Can COVAX vaccinate the world?

As fears about global vaccine inequality intensify, COVAX, the UN-backed scheme set up to secure doses for low and middle-income countries, is struggling.

Despite warm words from developed nations, the scheme has fallen far short of its target to spread vaccines more evenly across the world.

This week, Boris Johnson is welcoming world leaders to Britain for the G7 summit, where member countries will have the opportunity to make concrete commitments to close the global vaccine gap. 

Some have already acted. The White House has announced plans to swiftly donate 25 million doses of surplus vaccine overseas, via COVAX. By the end of June, Biden has vowed to share 80 million doses with struggling countries, primarily with those in Asia, South and Central America and Africa. The move will pile pressure on other economically powerful countries to follow the US lead. 

Between them, the G7 countries have purchased over a third of the world’s vaccine supply, despite making up only 14 per cent of the global population. 

By the time leaders gather, COVAX will have delivered just over 80 million vaccine doses to 129 countries – less than 30 per cent of its target for the first half of this year. By the end of June, the scheme is estimated to have fallen short of 190 million doses.

In anticipation of the summit, more than 100 cross-party MPs and peers have called on Boris Johnson to show “global leadership” and follow his “moral duty” by announcing that the UK will donate jabs to COVAX “as a matter of urgency”. Similarly, Unicef is urging the government to commit to sharing 20 per cent of its vaccine supply with COVAX from June, and to ask other nations to match this. 

In order to understand the importance of such a pledge, it’s first crucial to grasp how the COVAX scheme works, and why it has fallen woefully behind target. 

COVAX is an ambitious project, jointly set up in early June 2020 by the World Health Organisation (WHO), the Global Vaccine Alliance (Gavi), the Coalition for Epidemic Preparedness Innovations (Cepi) and Unicef to ensure the equitable distribution of Covid vaccines around the world. It made a target to distribute two billion doses by the end of 2021, at least two thirds of which would go to 92 lower-income economies. This would enable poorer countries to receive sufficient doses to vaccinate 20 per cent of their populations – enough to protect high risk and vulnerable people, as well as frontline healthcare workers. 

Originally, COVAX wasn’t just a scheme intended to secure vaccines for low and middle income countries. Rather, it was envisioned as a single clearing house – a way to pool funding – for the world’s vaccine orders, from which all countries, rich and poor, would procure their doses. Wealthier, self-financed countries would pay into the fund and receive a share of vaccines while the 92 countries which couldn’t afford to buy their own would receive them for free. 

Most advanced economies have backed COVAX – and many have provided generous amounts to the scheme. The UK, for instance, has donated £500m. 

But there is a caveat: these same countries have simultaneously undermined the scheme by competing against it for coveted supplies, rather than waiting for COVAX to allocate vaccines.

As soon as many wealthy governments signed up to COVAX, they started to negotiate their own side deals directly with vaccine manufacturers, with many offering to pay higher prices to secure supplies more quickly. These bilateral deals have left COVAX with a scarcity of doses.

By last November, high-income countries making up just 14 per cent of the world’s population had negotiated pre-market agreements covering 51 per cent of the global supply.

Dr Tedros Adhanom Ghebreyesus, the WHO’s Director-General, has accused richer nations of “gobbling up” the global vaccine supply by ordering far more doses than they need to vaccinate their own populations. 

Canada has ordered five vaccine doses a head, the UK has secured enough doses to vaccinate its entire population 3.6 times over, and the US has enough for twice over. 

The UK – which accounts for less than 1 per cent of the world’s population – has secured roughly 1 in every 25 vaccines forecast to be supplied in 2021, and is expected to have 347 million doses available by the end of 2021.

India, by contrast, has enough doses to vaccinate just 4 per cent of its population. And less than 30 million doses have been delivered to Africa so far – covering less than 2 per cent of the continent’s population.

In May, WHO officials in Africa made a fresh plea for vaccine sharing, saying virus cases have spiked in the past two weeks and COVAX shipments have “ground to a near halt.”

COVAX delivery delays aren’t solely a result of rich countries gobbling up supplies. Another setback to the COVAX scheme came more recently in India, where the country’s devastating second wave is having a knock-on effect. 

The Serum Institute of India (SII) – an Indian manufacturing site producing AstraZeneca vaccines – is the single largest supplier to the COVAX scheme, meaning poorer countries are counting on the SII for their inoculation programmes. This institute alone has committed to delivering 1.1 billion doses to COVAX, for over 100 countries, and 64 per cent of the COVAX supply forecast for the first half of this year was set to come from this site alone. 

However, in light of the crisis on home soil, the Indian government has imposed an indefinite ban of vaccine exports. Since March, none of the planned shipments have taken place, causing significant shortfalls in COVAX deliveries across the globe.

If the wealthier nations, accused of hoarding vaccines, were to share their supplies more readily, could they do so without compromising their national roll-outs?

Yes, according to Airfinity. The life sciences research facility, which has conducted extensive research on global vaccine distribution estimates that if all of the G7 countries donate 20 per cent of their vaccine stocks for June, July and August, this would release around 153 million doses for the COVAX scheme. And, “they could do this while still fulfilling their vaccination commitments to their own populations.” 

Britain is on track to fully vaccinate its entire adult population by 9 July. If the UK commits to sharing 20 per cent of available vaccines from when the G7 Leaders’ Summit is held, this would delay the roll-out by just ten days – meaning the entire UK adult population would still be vaccinated by the end of July. 

Once every British adult has been vaccinated and high-risk groups have received booster doses, Airfinity predicts that the UK will have enough surplus doses to fully vaccinate 50 million people – a considerably larger number than the total sum of vaccines to have reached African soil so far. 

It’s worth noting that it’s not just the US that has made a pledge to donate supplies directly to COVAX. France has committed to sharing half a million doses by mid-June while Sweden has pledged 1 million. In February, Boris Johnson promised to donate most of the UK’s surplus doses to poorer countries but he has not provided any timeframe for doing so. Despite Johnson repeating this vague promise many times since, the UK is yet to donate a single dose. 

The global effort to develop and manufacture Covid-19 vaccines from scratch has been a remarkable feat. In a matter of months, we have seen production increase from zero to 2.2 billion vaccine doses. By the end of 2021, the total number of doses produced should surpass 11 billion – enough to vaccinate the entire world’s adult population. But we need more urgent action to share available doses. 

Of course, it’s also true that things are likely to pick up for COVAX as time goes on, even without the help of richer nations. While the scheme is currently relying on AstraZeneca and Pfizer doses, COVAX has now secured doses from J&J, Novavax, Moderna and Sanofi/GSK, creating a bigger export portfolio of vaccines towards the second half of the year, pending WHO approval. However, these extra deals won’t help in the immediate short-term. And time is of the essence. 

This week is a vital opportunity for Britain’s PM to demonstrate global leadership. Ahead of the G7 summit, Sir Jeremy Farrar, head of the Wellcome Trust, and Steven Waugh, executive director of Unicef UK, have published an open letter to the PM urging him to set an example: “As president of the G7, the UK has the opportunity to set the standard for global action on sharing doses. Three months ago, you proudly pledged that the UK would share vaccines with the world. Now we ask that you turn this pledge into reality.”