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President Biden has committed the United States to COVAX, the scheme to help the poorest nations obtain vaccines.
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But the project is already experiencing difficulties and the details of the US contribution are vague.
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Experts see the scheme as the minimum, which will leave profound inequality even if it works.
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While the world’s richest countries order enough coronavirus vaccines to inoculate their populations multiple times, the World Health Organization is promoting a scheme to gain access to the poorest countries as well.
The scheme, called COVAX, hopes to distribute 2 billion doses of the COVID-19 vaccine worldwide by the end of 2021.
But it faces underfunding and supply problems, and WHO has accused rich countries of accumulating doses and raising prices, thwarting their progress.
COVAX has just received a big boost: President Joe Biden’s government has announced that it will support the scheme, a marked contrast to the Trump White House, which was left out.
But experts and activists noted that Biden’s commitment is still poorly defined. At the same time, the United States government is campaigning for vaccination while other nations are struggling to get any dose.
The reality is that even with a contribution from the United States, it is unlikely that vaccines will end up being distributed in a way that would be widely seen as fair.
This failure is likely to have huge consequences – many thousands of deaths, deepening global equality and prolonged outbreaks in poorer nations that can again affect even richer countries with widespread vaccination.
What exactly did Biden promise?
The day after Biden took office, Dr. Anthony Fauci of the United States National Institute of Allergy and Infectious Diseases said that the Biden government would join COVAX.
But the government gave few details.
Kate Elder, senior vaccine policy advisor at Doctors Without Borders / Doctors Without Borders, told Insider that US membership will be “invaluable”.
But she and other experts have warned that her help comes while vaccine supplies are currently limited, meaning that extra money and resources are likely to do little to meet immediate needs.
Professor Ken Shadlen, a professor of development studies at the London School of Economics and Political Science, told Insider about some of the ways in which US participation can help.
He said that US funding would help low-income countries buy more vaccines and perhaps compete better with richer countries, which can pay more per dose.
But he also said that these efforts could be hampered by a lack of transparency about which countries have guaranteed access to vaccines and how much they are paying.
He said that, ultimately, the usefulness of US participation “depends on the size of the contribution”, especially as the scheme grapples with existing problems.
Matthew McCoy, assistant professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania, told Insider that the Biden administration’s membership of COVAX is an “important step” in ensuring that the project meets its objectives.
But he warned that the size of this impact “depends on the resources the United States allocates to the initiative”.
COVAX has problems to overcome
Reuters reported in December that COVAX faced a “very high” risk of failure due to underfunding and supply risks.
McCoy noted that COVAX could suffer more if rich countries continue to drain a large proportion of the available vaccines, as has been the case so far.
Countries like the USA, the UK and Canada have ordered in advance enough doses to immunize each person who lives there multiple times.
The logic is that overcapacity will help countries run the risk of a vaccine not being approved or that some will take longer than expected to arrive. These countries are already fighting each other to see who gets the doses first.
McCoy and Elder said the United States should do what Canada says it will do: donate the excess vaccines it ordered to COVAX.
But that will not help at all until these countries decide that they no longer need it for themselves.
Elder also said that the situation in poor countries is arguably worse because of wealthy nations like the United States pursuing their domestic vaccination programs so aggressively.
She said that high-income countries “sucked the supply” and “possibly raised prices”.
As a result, she said, COVAX “has very few tangible doses ready to distribute to the multitude of countries that depend on it.”
His warning reflects that of Dr Tedros Adhanom Ghebreyesus, WHO’s chief, who said that countries were “bypassing COVAX, raising prices and trying to jump to the front of the queue”.
Shadlen, the professor in London, said that even if COVAX achieves all of its objectives, inequality in access to the vaccine will still be great.
“COVAX has a very, very modest ambition and, therefore, even if it works exactly as planned, it will not fill the gap in vaccine inequality.”
COVAX is the ‘minimum’
Shadlen noted that many wealthy countries plan to vaccinate most of their adult population by the end of the summer.
But in contrast, he described COVAX’s goal – to vaccinate about 20% of the populations in 92 countries by the end of the year – as “the minimum”.
He said the scheme was put in place to avoid the “worst case scenario” in global inequality.
“But I just think that avoiding the worst case should be understood as what it is: what it is to avoid the worst case.”
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