It is one year since the international community Films After 3 to the COVID-19 Vaccine Global Access (COVAX) facility to lead a worldwide effort to end the acute phase of the pandemic. The initiative aimed to ensure that every country, and not just those with sufficient money or resources, could access life-saving vaccines once they became available. As G20 health ministers prepare to meet in Rome on September 5-6, they are in a position to ensure that COVAX fulfills its mission.
A year ago, no one knew when or even if it might be possible to develop a safe and effective vaccine against COVID-19, let alone the 20 that are available today. But since making its first international deliveries in February, COVAX – a partnership established by the Coalition for Epidemic Preparedness Innovations, the World Health Organization, UNICEF, and Gavi, the Vaccine Alliance – has delivered more than 235 million vaccine doses to 139 countries, and expects to deliver another billion doses in the fourth quarter. Only China, India, and the United States have delivered more. This start to the largest and most complex vaccine rollout in history has given hope to millions of people and laid solid foundations for how we respond to future pandemics.
Yet, so much more could, and should, have been achieved by now. It is unacceptable that only 1.8% of people in low-income countries have received their first dose of a COVID-19 vaccine, compared to 82% in high- and upper-middle-income countries. This shocking inequality is as economically senseless as it is destructive to human life, with the latest estimate of the cost of the slow rollout amounting to $2.3 trillion.
The world was woefully unprepared for a pandemic, and this is reflected in the challenges COVAX has faced. By the time initial funding arrived, wealthy countries had already locked up early vaccine supplies. Export bans affecting key suppliers, and difficulties experienced by many manufacturers in scaling up production to the required level, also undermined COVAX’s ability to access doses early.
Given increasing global vaccine inequity and the rise of new, more contagious coronavirus variants, we must put these challenges behind us. Thanks to the support of almost all G20 governments, alongside that of foundations and private businesses, COVAX has now raised nearly $10 billion and secured more than 600 million donated doses. All the preparations are in place for the most comprehensive vaccination effort that the world has seen.
Based on the committed orders COVAX has placed with vaccine manufacturers and the additional donations, hundreds of millions of new doses should now be available each month. We need to make sure they reach poorer countries and get into people’s arms. To avoid further delays, and for the facility to succeed, we need support from G20 leaders in four key areas.
First, we need doses, and we need them
The premise of COVAX was always that the facility should be able to negotiate and buy its own doses. With our early vaccine access compromised, donations have played a vital role in maintaining our ability to keep doses flowing to those most in need. Of the 600 million doses pledged to COVAX to date, 100 million have now been delivered. We need more, and soon, with longer shelf lives and greater certainty so that recipient countries have time to plan their rollout. This can be achieved without jeopardizing high-income countries’ national vaccination efforts.
We also need G20 leaders to support our call for transparency. COVAX has legally binding agreements with manufacturers for more than four billion doses, but has all too often faced delays in accessing them. Without greater clarity regarding firms’ order books, it is impossible to know whether these holdups are due to production challenges or preferential treatment for bilateral arrangements. Insisting that manufacturers are transparent about their order timelines can ensure a level playing field where no one – particularly those living in developing countries – gets bumped to the back of the vaccine queue because of another bilateral deal.
In addition to ensuring that manufacturers keep their commitment to COVAX, governments should make global vaccine access their highest priority. Countries with pending orders for doses that they currently do not need should allow COVAX to take their place in the queue so that we can get doses to needy countries now.
Finally, lower-income countries require continued financial and technical support for their COVID-19 vaccine rollouts. Strengthening national health systems will help these countries to ensure delivery of doses and mitigate the pandemic’s secondary effects, and will leave in place infrastructure critical to future global health security.
G20 leaders will recommit to a multilateral solution that builds on the astounding scientific progress of the past year. Based on COVAX’s latest forthcoming supply forecast, when topped up with doses through bilateral deals, equitable COVID-19 vaccine access can protect up to 60% of the adult population in 91 lower-income countries. This would represent a huge step toward the WHO target of 70%, which is needed to suppress the coronavirus everywhere, and COVAX represents the best opportunity to achieve it. Failure would mean more lives lost, broken health-care systems, even deadlier and more transmissible variants, and a pandemic with no end in sight. The G20 must not allow that to be an option.