Is the Covax scheme failing to help tackle the Covid-19 pandemic?

The Covax facility, co-led by the World Health Organization, Coalition for Epidemic Preparedness Innovations and Gavi, the vaccine alliance was launched in April 2020 as one of the three pillars of the Access to Covid-19 Tools (ACT) Accelerator.

Since delivering the first shipment in February this year, the facility has supplied 135 million Covid-19 vaccines to 136 countries and territories around the world.  However, the more vaccines available, the more problems and distribution become apparent.

When it was first conceived the aim was to provide vaccination to 20 per cent of each country’s population, but this is proving difficult, as the World Health Organization director-general on Tuesday said only one per cent of people in low income countries have received one jab, showing real cracks in a well meaning endeavour.

Speaking Marcela Vieira, access to medicines and innovation expert at the Graduate Institute’s Global Health Centre, she tells Geneva Solutions what Covax’s role is in ending the pandemic and some of the challenges the facility faces in taking on this role.

GS: What do you think Covax’s role is in helping to tackle the Covid-19 pandemic?

MV: I think Covax has the potential to be a global solution, not only for Covid-19 but also for future pandemics, and I hope that this is still being considered particularly, for the preparedness for further pandemics.  But clearly Covax as we have it today has several important shortcomings that makes it difficult to deliver on the vaccines, a fundamental way to end the pandemic as soon as possible. This is because of its design but also due to its limited supply and for the supply, this has to be paired with policies to increase production such as waiving intellectual property rights and other barriers that impedes production.

GS: What were some of these design problems you mention?

MV: Thinking about Covax as a stand alone mechanism, the main design flaw was that it relies heavily on donations for low income and lower-middle income countries. And we've seen more and more that there are limitations of these donation policies because it keeps countries dependent on other countries that are donating to them.

Such a mechanism and other global health tools that rely on donations can be limiting because it does not build the capacity of countries to be able to become more independent and have more sovereignty to actually decide on how and what they want to do to deal with lets say the vaccination in their own countries of their own populations.

If you look at it as part of a whole including C-TAP and other technology transfer hubs they didn't work either in the way that they were intended to because no company decided to open up and make technology and knowledge openly available for other producers in other parts of the world to use.

GS: Is it too late to do something about these flaws?

MV:The Technology Transfer hubs are starting to progress, although slowly. If technological know-how was shared earlier we would not be in the situation we are today.

To address the problem now, in the short term, donations will work to fill a widening gap as we are already in the state, but to end the pandemic and tackle future ones it is important to share the technology. The TRIPS [Trade-Related Aspects of Intellectual Property Rights]

waiver has to be approved as soon as possible. So, those that actually have manufacturing capacity can start the production without worrying about any of the consequences of infringing patents, having to face lawsuits afterwards or having to pay indemnities and so on.

GS: Was Covax too ambitious to start with?

MV: It is a good scheme but in the very beginning when it had the 20 per cent target they quickly realised that there would be a lag in donations to Covax. I would say naive rather than ambitious in that it thought the countries that had the power to buy the vaccines for themselves would actually accept that the vaccines are allocated only through Covax.The Covax scheme largely neglected the fact that a lot of countries would want to engage in only bilateral agreements.

GS: Why did bilateral agreements impede the global equitable sharing scheme?

MV: The bilateral agreements put additional limitations on Covax in terms of the vaccine inequality that we see today. Vaccines first go to high income countries, and some middle income countries managed to get into manufacturing agreements with some of the vaccine producing companies, whilst low and lower middle income countries could not. Bilateral agreements have therefore caused huge inequalities, where manufacturers set their own prices.

Bilateral agreements further reduce the amount of doses available to be distributed through Covax. A handful of countries already secure most of the supply, limiting the amount needed to be shared through Covax or even to be bought by other countries. This is then linked to the question of limited global supply, so if we increase the global supply, maybe the bilateral agreements wouldn't be such a problem but there isn't.

GS: What is needed at this point?

MV: What we can rely on now is political will, which is severely lacking at the moment. Covax is not part of any international agreements and that is why with the pandemic treaty proposed, a mechanism like Covax has to be included to make it mandatory.

GS: What are your future expectations for Covax?

MV: My expectations are to see vaccines being treated as global public goods as we heard from a number  of high level leaders in the beginning of the pandemic including in Europe but also all the UN agencies. Having vaccines as a global public good means global production of vaccines, which is not treated as a commercial commodity.