Has COVAX delivered on its vaccine access promises?

Organisations behind the vaccine arm seem to be losing interest in COVID-19

By Vibha Varshney
Published: Thursday 19 January 2023
Delivery of COVAX vaccine. Photo: © UNICEF/UN0579046/Kanobana__

Talk of new pandemics of unknown origin is escalating and hopes are pinned on the systems set to deal with COVID-19. These systems include COVAX, the vaccine arm of the Access to COVID-19 Tools (ACT) Accelerator, which was launched in April 2020. 

COVAX hogged the limelight through the pandemic as effective vaccines can prevent morbidity and mortality. The facility is the brainchild of Gavi-the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), World Health Organization (WHO) and United Nations Children’s Fund (UNICEF). 

Read more: COVID-19 Vaccine Watch: COVAX has 2 billion doses to supply to 190 countries

COVAX was supposed to make the vaccines available equitably and, more importantly, to low-income countries that otherwise would not be able to afford them.

But did COVAX do a good job? Since the beginning of the pandemic, COVAX has delivered more than 1.8 billion doses to 146 countries, with more than 90 per cent of these doses going to people in lower-income countries, according to UNICEF data. 

However, 13.2 billion doses have been administered globally and this 1.8 billion is a mere drop in comparison.

The result is that while 69.2 per cent of the world population has received at least one dose of a COVID-19 vaccine, only 25.9 per cent of people in low-income countries have received at least one dose till January 18, 2023, according to the data analysis website Our World in Data.

Only 0.22 per cent of the population in Burundi, one of the poorest countries in the world, has received the full initial recommended doses of vaccination. Somalia, yet another poor country, has done a little better than average and as many as 37 per cent of the people are fully vaccinated. 

UNICEF’s database shows that deliveries are being made this month to Ethiopia, Guinea, Libya and Sudan. These countries reported 0.43, 0.14, 0.10 and 0.05 cases per million of the population on January 17, 2023, according to Our World in Data.

With the surge of cases in countries like China, the WHO recommended that people take booster doses. The inability of COVAX to scale up would increase the inequity in vaccination action. 

But the organisations that make up the COVAX seem to be losing interest in COVID-19. The last press release on CEPI’s website related to COVAX is from May 2022.

Read more: COVID-19 vaccines for all: Why COVAX is not working

It said that while the vaccine arm has access to enough COVID-19 vaccines to help protect 70 per cent of the population in 91 lower-income countries, the demand and uptake are low. 

The latest press release related to COVAX on Gavi’s site is from October 2022. It announced its previous agreement with Moderna has been cancelled and a new one will begin in 2023 to access the company’s variant-containing vaccine (VCV) for lower-income countries. 

Gavi will have the right to access up to 100 million VCV doses at Moderna’s lowest-tiered price.

The oft-repeated sentence during the COVID-19 pandemic, “no one is safe until everyone is safe”, seems to have lost relevance as the organisations plan for 2023 and ahead. 

For example, CEPI is now working on pandemic preparedness per se. They recently partnered with a biotech company to evaluate next-generation RNA vaccine platform technology to respond to ‘Disease X’. 

Gavi’s five-year programme was launched on December 8, 2022. This indicates that they will work more on routine immunisation to make up for the backslide due to the pandemic. However, they would continue to work on COVID-19 vaccination too.

The simplest learning from the pandemic in relation to vaccines is that each country needs to have vaccine manufacturing capacity. COVAX’s role would then have been to ensure quick development of the technology and its transference to developing countries. As of now, this hasn’t happened much, but it needs to be ensured in the future. 

Read more: COVID-19 vaccine update: How much is the world lagging behind in vaccination

There have been efforts towards this during the pandemic when Africa was left without access to vaccines. The African Union launched the Partnerships for Africa Vaccine Manufacturing in 2021 to ensure that 60 per cent of vaccines administered on the continent are locally manufactured by 2040.

The continent currently imports about 99 per cent of its vaccines. The WHO put in place an mRNA vaccine technology transfer hub in South Africa, Senegal established the MADIBA vaccine facility and BioNTech set up a vaccine manufacturing plant in Rwanda. 

Results will take time to materialise. Meanwhile, COVID-19 continues to kill people. 42.85 new cases per million population were reported on January 17, 2023. To date, a total of 663 million cases of COVID-19 have been reported from around the world, out of which 6.7 million could not be saved.

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