Global Covid-19 vaccination efforts need more than just money.
The Biden administration has officially committed to Covax, the global effort to fund and deliver Covid-19 vaccines around the world, including to lower-income countries.
The administration will commit $4 billion to Covax, releasing the first $2 billion immediately to Gavi, the Vaccine Alliance, which is one of the partners in this effort along with the World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI). Another $2 billion will follow over the next two years, an effort to spur other countries to contribute more money.
The announcement came during President Joe Biden’s attendance at the Group of Seven (G7) meeting of the world’s biggest economies, where the pandemic is at the top of the agenda and where others, including the United Kingdom, have made similar commitments to help global vaccination efforts.
The Biden administration had announced last month that it would join Covax, another example of the White House’s larger recommitment to international cooperation. President Donald Trump had declined to join, one of a few notable holdouts in an initiative that now has more than 190 countries participating.
Congress, however, had set aside $4 billion for Gavi in its December spending bill, which is the money Biden is using for this announcement.
The US announcement also came on the heels of British Prime Minister Boris Johnson pledging to donate the UK’s surplus vaccines. The president of the European Commission (the European Union’s executive branch) also said Friday that the EU is doubling its Covax contribution to $1 billion.
All of these commitments are welcome news, and will make up for real funding shortfalls in the purchase of vaccine doses. At the same time, though, many of these wealthier countries are also racing to inoculate their own populations, securing doses for their citizens at all costs and purchasing far more doses than they need, while the rest of the world, especially lower-income countries, lags very far behind.
About one-quarter of the world’s population, mostly in lower- and middle-income countries, may not have access to vaccinations until 2022 — a precarious situation that could give new variants a chance to emerge and that could extend the pandemic for everyone.
This is a good first step, but “vaccine nationalism” is still the order of the day
The COVID-19 Vaccine Global Access Facility, or Covax, was designed as a financing instrument to ensure all countries — wealthy and less-wealthy alike — have equitable access to a vaccine. Higher-income countries contribute to the fund, pooling their resources to invest in several different vaccine candidates and fund free vaccine doses to 92 lower-income countries.
The perk for higher- and middle-income countries is that they increase their odds of landing a successful vaccine; these collective investments would also ideally lower the cost of doses. And, of course, priority groups like health care workers and the elderly would get early access to the vaccine in lower-income countries, easing the worst toll of the pandemic.
The idea was born out of the lessons learned from the 2009 swine flu pandemic, when rich countries bought up all the vaccines and immunized their populations, and only then donated to other countries, at which point the worst of the pandemic had passed.
A version of this is happening now, just on a more dramatic scale. In January, more than 80 million Covid-19 vaccine doses had been distributed around the world, while only 55 doses had gone to people in low-income countries. The pace has picked up since then, but vaccinations have only started in 87 countries, the bulk of them happening in higher- and middle-income countries.
Even though many rich countries joined Covax and pledged funds, most still made individual pre-purchase agreements with pharmaceutical companies to bet on promising vaccines and secure their own doses.
Rich countries — with 14 percent of the world’s population — have bought up more than 53 percent of the vaccines most likely to be successful. An analysis from ONE campaign, an international anti-poverty group, said the United States has an estimated 453 million excess Covid-19 vaccine doses, or what would be left over after every eligible person in the US has at least two shots.
But that doesn’t mean the US or any other country has millions of doses just hanging around; right now, demand still exceeds supply. Richer countries, because of these procurement deals, are very often at the front of the line, and their ability to make huge purchases also can drive up the cost of doses.
All of this has meant that lower-income countries are struggling to even begin vaccination campaigns, if they’ve started at all. Covax has set the goal of delivering 2 billion vaccines to poor countries by the end of 2021, with deliveries happening in the first quarter of this year, most of which will begin in March.
An estimate by the Economist Intelligence Unit suggests some lower-income countries won’t really be able to achieve widespread vaccination coverage until about 2023. In the United States, by comparison, it may be this summer.
Additional funds for Covax are important, as it will allow Covax to enter into more agreements with vaccine makers and deliver more doses. But as Vox’s Julia Belluz reported last month, the bilateral vaccine deals have already undermined Covax.
Rich countries “want to have it both ways,” Georgetown global health law professor Lawrence Gostin told Belluz. “They join Covax so they could proclaim to be good global citizens, and at the same time rob Covax of its lifeblood, which is vaccine doses.”
The United Nations has called on richer countries to donate vaccine supplies, but other than Norway, few have said whether they’d do it while still trying to inoculate populations at home. The United Kingdom has said it would donate surplus supply, though didn’t give a timeline. According to CNN, the Biden administration is looking to donate doses once “there is sufficient supply in the US.”
French President Emmanuel Macron said in a recent interview with the Financial Times that the EU and the US should set aside 5 percent of their current Covid-19 vaccine supplies and get them to poorer countries “very fast, so that people on the ground see it happening.”
But neither the EU — which recently took dramatic steps to try to secure more vaccine doses for its own struggling campaign — nor the US seems ready to make those moves, despite rivals like China and Russia making a show of “vaccine diplomacy” by sending their own doses to countries in Africa and Latin America.
Beyond delivering doses, rich countries could also do more to build up manufacturing and production capacity in lower-income countries and to pressure pharmaceutical companies to potentially waive intellectual property rights to better share knowledge and technology.
The United States and its allies putting leadership and money behind such efforts is a public health necessity. The globe can’t recover from the pandemic, or the economic crisis it created, unless the rest of the world joins richer countries in getting closer to herd immunity.
The United States and its partners making greater commitments to Covax and other global vaccine efforts is a real and important step toward these efforts. But it’s just the first.