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Can Covax provide the vaccines that most of the world’s needs need?

Dozens of poorer countries around the world are nervously waiting to see whether the multilateral Covax program will provide the coronavirus vaccines they need to stem the pandemic – even as some wealthy countries are pushing ahead with vaccination.

The program was set up in June by Gavi, a vaccine alliance with the aim of improving access to immunization in poor countries; the Coalition for Epidemic Preparedness Innovations (CEPI); and the World Health Organization. It aims to ensure an equitable global distribution of vaccines, initially by providing 2 billion doses to participating countries in 2021.

At least two-thirds of those doses will go free to 92 low-income economies, and Covax says it’s on track to meet the goal.

But, more than two months after Western countries started vaccinating their populations, Covax has yet to deliver its first doses, leaving many poorer countries without any vaccine with which to start inoculations.

“Covax is lagging behind because they didn’t have the purchasing power to come to the table while the others were busy making deals,” said Jenny Ottenhoff, senior policy director of the ONE Against Campaign. global poverty.

While the UK administered 21 doses per 100 population and the EU gave 4.2, Bangladesh administered only 0.02, Myanmar 0.007 and Algeria 0.00007, according to latest data compiled by the Financial Times. Many African countries have yet to see a single blow.

The widening gap is a striking symbol of the challenges Covax has faced in trying to turn theoretical support for the idea of ​​a global immunization campaign into reality. While most advanced economies backed Covax, those same governments went on to compete with the manufacturers’ coveted vaccine supply program.

Covax beneficiaries, like Nigeria, appreciate the ambition of the program but agree that it has struggled. “We recognize that Covax is working as hard as possible in an environment where wealthier nations are buying vaccines,” said Dr Faisal Shuaib, director of the National Primary Health Care Development Agency in Nigeria, the world’s largest country. populated by Africa.

Women in Lahore, Pakistan, demand equitable distribution of vaccines to developing countries © Rahat Dar / EPA-EFE / Shutterstock

Covax was first envisioned as a single clearinghouse for global vaccine orders, from which all countries, rich and poor, would source their doses.

But almost immediately, rich and middle-income nations sought to strike their own bilateral deals as nationalism prevailed over multilateralism. Some observers say this was inevitable and suggest that Covax could have progressed faster and more efficiently had he accepted this reality sooner.

“It’s good that Covax is there, but some of the stakeholders were too optimistic or naive about a multilateral solution to the pandemic,” said an international health expert, who asked not to be named due to the sensitivity of the subject.

It also means that Covax has remained open to wealthy countries, allowing countries like Canada to take doses of the Covax pot, while also placing their own vaccine orders directly from manufacturers.

Despite criticism that such a “double dip” diverts other supplies from developing countries, Covax argues that the involvement of high-income countries as vaccine buyers is crucial to achieving its ambitions to serve states. poorer.

“For Covax to be successful at the scale of its ambition, it is important that Covax serves both groups, as the initial cash flow of the self-funded participants is vital to enable our ability to enter into deals with manufacturers,” said Gavi .

In Bangladesh, the health authorities administered only 0.02 doses of Covid-19 vaccine per 100 inhabitants © Md Rafayat Haque Khan / ZUMA Wire / DPA

Gavi is “optimistic” that Covax will start delivering vaccines in February. As such, confidence in the system may be on the verge of turning a corner.

In Rwanda, Dr Daniel Ngamije, Minister of Health, said he expected the first batch of an order for 996,000 doses of the Oxford / AstraZeneca vaccine to arrive within a few weeks, as well as some doses of BioNTech / Pfizer.

He added that Covax had promised to deliver 7 million doses by the end of the year – more than enough to immunize 25% of the 13 million Rwandans with the two-dose vaccine. “So far it’s working,” he said of the program.

Covax announced last week that it is expected to deliver 337.2 million doses worldwide by June, with the pace picking up in the second half of the year.

Covax will be heavily dependent on the Oxford / AstraZeneca vaccine, particularly over the next six months. In contrast, it only purchased a smaller number of two of the other more advanced vaccines made by BioNTech / Pfizer and Moderna, both of which use mRNA technology and have been shown to be highly effective against the coronavirus.

Covax vaccine portfolio.  Waterfall graph showing the available supply of Covax (million doses, 2021 and 2022, as of January 20, 2021).  Volumes guaranteed by legally binding BioNTech / Pfizer Oxford / AstraZeneca SII (Novavax) SII (Oxford / AstraZeneca) agreements totaling 1.31 billion volumes secured by non-binding Sanofi / GSK Johnson & Johnson agreements totaling 700 million agreements in the short term on volumes under active negotiation with candidates A, B and C totaling 780 million, i.e. 2.79 billion doses in total

Seth Berkley, chief executive of Gavi, said Covax partners were concerned about the price of mRNA vaccines, the initial lack of availability and the need to keep them at very low temperatures. “It may be that at the end of the day we will buy more of these doses,” he said. “The challenge will be how to lower the price, how to improve stability.”

Covax hopes its target for 2021 will be enough to ensure that high-risk and vulnerable people around the world, as well as frontline health workers, will be vaccinated by the end of the year – at least 20% of world population. “With the right funding in place, it might be possible to deliver more – potentially 27 percent,” Gavi said.

Soumya Swaminathan, WHO chief scientist, said she was confident Covax would ‘deliver’ but said it was clear initial doses would be ‘limited’ due to global competition for scarce supplies. .

“We need to make sure that most of the high risk groups get the vaccine around the same time or around the world, rather than going to immunize your whole country before you are ready to think about it,” he said. she declared.

A looming debate is how long-term Covax’s reach will need to be. Ultimately, delivering vaccines to a vast majority of the 7.8 billion people globally would require a big extra injection of cash and perhaps years for full deployment.

“If the problem is, what we need to do is just immunize 100 percent of the people on earth, it will take time,” Berkley said. “But I don’t think we know that.”

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