The relative obscurity of this vaccine program belies its critical role in the global battle against Covid-19. In fact, COVAX may well be the most important acronym of 2021. As the nationalism of the vaccine rises, it is the best – perhaps the only – bet on getting billions of doses for low and middle income countries.
COVAX is an entity managed by a coalition that includes the Vaccine Alliance known as Gavi and the World Health Organization (WHO), and is financed by donations from governments, multilateral institutions and foundations. Its mission is to buy coronavirus vaccines in large quantities and send them to the poorest nations that cannot compete with the rich countries in obtaining contracts with the main pharmaceutical companies.
He secured nearly 2.3 billion doses for distribution this year. Of this total, 1.8 billion is to be made available to 92 of the world’s poorest countries – the majority of which (1.3 billion) will be free.
Gavi has a lot of experience in bringing vaccines to populations in need – he helped vaccinate half of the world’s children against other diseases, such as polio, meningitis and typhoid. But the Covid-19 campaign outperforms these programs.
Shipments of the coronavirus vaccine by COVAX will begin this month and increase in the second half of the year. The countries of Latin America and the Caribbean will be among the first in line, receiving around 35 million doses of the Pfizer-BioNTech and AstraZeneca vaccines by the end of June.
Countries must submit a detailed plan for the handling and distribution of the vaccine – any country that has enrolled in the program is eligible to receive a vaccine. Some nations are financing their own portion of vaccines to be delivered through COVAX, but 92 are eligible for large discount or free shipments.
The Pan American Health Organization (PAHO) states that there will be no distinction between countries that pay for vaccines and those that receive them free of charge.
For now, only two vaccines are approved for distribution by COVAX – those made by Pfizer-BioNTech and AstraZeneca – but Gavi says he will need as many vaccine candidates as possible to achieve his goal “once they have received approval from a regulator strict authority and / or prequalification by WHO. “
According to Gavi, Southeast Asia should receive 695 million doses by the end of 2021, and Africa 540 million doses. A strip from the Middle East, Afghanistan and Pakistan is expected to receive 355 million doses by December, according to the WHO. PAHO says it plans to distribute 280 million doses to the Americas by the end of the year.
Several countries in Eastern Europe, including Ukraine and Moldova, are also eligible for subsidized COVAX supplies.
More than a billion of the necessary doses are likely to be produced by the Serum Institute of India (SII), the largest vaccine manufacturer in the world, at a cost of about $ 3 per injection, thanks to the collaboration of Gavi, the Bill & Melinda Foundation Gates and SII.
The great if
It is an impressive effort, but hardly enough. To begin with, ‘insurance’ does not mean obtained. Gavi herself warns that there is “a big if, with uncertainties around the country’s capacity, financing and readiness”. Governments must present detailed plans to show that they can distribute the doses they receive and identify areas where they need help.
The logistics involved are scary. The United Nations Children’s Fund – which will be a major distributor – is trying to double its transport capacity this year so that it can transfer 850 tons of Covid-19 vaccines per month.
A major obstacle faced by COVAX: money. So far, it has raised more than $ 6 billion, but is trying to raise “an additional $ 2.8 billion in 2021 – $ 800 million for research and development and at least $ 2 billion for vaccines for low-income countries. “a spokesman for Gavi told CNN.
Major donors to date include the United Kingdom ($ 750 million), the European Union (almost $ 600 million) and Canada ($ 250 million). The Biden government has pledged to join COVAX, which was boycotted by the Trump administration.
Nguyen said that “without a joint effort, low-income countries will be left behind because of constraints on their financial capabilities”.
Even if the 2.3 billion dose target is reached, the vast majority of people in low-income countries will have to wait at least until 2022. Gavi herself predicts that vaccines distributed by COVAX will reach 27% of the countries’ population. low income. year.
This will depend on a massive intensification of the program in the second half of 2021. WHO officials expect that only 3.3% of populations in low-income countries will be vaccinated by the end of June. India, Pakistan and Nigeria will receive the largest number of doses according to COVAX, receiving 97.1 million, 17.1 million and 16 million doses, respectively.
In the case of India, this allocation would treat less than 4% of its population. Latin America and the Caribbean should receive sufficient doses of COVAX for almost 20 million people by the end of June, but the region’s population is 500 million.
On the other hand, many rich countries plan to vaccinate their entire population by the last quarter of 2021. In Germany, Chancellor Angela Merkel has set a September 21 target for each adult to receive a vaccine.
Some middle-income countries in the COVAX program are protecting their bets by opting for a hybrid approach that includes direct purchases from vaccine manufacturers. Colombia and several countries in the Balkans have closed bilateral agreements pending the start of COVAX.
The African Union has also entered the market – guaranteeing 670 million doses of different vaccines, in addition to the COVAX program.
‘Me first’
The biggest challenge for global coverage is an “me first” attitude that has been criticized by global health officials. WHO Director-General Tedros Adhanom Ghebreyesus says that bilateral agreements effectively increase vaccine prices for everyone.
“Many countries have bought more vaccines than they need,” said Tedros in January. “Now we face the real danger that, even with vaccines bringing hope to rich countries, much of the world could be left behind,” he said.
It was not certain, he added, that younger, healthier adults in wealthy countries could receive the vaccine before health professionals and the elderly in poorer countries, especially with the emergence of new variants of the virus.
Gavi told CNN: “Each time a new bilateral agreement is made, it reduces the potential supply to COVAX, so we continue to ask manufacturers and governments to support our work.”
The longer it takes to achieve vaccination globally, the greater the risk that new variants may flourish. However, Gavi told CNN that his partner – the Coalition of Epidemic Preparedness Innovations – is investing in the ‘next generation’ of vaccine candidates, which will give the world additional options to control Covid-19 in the future.
If, as is widely expected, the coronavirus vaccine is an annual necessity, the pressure on supplies will not ease. Long before most of the developing world was vaccinated, people in rich countries could be receiving their second annual dosage.
Tedros’ comments are echoed by Dr. Seth Berkley, CEO of Gavi, who criticized the feeling of “vaccine panic” among the wealthiest countries.
“We will only be safe anywhere if we are safe everywhere,” he said.
The story is not encouraging. Tedros recalls the H1N1 epidemic in 2009, when developed countries monopolized the first vaccine supplies.
Going further, Africa only received life-saving antiretroviral treatments several years after they were widely available in the developed world, even when the continent suffered catastrophic HIV / AIDS mortality rates.
The director of the African Centers for Disease Control and Prevention, John Nkengasong, says that dealing with Covid-19 needs more urgency.
“We need to reach 60% [vaccination] target within two years “in Africa, he said. Otherwise, he warned,” the virus will be endemic in our communities. “
Tedros used stronger language. Unless COVAX gets the resources it needs, the world will face a “catastrophic moral failure,” he said.