July 25, 2021

many promises, but still few deliveries

One billion. This is the number of doses of vaccines against Covid-19 that the G7 countries announced they wanted to give to the poorest states on Friday, June 11. The pledges from rich countries have been accumulating for several weeks, while vaccination rates in these territories are now allowing populations to return to a semblance of normal life.

Almost 64% of American adults have received at least one dose, and in the 53 territories of the European region according to the World Health Organization (WHO) criteria, 30% of the population received a first dose of vaccine. But vaccination remains, for the time being, a privilege of rich countries. A quarter of the 2.295 billion doses administered worldwide were administered to the G7 countries, which are home to only 10% of the world’s population. Only 0.3% were in low-income countries, according to the WHO.

The Covax device was created to respond to this vaccine inequality. It is clear that, for the moment, it has not achieved its objectives, and that the many promises of the best endowed countries have, for the time being, only translated into a very low number of deliveries.

How does this device work?

Covax was created to support the vaccine aspect of the device aimed at accelerating access to tools to fight against Covid-19 (ACT), created at the end of April 2020. This public-private partnership under the the umbrella of the WHO, the Vaccine Alliance (GAVI) and the Coalition for Innovations in Epidemic Preparedness (CEPI), aims to ensure equitable distribution of vaccines. It is based on two mechanisms: the Covax Facility and the market guarantee (AMC).

The first is a group vaccine purchase program in which 190 countries participate, which was originally intended to avoid reflexes of “vaccine nationalism”, necessarily penalizing for poor countries. They are therefore not the only ones to benefit from Covax deliveries. Canada and New Zealand have ordered and received doses via the device.

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The second, the market guarantee, is a financing mechanism that allows 92 “low and middle income” countries – with 4 billion inhabitants – to participate in the Covax Facility. It covers the purchase of the doses that these 92 countries thus receive free of charge. Several countries have made donations to finance AMC Covax without ordering a dose via Covax: this is the case of the United States, Japan, or even the countries of the European Union, which directly negotiated the purchase of their vaccines.

How many doses have been delivered by Covax?

The Covax device initially provided for the acquisition of nearly 2 billion doses by the end of 2021, including at least 1.3 billion doses for low- and middle-income countries. The objective: to enable all participating countries to vaccinate at least 20% of their population, starting with healthcare workers and the most vulnerable.

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As of June 8, however, less than 82 million doses had been delivered to 129 countries, including nearly 54 million in 80 countries eligible for the Covax market guarantee, according to data from Unicef. The objectives are far from being achieved and the WHO has continued to sound the alarm: by the end of June, 190 million doses will be missing compared to the initial schedule.

This is not, however, for lack of funding. In early June, more than $ 2.4 billion in commitments were collected from governments and private donors, bringing the total amount of pledges made to the Covax market guarantee over the past year to $ 9.6 billion (including 4 billion from the United States). According to GAVI, the Vaccine Alliance, these funds allow Covax to secure 1.8 billion doses of vaccine for low-income countries. They should be delivered between the end of 2021 and the beginning of 2022 and protect nearly 30% of the populations of these states. An additional country, India, will receive 20% of the total available doses.

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But Covax has been facing production and supply difficulties for months. In May, Pfizer-BioNTech, Moderna and Johnson & Johnson pledged to deliver 3.5 billion doses at cost or reduced to the poorest countries in 2021 and 2022. But until today, the device rests primarily on AstraZeneca’s product, which is easier to store and less expensive than messenger RNA vaccines.

More than 94% of the doses delivered by Covax are doses of AstraZeneca, according to figures communicated to World by GAVI. One of the main production plants for this vaccine, the Serum Institute of India (SII), is located in India. However, faced with an epidemic that has become out of control on its territory, the country in March blocked the export of vaccines produced by the IBS, largest vaccine producer in the world, jeopardizing Covax’s ambitions.

Which countries have promised what and by when?

This is the reason why the issue of vaccine donations from rich countries, which have reserved and purchased most of the vaccine doses available, has become central in international discussions for several weeks. Several countries, foremost among which is China, have already given more than 37 million doses, of which 29.8 million have been delivered, but under bilateral agreements and not through Covax.

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The G7 countries on Friday promised to give a billion doses, mainly to Covax. However, the details of each country’s commitments are not yet known.

The United States, which until recently blocked exports of vaccines produced on its soil in order to reserve all doses for its population, has pledged to buy 500 million doses from Pfizer-BioNTech and give them to Covax. They will start to be sent from August, and 200 million doses are expected to be delivered by the end of the year. The remaining 300 million will be delivered by June 2022, according to the White House. Washington had, a few days earlier, promised a donation of 80 million doses, mainly of AstraZeneca, of which 60 million were intended for Covax.

The UK, through its Prime Minister Boris Johnson, has also pledged to donate 100 million of its excess doses by the end of the year. Moreover, France had announced in May a donation of“At least 30 million doses of different vaccines” before the end of 2021, after having promised 500,000 doses of AstraZeneca in April. Germany is committed to the same goal. Spain had already promised more than 22 million doses, Belgium 4 million, Sweden 2 million. The European Union has announced a donation of 100 million doses.

To date, however, the gap is immense between promises and achievements. Only 628,800 doses given by France to Covax have actually been delivered to eight African countries, according to figures transmitted by GAVI. Some 24,000 doses, of the 1.6 million promised by New Zealand, have been transferred to East Timor.

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Will the new promised doses be enough?

A man walks past a gate with a poster saying no vaccine doses have been received at this vaccination center in Hyderabad, India on May 3, 2021.

The promises made to the G7 on Friday were welcomed. “If we get a billion doses at the end, it will be very welcome”Covax co-chair Jane Halton said on Times Radio on Friday.

But the WHO as well as many NGOs point to still too long deadlines. To be able to immunize 30 to 40% of the world population this year, it would be necessary to immunize at least 250 million people by the end of September, that is to say a need of hundreds of millions of doses, since many vaccines require two doses, underlined in early June Bruce Aylward, in charge of the Covax file at the WHO.

In Africa, only 2% of the population received a first dose. Almost 90% of African countries will not meet the goal of 10% of their population vaccinated by the end of the summer if they do not urgently receive at least 225 million doses. To date, deliveries are almost at a standstill on the continent, and fourteen African countries have already used between 80% and all of the doses received through Covax.

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For the WHO, better access to vaccination for the poorest populations also requires the temporary lifting of patents and the transfer of technologies so that developing countries can produce the vaccines they need themselves. Discussions on this subject at the World Trade Organization (WTO) saw a small advance this week after months of deadlock, but an agreement – still hypothetical – will take months.

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“At the current rate of vaccination, it would take fifty-seven years for low-income countries to achieve the same level of protection as that of the G7 countries, the NGO Oxfam pointed out on Friday. This is morally unacceptable, but also counterproductive given the risk posed by mutations in the coronavirus. “