Covax is our best chance to get the better of Covid-19

Covax is the world’s best opportunity to avoid this scenario.

The first vaccine deliveries by the Covid-19 Vaccine Global Access (Covax) facility to Ghana, Nigeria, and Ivory Coast brought a glimmer of hope to African countries keen to start immunising their populations against the disease. But while Covax is ramping up deliveries, its mission to provide rapid, fair, and equitable access to Covid-19 vaccines to people everywhere is being threatened by rich countries ordering more than they need. This worrying global imbalance in vaccine distribution could hold back Africa’s recovery and prolong the pandemic worldwide.

Covax is the world’s best opportunity to avoid this scenario. Never before has the entire global population simultaneously needed a vaccine against the same disease, and Covax is enabling remarkable collaboration to meet the challenge, bringing together governments, global health organisations, the private sector, scientists, and many other partners to develop, manufacture, and deliver vaccines.

We will ultimately measure the success of this unprecedented undertaking over several years, if not decades. But Covax is already on track to deliver two billion Covid-19 vaccine doses to countries of all income levels in 2021, and has the world’s most diverse and actively managed vaccine research-and-development portfolio. The goal is to ensure that the most vulnerable populations receive Covid-19 vaccines by the end of this year.

And yet developing countries must compete with wealthy countries, some of which have ordered sufficient vaccine supplies to vaccinate their populations several times over. The African Union (AU), by contrast, has ordered vaccines for only 38 per cent of the continent’s population, and even if countries want more, supplies are not immediately available. Some even fear that vaccine manufacturers may be focusing on fulfilling bilateral agreements with wealthy countries, instead of delivering doses to Covax.

Fears about lagging vaccine supplies may be contributing to African authorities’ efforts to source vaccines elsewhere. The AU has set up the African Vaccine Acquisition Task Team (AVATT), a platform for African countries to preorder and purchase vaccines. Russia has offered 300 million doses of its Sputnik V vaccine for purchase through AVATT, but it is unclear when such doses might be delivered, or at what price. Meanwhile, some governments are pursuing bilateral arrangements. South Africa has paid $5.25 per dose of the Oxford-AstraZeneca vaccine, more than double the price that European countries are paying. Zimbabwe is using the Chinese Sinopharm vaccine, and Nigeria’s health authorities have announced that they are in discussions with Russia and India to procure vaccines.

Although the costs of many of these bilateral deals are unclear, they are happening outside of Covax, which is committed to negotiating the most affordable price for the vaccines it procures.

Covax can succeed as a central mechanism for ensuring equitable vaccine access, but not if countries pursue their own interests or are forced to procure doses in other ways. Some countries appear to be using their vaccines to advance political ends. While the AU has shown leadership by establishing AVATT, it should continue to coordinate with Covax to avoid duplicating or undermining collective efforts.

At the same time, Covax itself should focus on supplying higher volumes to low- and middle-income countries (LMICs), including African countries. Currently, the scheme aims to provide vaccine doses to at least 20 per cent of these countries’ populations by the end of 2021, which is lower than many African governments would like. The Africa Centers for Disease Control and Prevention has set a target of vaccinating 35 per cent of Africa’s population this year, and eventually at least 60 per cent, which is consistent with the goals of higher-income countries.