A beautiful idea: how COVAX has fallen short.

COVAX was meant to supply COVID-19 vaccines for all based on solidarity and equity. Instead, it relies on rich countries’ willingness to share their doses. Ann Danaiya Usher reports.

Launched 1 year ago, the COVAX facility was conceived as an “unparalleled and ambitious” attempt to create a global procurement mechanism to supply COVID-19 vaccines to all countries in the world. It was hailed as a “global, heroic effort” that would “transcend the limits of human ingenuity” to ensure that vaccine development progressed as fast as possible, at “a speed, scale, and access never before seen in human history”. Underlying everything, according to early descriptions by Gavi, the Vaccine Alliance, it was “single minded in its goal to ensure equitable access to COVID-19 vaccines”.

“Today, ten countries have administered 75% of all COVID-19 vaccines, but, in poor countries, health workers and people with underlying conditions cannot access them. This is not only manifestly unjust, it is also self-defeating”,

Of the 2·1 billion COVID-19 vaccine doses administered worldwide so far, COVAX has been responsible for less than 4%.

«Rich countries behaved worse than anyone’s worst nightmares.”

The UK had bought into five bilateral deals giving it access to 270 million doses, equivalent to 225% of its population. These early investments by rich countries in multiple vaccines secured them a place at the front of the queue. Because COVAX did not have the means to compete, it was pushed to the back.

“COVAX was premised on an all-for-one-and-one-for-all approach to defeating the pandemic”, adding that “this would have led to the best outcomes for everyone and was our best hope for ending the pandemic quickly.

Everyone knew that rich countries would enter into bilateral vaccine deals,

As rich countries busily signed bilateral agreements with individual vaccine manufacturers and the interest in engaging with COVAX faded, Gavi gave up on the original idealistic approach and made two key concessions that would sweeten the deal for self-financing participants.

Initially, all countries were to receive equal treatment by COVAX.

Oxfam criticised Canada for the delivery, accusing the Government of taking doses from the poor when it has signed bilateral deals with manufacturers for enough vaccine to cover four times the country’s population.

“I have always thought that the 20% target was unfair from the start. No high-income country would tolerate vaccinating only 20% of its population by the end of this year”, said Lawrence Gostin at Georgetown University. Comparing the 20% vaccination target for LMICs with the 50% coverage that was offered to HICs through the self-financing window, he said: “We can’t have double standards.”

The original notion of a global vaccine hub more or less collapsed, and COVAX ended up using a traditional aid-financed approach, which has left lower-income countries wholly at the mercy of wealthy nations and profit-driven companies.

“It is still this model of seeing how much money you can bring in and then seeing what you can negotiate with industry based on that money”, said Elder. “The promise of COVAX from the beginning that it would be the most attractive buyer for industry because it represented the ‘global need’ obviously did not pan out.”