COVAX
Launched in April 2020, the Access to COVID-19 Tools (ACT) Accelerator partnership was convened by the World Health Organisation (WHO), Gavi – the Vaccine Alliance and The Coalition for Epidemic Preparedness Innovations (CEPI). COVAX is one of ACT’s three pillars, born with the purpose of providing innovative and equitable access to COVID-19 diagnostics, treatments and vaccines. All participating countries will have equal access to the pooled procurement and distributions of developed vaccines; as of December 2020, more than 189 countries have signed up. However, documents leaked to Reuters highlight the programme is struggling from a lack of funds, supply issues and complex contractual problems which make failure a ‘very high risk’.
How COVAX plans to operate
Through the Advance Market Commitment (COVAX AMC) launched at the Global Vaccine Summit in June, it plans to have delivered 2 billion doses by the end of 2021. Wealthier countries can participate as ‘self-financing countries’, committing to procure enough doses through the facility to vaccinate 10-50% of their population, making an upfront payment. The more that participate, the greater the financial risks will be shared. Poorer nations participate as “funded”, covering their financial commitments with the Advanced Market Commitment (AMC). Critically, the success of the facility is hinged on the participation of high-income countries – an issue plaguing COVAX since its inception, as these act increasingly in their own interest.
COVAX – a pioneering purpose?
The COVAX facility must be commended for its pioneering objectives, truly the first global solution to ensuring fair access for all nations, regardless of income, to avoid supply levels disproportionately favouring higher income nations. Such, ‘vaccine nationalism’ is a concept that has gained traction within academic circles, suggesting these states will actively leverage their purchasing power to procure vaccines for their own civilians, structurally embedding inequality. One report published October 2020 suggested the financial burden of inequitable access could cost up to $1.2 trillion a year in GDP terms. Further, there critically exists financial incentives for these high-income nations to engage in equal distribution measures – themselves losing an estimated $119 billion a year if the poorest nations are denied a supply. Despite this, several key nations, including the US have shown little interest in COVAX, suggesting these incentives are simply not enough.
GAVI Global Vaccine Summit, June 2020 – world leaders came together in June to pledge funding for COVAX.
Challenges to success
Despite these incentives, a report leaked to Reuters at the beginning of December indicated gaping internal weaknesses that must be addressed for COVAX to reach its targets. Evaluating these risks is critical to gaining a clearer understanding of the realistic impact COVAX will have in tackling the pandemic.
Short financing – COVAX has received about a quarter of the $16 billion that WHO and Gavi, The Vaccine Alliance stated it needs by the end of 2021 to procure 2 billion doses. Additionally, the poorest countries that qualify for free or cheaper vaccines are also required to chip in to buy vaccines with up to USD $2 billion by the end of 2021. Those unable to pay could be exempted, but the confidential document further stated they ‘will be expected to co-finance COVID-19 vaccines with tiered contributions that reflect economies’ ability to pay’. The World Bank along with international donors are expected to finance loans to plug the funding gap, however since the success of COVAX depends on wealthy nations participating, there remains significant uncertainty over the size of this gap.
Supply issues – Furthermore, the scheme is dependent on vaccines that are cheaper and easier to transport, including the Oxford University-AstraZeneca vaccine, which has been slower in testing and receiving regulatory approval. COVAX has so far reached non-binding supply agreements with AstraZeneca, Novavax and Sanofi for 400 million doses – but all three have faced delays in their trials, pushing back regulatory approval until mid-2021. Given this, huge questions exist over the ability of COVAX to fulfil its targets, and more transparency is desperately needed to inform expectations.
Limited transparency – According to papers leaked to Reuters, the liability for any issues experienced by the participating nations will not be footed by COVAX, operating without financial contingency funds. This means that for the poorer countries that do not have access to public or private funds that could pay indemnities to victims, they would face uncapped costs for which they have no insurance – or victims receive no compensation at all. The lack of transparency over these contingency measures has already been raised by The Gates Foundation, for their potential to act as a significant barrier to delivery of the vaccines.
Lack of support from key nations – Enthusiasm for the facility has in part been dampened over the summer by refusals to support from the United States, with White House spokesman Judd Deere calling the WHO ‘corrupt’ and ‘constraining’. Beijing was a late joiner at the end of October, refusing to contribute financially, with Russia opting to not join the facility at all. It is clear these nations intended to rely on their own scientific acumen to develop effective vaccines to prioritise their own civilians, entirely culpable for exuding ‘vaccine nationalism’. President Trump banked on the 6 vaccine candidates within the US to succeed (https://www.ft.com/content/89acf0bb-8dac-4f73-8962-5780546eadca), including the Pfizer and Moderna vaccines, funnelling $10 billion for trials under Operation Warp Speed. Russia began distributing the Sputnik V vaccine in December; China similarly has approved the Sinopharm vaccine in the same month.
https://eu.usatoday.com/story/news/world/2020/12/08/covid-19-pfizer-biontechvaccine-rollout-uk/3821483001/ USA Today – Margaret Keenan was the world’s first person to receive the Pfizer COVID-19 vaccine on December 8, 2020.
Prospects for COVAX…
COVAX must be commended for its objectives, given that vaccine distribution will undoubtedly end the pandemic. However, signs that nations are already getting left behind are emerging; the EU, United States, Britain, Canada, Japan, Switzerland, Australia, Hong Kong, Macau, New Zealand, Israel and Kuwait – accounting for 14% of the world’s population – have acquired 53% of potential doses. It is plain that ‘vaccine nationalism’ is rife, and those in the poorest of nations will have to wait an undetermined amount of time to receive their share.
