Scores of poorer countries around the world are waiting nervously to see if the multilateral Covax programme will deliver the coronavirus vaccines they need to stem the pandemic — even though some rich nations are forging ahead with immunisation.
The scheme was set up in June by Gavi, a vaccine alliance with the goal of increasing access to immunisation in poor countries; the Coalition for Epidemic Preparedness Innovations (CEPI); and the World Health Organization. It aims to ensure the equitable global distribution of vaccines, initially by providing 2bn doses to participating countries in 2021.
At least two-thirds of those doses will go for free to 92 lower-income economies, and Covax says it is on course to hit the target.
But, more than two months after western countries started vaccinating their populations, Covax is yet to deliver its first doses, leaving many poorer countries without any vaccines with which to start inoculations.
“Covax is lagging because they lacked the purchasing power to come to the table while the others were busy making deals,” said Jenny Ottenhoff, senior policy director at the ONE Campaign against global poverty.
While the UK has given 21 doses per 100 residents and the EU has given 4.2, Bangladesh has administered only 0.02, Myanmar 0.007 and Algeria 0.00007, according to the latest data compiled by the Financial Times. Many African countries have yet to see a single jab.
The widening gap is a stark symbol of the challenges Covax has faced in trying to turn theoretical support for the idea of a global vaccination drive into a reality. While most advanced economies have backed Covax, those same governments have then competed against the scheme for coveted vaccine supplies from manufacturers.
Beneficiaries of Covax, like Nigeria, appreciate the ambition of the programme but agree that it has struggled. “We recognise that Covax is working as hard as they can in an environment where richer nations are snapping up vaccines,” said Dr Faisal Shuaib, director of the National Primary Health Care Development Agency in Nigeria, Africa’s most populous country.
Covax was first envisaged as a single clearing house for the world’s vaccine orders, from which all countries, rich and poor, would procure their doses.
But almost immediately rich and middle-income nations sought to do their own bilateral deals as nationalism trumped multilateralism. Some observers say this was inevitable and suggest that Covax could have progressed quicker and more efficiently if it had accepted that reality earlier.
“It’s good that Covax is there, but some of the parties to it were over-optimistic or naive about a multilateral solution to the pandemic,” said one international healthcare expert, who asked not to be named because of the sensitivity of the subject.
It also meant that Covax has remained open to rich nations, allowing countries such as Canada to take doses from the Covax pot, while also placing their own vaccine orders direct with manufacturers.
Despite criticism that such “double-dipping” is diverting further supplies from developing nations, Covax argues that the involvement of high-income countries as buyers of vaccines is crucial to achieving its ambitions to serve poorer states.
“For Covax to succeed at the scale of its ambition, it’s important that Covax serves both groups, with the upfront cash from self-financing participants proving vital in enabling our ability to make deals with manufacturers,” Gavi said.
Gavi is “optimistic” that Covax will begin to deliver vaccines in February. As such, confidence in the scheme may be about to turn a corner.
In Rwanda, Dr Daniel Ngamije, health minister, said he was expecting the first batch of an order for 996,000 doses of the Oxford/AstraZeneca vaccine to arrive within weeks, along with some doses from BioNTech/Pfizer.
He added that Covax had promised to deliver 7m doses by the end of the year — more than sufficient to immunise 25 per cent of Rwanda’s 13m people with the two-dose vaccine. “So far, it works,” he said of the programme.
Covax announced last week that it should deliver 337.2m doses globally by June, with the pace ramping up during the second half of the year.
Covax will depend heavily on the Oxford/AstraZeneca vaccine, particularly over the next six months. In contrast, it has only bought a smaller number of two of the other most advanced vaccines made by BioNTech/Pfizer and Moderna, which both use mRNA technology and have proved highly effective against coronavirus.
Seth Berkley, Gavi’s chief executive, said the Covax partners had been concerned about the price of mRNA vaccines, the initial lack of availability, and the need for them to be kept at very low temperatures. “It may be that ultimately, we will purchase more of those doses down the line,” he said. “The challenge is going to be how to get the price point down, how to get the stability better.”
Covax hopes that its target for 2021 will be sufficient to ensure high-risk and vulnerable people around the world, as well as frontline healthcare workers, are vaccinated by the end of the year — at least 20 per cent of the global population. “With the correct funding in place, it might be possible to deliver more — potentially 27 per cent,” Gavi said.
Soumya Swaminathan, WHO chief scientist, said she was confident that Covax would “deliver”, but said it was clear that initial doses would be “limited” because of the global competition for scarce supplies.
“We need to ensure that most high-risk groups get the vaccine around the same time or across the globe, rather than go vaccinate your entire country before you’re willing to think about that,” she said.
A looming debate is how extensive Covax’s reach will need to be long term. Ultimately, providing vaccines for a large majority of the world’s 7.8bn people would require a big further injection of cash and perhaps years for the full rollout.
“If the issue is, what we have to do is just vaccinate 100 per cent of people on earth, that will take the time,” Berkley said. “But I don’t think we know that.”
Can Covax deliver the vaccines much of the world needs? – Financial Times