Why has the Covax coronavirus vaccine delivery plan failed?

Coronavirus deaths were on the rise across Africa in June, when 100,000 doses of the Pfizer-BioNTech vaccine reached Chad. The delivery looked like a test.a that the United Nations-backed program to immunize the world could bring the most desirable vaccines to less developed countries. However, five weeks later, according to the Chadian Minister of Health, 94,000 doses were still not used.

Nearby in Benin only 267 vaccines were administered per day, a rate so slow that 110,000 doses of the AstraZeneca program had expired. Across Africa, according to confidential July documents, the program has monitored at least nine countries where doses to the poor were likely to deteriorate this summer.

Accumulation of vaccines explains one of the most serious problemsBut largely unrecognized, those facing the vaccination program as it tries to recover from months of errors and disappointments: the difficulty of getting doses from airport runways into people’s arms.

Known as COVAX, the program was meant to be a powerful engine, a multi-million dollar alliance of international health agencies and nonprofits that, through their purchasing power, would ensure that poor countries received vaccines too. faster than rich countries.

But COVAX struggled to get doses: 500 million missing to reach its goal. Poor countries are dangerously unprotected at a time when the delta variant is spreading out of control – exactly the scenario for which COVAX was created.

The urgent need to immunize the world goes far beyond protecting people in poor countries. The more the virus circulates, more dangerous can beeven for people vaccinated in rich countries.

Without billions of additional vaccines, experts warn, new variants could continue to appear that would endanger all nations.

“COVAX has not failed, but it fails”said Dr Ayoade Alakija, co-chair of the African Union vaccine supply program. “We really have no other options. For the good of humanity, COVAX must work.”

The problems

Now more supplies are finally on their way, thanks to the Biden administration, than purchases 500 million doses of Pfizer and disseminate them through COVAX, the centerpiece of a broader engagement of rich democracies. The donated doses are expected to start shipping this month.

But Biden’s gift, worth $ 3.5 billion, comes with a caveat: To help fund it, the administration will divert hundreds of millions of dollars pledged to vaccination campaigns in poor countries, according to notes from a meeting between COVAX and U.S. officials.

For lack of funds, these countries had difficulty purchasing fuel to transport doses to vaccination centers, train people who administer vaccines, or convince people to receive them.

Even though COVAX officials are struggling to close this funding gap, the overriding problem is whether the program can overcome its errors and the imbalance of power that has left it at the mercy of rich countries and pharmaceutical companies.

Pfizer, for example, refused to deal directly with COVAX this spring, interviews reveal and instead reached a deal with the Biden administration, a deal that has damaged COVAX’s credibility as an independent vaccine buyer.

The program suffered from delays and internal conflicts. According to interviews and COVAX logs, bureaucratic barriers imposed by his management delayed the disbursement of $ 220 million to help countries administer vaccines.

COVAX, a program promoted by a non-profit organization funded by the Gates Foundation, is an unprecedented creation. Received vaccines reach poor countries faster than usual and developed a system to compensate people for severe post-vaccination reactions and exempt vaccine manufacturers from legal liability, a plan that spared these countries months of negotiations.

However, the 163 million doses distributed – most free for poor countries and the rest for countries like Canada, which paid for them – are far from plans to have at least 640 million doses available now.

Dr Seth Berkley, CEO of Gavi, the non-profit organization on which COVAX is based, said that insufficient initial funding made supply shortages inevitable. When distribution problems arise like those in Chad and Benin, COVAX tries to “move these vaccines to other countries, but then it works with them to try to improve their capacity,” he explained.

Supporters and critics alike agree that the program should improve quickly. In early July, confidential COVAX documents indicated that 22 countries, including some with increasing numbers of deaths, reported that they had almost or completely used up doses of the program.

“Due to the way COVAX has been presented, African countries they thought i was going to be their savior“said Dr Catherine Kyobutungi, who heads the Center for Population and Health Research in Africa.” When it fell short of expectations, there was nothing else to do. “

Rich and poor

In the frenetic first months of 2020, health experts have drawn up a strategy immunize the world fairly.

COVAX was the answer, and brought together two non-profit organizations funded by Gates, Gavi and the Coalition for Innovation in Epidemic Preparedness (CEPI); at the World Health Organization; and UNICEF, which would lead the distribution efforts.

I hoped to be a major purchaser of vaccines in the worldfor rich and poor countries alike, which gives it the ability to put pressure on vaccine manufacturers.

But as the rich nations pledged to donate, they weren’t complacent partners. Britain negotiated so that richer participants could choose which vaccines they would purchase through COVAX, causing delays, said Kate Elder, senior vaccine policy adviser for the Access Campaign. Doctors Without Borders.

And above all, the rich countries they have become rivals in a race to buy vaccines, paying premiums to insure their vaccines while delaying the financial commitments COVAX needed to sign agreements.

“You cannot pass the piggy bank in the middle of a pandemic”said Dr Nicole Lurie, director of CEPI in the United States, referring to the desperate struggle for funding.

Initially, COVAX planned to have huge shipments from Serum Institute, an Indian manufacturer. But after the virus spread in India in March, the Indian government stop vaccine exports. Many poor countries have been affected. They had trusted COVAX, even though they were often excluded from decision-making.

Alakija, who is leading distribution efforts in Africa, said African health officials had barely been consulted by mid-2020, when the program set an initial goal of immunizing at least 20% of the population of poor countries.

Alakija recalled that those involved in COVAX had said that they believed Africa was at low risk and that mass vaccinations were unnecessary, a claim that a Gavi spokesperson denied.

The spokesperson said the target was set taking into account “limited resources” and the “misunderstanding of the epidemiology of COVID-19”, and that he now had enough money to buy vaccines for nearly 30% of the population in poor countries.

Desperate, 17 countries entitled to free doses of COVAX, including Rwanda, have entered into agreements to purchase doses directly from Pfizer.

In May of this year, COVAX appeared to be on the verge of entering into a new deal to purchase low-cost doses from Pfizer. He had already asked for 40 million in January; this agreement had to be more important.

Behind the scenes, however, the tension between Pfizer and COVAX it was felt, according to two people with knowledge of the negotiations. The company wanted the new doses to be intended only for poor countries.

As a global buying pool, COVAX also insisted on fulfilling the orders rich countries that had bought directly at higher prices. South Korea, for example, had received doses of Pfizer from the program.

And the two parties had already had clashes. In negotiations for the first batch of doses, Pfizer had asked for disclaimers that went beyond the COVAX-type compensation agreement, Berkley said, asking countries sign additional legal letters.

PB