
Toole, M. (2021, February 28). 3 ways to vaccinate the world and make sure everyone benefits, rich and poor. The Conversation. http://theconversation.com/3-ways-to-vaccinate-the-world-and-make-sure-everyone-benefits-rich-and-poor-155943
WHO. (2020). COVID-19 technology access pool. World Health Organization. https://www.who.int/initiatives/covid-19-technology-access-pool
WHO Director-General. (2021, January 18). WHO Director-General’s opening remarks at 148th session of the Executive Board. World Health Organization. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board