Early on in the pandemic, global health experts envisioned a nightmare scenario: Covid-19 vaccines are created, but they go almost exclusively to rich countries that can afford to buy them. People in poorer countries are left to get sick and die. <\/p>\n
To prevent this, the experts set up an international initiative called Covax, designed to make sure every country in the world gets access to vaccines regardless of its ability to pay. In the fall of 2020, Covax set a clear goal: Buy 2 billion doses and make them available to nations in need before the end of 2021. <\/p>\n
But we\u2019re now nearly five months into the year, and Covax has delivered just over 68 million doses. In other words, it\u2019s only 3.4 percent of the way to its goal. <\/p>\n
The nightmare has become reality. Around 1.5 billion vaccine doses have been administered around the world \u2014 yet only 0.3 percent have gone to low-income countries. And in places like India and Brazil, thousands of unvaccinated people are dying every day of Covid-19, even as many Americans revel in their vaccinated status.<\/p>\n<\/div>\n<\/div>\n
\u201cPeople keep asking me, \u2018What keeps you awake at night? The variants?\u2019 Christ, no! It\u2019s human behavior \u2014 the unwillingness to share!\u201d said Bruce Aylward, a senior adviser at the World Health Organization (WHO) who works on Covax. \u201cHow do other people sleep at night? They should be so energized to fix this!\u201d <\/p>\n
If the epidemiologist and his colleagues at Covax have not managed to avert global vaccine inequity, it\u2019s not for lack of trying. They\u2019ve gotten lifesaving doses to 124 countries from Argentina to Zambia, and they\u2019ve pushed wealthy countries to help them do more. <\/p>\n
\u201cCovax has been an essential tool. I think that\u2019s pretty indisputable,\u201d said Kate Dodson, the vice president for global health at the UN Foundation. But, she added, \u201cThey\u2019re struggling right now.\u201d <\/p>\n
So what explains Covax\u2019s struggles? What are the biggest obstacles getting in the way?<\/p>\n
The experts I talked to identified three main problems: Money, vaccine supply, and global willingness to share have all been too constrained. But, the experts emphasized, these are solvable problems. And there are things everyday individuals can do to help. <\/p>\n
\u201cThe money was insufficient, and the money was late\u201d <\/p>\n
The WHO is one of three groups leading Covax. The other two are Gavi, a public-private partnership that spearheads immunization efforts in developing countries, and the Coalition for Epidemic Preparedness Innovations, an international collaboration (formed as a Gates Foundation initiative after the West African Ebola epidemic) to make vaccines available quickly when outbreaks happen. <\/p>\n
All three groups have collaborated to make Covax into a unique not-for-profit financing mechanism. It\u2019s designed to work kind of like a mutual fund, but for vaccines. The idea was that high-income countries would pool their money to fund research and development for a diversified portfolio of vaccine candidates. That investment would up the chances that they\u2019d land on an effective vaccine, and it would also serve to fund free vaccine doses for 92 lower-income countries that couldn\u2019t afford to pay. <\/p>\n
It sounded like a win-win. But for it to work as planned, enough rich countries had to buy into Covax and commit to getting their doses through the fund. <\/p>\n
Instead, many governments made separate bilateral deals with companies like Pfizer and Moderna, locking up in contracts the vast majority of doses slated to be produced in 2021. That robbed Covax \u2014 which didn\u2019t have much money on hand in the early stage of the pandemic \u2014 of the opportunity to buy vaccines for less wealthy countries. <\/p>\n
\u201cThe main issue is that the money was insufficient, and the money was late,\u201d said Amanda Glassman, director of global health policy at the Center for Global Development, a nonprofit think tank based in London and Washington, DC. \u201cIf they\u2019d had all the money in March 2020, we\u2019d be in a different space in terms of the delivery. There was more wiggle room in March through July of last year to reserve doses if they\u2019d had the money in place.\u201d<\/p>\n
Covax was stymied in its ability to buy. And even now, it still doesn\u2019t have the funding to buy enough vaccine doses to cover 20 percent of the population in each low-income country \u2014 the health care workers and most vulnerable groups \u2014 by the end of 2021. To achieve that, it needs to raise another $2.6 billion. <\/p>\n
Aylward was clear that that remains Covax\u2019s foremost obstacle. \u201cThe first thing we need is money,\u201d he said. <\/p>\n
You might wonder how much good it would do for Covax to have more cash on hand right now. With so many doses already locked up in contracts, would extra money get shots into arms any faster? <\/p>\n
The experts I spoke to acknowledged that it wouldn\u2019t enable people in low-income countries to get shots tomorrow, but it would certainly bump up the timeline. For some populations, it could mean being immunized in the third quarter of 2021 rather than the fourth; for others, it could mean the difference between early and mid-2022.<\/p>\n
It\u2019s crucial for Covax to get more funding now because it will need cash in hand to buy more of the vaccines that are starting to coming online, such as Novavax (an American-made vaccine) and Sinopharm (a vaccine created in China and recently approved for emergency use by the WHO). By June, Covax needs at least $1.6 billion above currently secured funding in order to lock in doses for 2021 and early 2022, a Gavi spokesperson said. Otherwise, the doses may get snatched up by wealthy countries just like they did in 2020. <\/p>\n
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\u201cSupply is incredibly tight\u201d<\/p>\n
The second huge challenge facing Covax is the simple fact that vaccines and the raw materials needed to make them are still in short supply. <\/p>\n
That\u2019s partly because rich countries bought up a lot of the early vaccine supply, as noted above. But it\u2019s also because the pandemic itself sometimes makes it hard to stick to a production schedule.<\/p>\n
The main supplier to Covax is the Serum Institute of India, which produces the AstraZeneca vaccine. But with Covid-19 raging in India, the supply has been necessarily turned to domestic use. Export restrictions mean that Covax is receiving much less vaccine than expected and has had to delay its shipments to countries. <\/p>\n
As Dodson said, \u201cSupply is incredibly tight for Covax.\u201d <\/p>\n
It\u2019s a good illustration of why we need a global plan to increase the scale and security of vaccine production. <\/p>\n
\u201cWe need a way to \u2014 faster than it\u2019s ever been done before, globally, in concert \u2014 work to dramatically increase the number of vaccine doses that are going to be available in 2021 and early 2022,\u201d said Ruth Faden, a founder of the Johns Hopkins Berman Institute of Bioethics, who co-drafted the WHO\u2019s Values Framework for vaccine allocation. \u201cReally what you would want to see is an Operation Warp Speed at the global level.\u201d<\/p>\n
That won\u2019t be an easy operation to pull off, because it\u2019s not just a matter of building more plants with more production capacity in more countries. It\u2019ll require coordination on a number of underlying factors \u2014 transferring technological know-how and personnel to countries in need, sending raw materials to prevent manufacturing bottlenecks, and loosening intellectual property rights. (The Biden administration\u2019s decision to support patent waivers for Covid-19 vaccines will hopefully help with the latter.) <\/p>\n
Aylward emphasized that it\u2019s not enough to just scale up production \u2014 a good part of that production needs to be earmarked for Covax. As companies learn how to optimize their capacity, he wants them to give Covax the right of first refusal on any vaccine they produce in excess of their original targets.<\/p>\n
\u201cWe need people to share\u201d <\/p>\n
Last but not least, Covax needs wealthy countries to share. <\/p>\n
That can mean sharing doses that have already been delivered. The US, for instance, currently has about 73 million doses sitting in its stockpile. But ideally, wealthy countries should donate doses even before they arrive on their shores.<\/p>\n
\u201cWe don\u2019t want them to receive doses and then say \u2018You know what, we decided we don\u2019t want this, we\u2019ll give this to you,\u2019\u201d Aylward said. Transferring doses after they\u2019ve been delivered can be tricky because of the need to guarantee that \u201cchain of custody\u201d is intact \u2014 that cold storage requirements, for example, were at no point interrupted. \u201cWe need people to share their space in the queue.\u201d <\/p>\n
In other words, when new vaccine doses come online, rich countries should not take up all the space at the front of the line to receive them. If they\u2019ve already contracted with the vaccine maker, their contract is essentially holding their place in line \u2014 but they can, and should, offer that place to a country in more urgent need. <\/p>\n
The US can certainly afford to do this. By July, Duke University researchers estimate, the country will likely have at least 300 million excess doses \u2014 and that estimate is assuming that the US will retain enough doses to vaccinate the vast majority of children. In other words, every eligible or soon-to-be-eligible American could get vaccinated, and there would still be 300 million doses left over \u2014 practically enough to give an extra dose to every person in the country.<\/p>\n
A surplus of that magnitude is so staggering that not sharing it with the world starts to look morally unjustifiable.<\/p>\n
What\u2019s more, Aylward said countries shouldn\u2019t focus only on donating excess<\/em> doses. If they wait until they\u2019ve vaccinated every eligible citizen, they\u2019ll spend several more months immunizing people who are at relatively low risk, while adults at high risk in countries like India go unvaccinated. Instead, rich countries should act more like Sweden, which recently decided to donate 1 million of its doses \u2014 one-fifth of its current supply \u2014 even though just over 30 percent of its population has received a shot. <\/p>\n<\/aside>\n Do you have $7? If so, Covax wants your help.<\/p>\n This month, the WHO Foundation launched a fundraising campaign called \u201cGo Give One,\u201d which urges individuals to donate $7 to buy a vaccine dose for someone in a low-income country through Covax.<\/p>\n \u201cThere was huge popular demand among private individuals to contribute to address this important global issue, so this campaign gave an outlet to that demand,\u201d a Gavi spokesperson said. <\/p>\n Faden said that if enough people were to contribute, it could potentially make a significant difference. \u201cIf you can come up with the money \u2014 say, $7 \u2014 then of course you ought to do it,\u201d she said. \u201cAt this point, it\u2019s everyone\u2019s responsibility. Everyone should be invested as a matter of obligation to global justice. Literally as a matter of duty.\u201d <\/p>\n But she was clear that retail fundraising \u2014 getting small donations from many individuals \u2014 is not going to net Covax the billions of dollars it needs. That\u2019s really a job for governments, and it requires the leaders of the world\u2019s wealthy countries to step up.<\/p>\n Dodson personally donated to Go Give One and also ran a Facebook fundraiser for the campaign, which raised $1,000. \u201cI feel really proud,\u201d she told me. But she thinks the campaign\u2019s main power may lie in its potential to catalyze government spending. \u201cWhen governments see everyday individuals saying, \u2018We care about vaccine inequity, and we\u2019re willing to put our pocketbooks against it,\u2019 then that can help spur more political will.\u201d<\/p>\n She also believes that advocacy in this arena is underfunded, though it can move the needle in a big way \u2014 as we saw when activist groups pressured Biden to back patent waivers. Arguably, donors could have a bigger impact by donating to an advocacy group than by donating to Go Give One, though this field is so new that it\u2019s hard to know for sure. <\/p>\n For donors who prefer to invest in advocacy, Dodson and Glassman both recommended three groups: Global Citizen, the ONE Campaign, and the Pandemic Action Network.<\/p>\n \u201cTo the extent that advocacy movements help reduce the political cost of doing the right thing and create political benefits, I think it\u2019s a good thing,\u201d Glassman said. \u201cAnd the amounts of money at stake that they could potentially influence are large, especially in the United States.\u201d<\/p>\n Aylward, for his part, is hoping that more individuals and governments will start to show concern for the world by investing in Covax. \u201cYou\u2019ve got this beautiful machine,\u201d he said. \u201cPut it to work.\u201d <\/p>\n<\/p>\n