![]() The UK had bought into five bilateral deals giving it access to 270 million doses, equivalent to 225% of its population. The EU was close behind with access to half a billion doses secured through two deals. However, by August, 2020, the USA had already entered into seven bilateral deals with six companies for more than 800 million doses, enough to vaccinate 140% of its population, according to the Duke University Launch and Scale Speedometer. Once any of the COVAX portfolio vaccines had successfully undergone clinical trials and proved themselves to be both safe and effective, both self-financing and AMC countries would be allocated vaccines at the same rate, proportional to their total population size.ĬOVAX would be “quite literally a lifeline” for self-financing countries that had not made any bilateral deals with vaccine manufacturers, Gavi's chief executive officer Seth Berkley explained last autumn. Additionally, as a pooled procurement mechanism, COVAX would have the financial muscle as a buyer to drive down prices for all participants. The grand idea of COVAX was that the combination of these two funding streams-the self-financed part and the aid-financed AMC-would give the facility the means to invest in research and development of several promising vaccine candidates. Most of these funds have been pledged only in the past few months. Team Europe (led by Germany) and the USA have together provided US$5 billion to the COVAX AMC, Japan has given US$1 billion, and the UK, US$735 million. ![]() The poorest of the 92 countries would receive them at no cost. In the other leg of COVAX, vaccines for lower-income countries would be financed with donor grants through an Advance Market Commitment (AMC). Australia, New Zealand, Norway, and South Korea also bought vaccine options from COVAX as self-financing countries. The UK, for example, paid £71 million for 27 million doses from COVAX, and Canada paid CA$220 million for 15 million doses. In the so-called self-financing leg of COVAX, HICs were asked to pay upfront by mid-September, 2020, for the option to buy vaccines for their own populations. “Unfortunately, it didn’t happen…Rich countries behaved worse than anyone's worst nightmares.”ĬOVAX, managed by Gavi, along with the Coalition for Epidemic Preparedness Innovations and WHO, was designed to stand on two legs: one for HICs, which would pay for their own vaccines, and the other for 92 lower-income countries, whose doses would be financed by donor aid. “It was a beautiful idea, born out of solidarity”, he said. Gavin Yamey at Duke University (Durham, NC, USA) was part of a working group, convened by Gavi in early 2020, to discuss the design of COVAX. But that is far less than 172 million it should have delivered by now.” Of the 2♱ billion COVID-19 vaccine doses administered worldwide so far, COVAX has been responsible for less than 4%. “COVAX has delivered over 72 million doses to 125 countries. This is not only manifestly unjust, it is also self-defeating”, UN secretary general António Guterres told the gathering. “Today, ten countries have administered 75% of all COVID-19 vaccines, but, in poor countries, health workers and people with underlying conditions cannot access them. ![]() Speaker after speaker at the summit lamented the gross inequity in access to vaccines. However, even with full financing, the COVAX roll-out has moved much more slowly than that in high-income countries (HICs). At the pledging summit for COVAX on June 2, 2021, hosted by Japan, Gavi finally reached its US$8♳ billion ask for the procurement and delivery of vaccines for the 92 eligible low-income and middle-income countries (LMICs) this year. Underlying everything, according to early descriptions by Gavi, the Vaccine Alliance, it was “single minded in its goal to ensure equitable access to COVID-19 vaccines”. It was hailed as a “global, heroic effort” that would “transcend the limits of human ingenuity” to ensure that vaccine development progressed as fast as possible, at “a speed, scale, and access never before seen in human history”. Launched 1 year ago, the COVAX facility was conceived as an “unparalleled and ambitious” attempt to create a global procurement mechanism to supply COVID-19 vaccines to all countries in the world. Instead, it relies on rich countries’ willingness to share their doses. COVAX was meant to supply COVID-19 vaccines for all based on solidarity and equity.
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