An ambitious humanitarian project to deliver COVID-19 vaccines to the world’s poorest people is facing potential shortages of money, cargo planes, refrigeration and vaccines themselves — and running into skepticism even from some of those it is intended to help most.
In one of the biggest obstacles, rich countries have locked up most of the world’s potential vaccine supply through next year, and the US and others have refused to join the project, called the COVID-19 Vaccine Global Access Facility (COVAX).
“The supply of vaccines is not going to be there in the near term, and the money also isn’t there,” said Rohit Malpani, a public health consultant who previously worked for Doctors Without Borders.
Illustration: Kevin Sheu
COVAX was conceived as a way of giving countries access to coronavirus vaccines regardless of their wealth.
It is led by the WHO; Gavi, the Vaccine Alliance, a public-private alliance, funded in part by the Bill & Melinda Gates Foundation, which buys immunizations for 60 percent of the world’s children; and the Coalition for Epidemic Preparedness Innovations (CEPI), another Gates-supported public-private collaboration.
COVAX’S aim is to buy 2 billion doses by the end of next year, although it is not yet clear whether the successful vaccine would require one or two doses for the world’s 7.8 billion people.
Countries taking part in the project can either buy vaccines from COVAX or receive them for free, if needed.
One early problem that emerged: Some of the world’s wealthiest nations negotiated their own deals directly with drug companies, meaning they do not need to participate in the endeavor at all. China, France, Germany, Russia and the US do not intend to join.
So many rich countries bought vaccines from manufacturers — before the shots have even been approved — that they have already snapped up the majority of the vaccine supply for next year.
The EU has contributed 400 million euros (US$468.7 million) to support COVAX, but the bloc of 27 countries would not use COVAX to buy vaccines, in what some see as a vote of no-confidence in the project’s ability to deliver.
Instead, the EU has signed its own deals to buy more than 1 billion doses, depriving COVAX of the bulk negotiating power of buying shots for the continent.
Gavi, the WHO and CEPI last month announced that countries representing two-thirds of the world’s population had joined COVAX, but they acknowledged that they still need about US$400 million more from governments or elsewhere.
Without it, according to internal documents seen by The Associated Press before the organization’s board meeting this week, Gavi cannot sign agreements to buy vaccines.
COVAX did reach a major agreement this week for 200 million doses from the Indian vaccine maker Serum Institute, although the company made clear that a large portion of those would go to people in India.
Gavi estimates that by the end of next year, the project will need US$5 billion more.
Negotiations to secure vaccines are moving forward despite the lack of funds, COVAX said.
“We are working with the governments who have expressed interest earlier to ensure we receive commitment agreements in the coming days,” Gavi vaccines and sustainability managing director Aurelia Nguyen said in an e-mail.
Nothing similar has ever been attempted in public health, she added.
COVAX “is a hugely ambitious project,” she said, “but it is the only plan on the table to end the pandemic across the world.”
Still, the project is facing doubts and questions from poor countries and activists over how it would operate and how effective it would be.
Clemens Auer, a member of the WHO’s executive board and the EU’s lead negotiator for its vaccine deals, said that there is a troubling lack of transparency about how COVAX would work.
“We would have no say over the vaccines, the price, the quality, the technical platform or the risks,” Auer said. “This is totally unacceptable.”
The WHO never consulted countries about its proposed vaccine strategy, he said, calling the health agency’s goal of vaccinating the world’s most vulnerable people before anyone else a “noble notion,” but politically naive.
As part of COVAX, WHO and Gavi have asked for countries to first prioritize frontline health workers, then the elderly, with the goal of vaccinating 20 percent of the world’s population.
One expensive hurdle is that many of the vaccine candidates need to be kept cold from factory to patient, according to internal documents from Gavi.
Industry has signaled that “air freight for COVID vaccines will be a major constraint,” and a “significant and urgent ramp-up of cold chain capacity” might be needed, the document said.
Another obstacle: Many of the leading vaccine candidates require two doses.
That would mean twice as many syringes, twice as much waste disposal, and the complications involved in ensuring patients in remote corners of the world receive the second dose on time and stay free of side effects.
“Because of the fact that we’re looking at trying to get vaccines out as quickly as possible, we’re looking at limited follow-up and efficacy data,” said Gian Gandhi, who runs logistics from the UN International Children’s Emergency Fund’s supply division in Copenhagen.
There is also concern that the fear of lawsuits could scuttle deals.
Gavi told countries that drug companies would probably require assurances that they would not face product liability claims over deaths or other side effects from the vaccine, according to the internal documents.
Officials in Thailand are reviewing whether that condition is acceptable, said Nakorn Premsi, director of the Thai National Vaccine Institute.
Thailand so far has only signed a nonbinding agreement with COVAX.
If anything, some critics say, Gavi is not ambitious enough.
The pandemic would not end — and the world cannot reopen its borders — until there is herd immunity well beyond the rich nations that have secured their own doses, said Eric Friedman, a global health law academic at Georgetown University who is generally supportive of COVAX.
“If we want to achieve herd immunity and get rid of this, 20 percent is not going to do it,” he said. “What’s the end game?”
Alicia Yamin, an adjunct lecturer on global health at Harvard University, said that she fears the “window is closing” for COVAX to prove workable.
It is disappointing that Gavi, the WHO and their partners have not pushed pharmaceutical companies harder on issues like intellectual property or open licenses, which might make more vaccines available, she said.
With little evidence of such fundamental change in the global health world, it is likely that developing countries would have to rely on donated vaccines rather than any equitable allocation program, Yamin said.
“I would say that poor countries probably will not get vaccinated until 2022 or 2023,” Yamin said.
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