Vaccine shortages prompt changes to COVAX strategy
COVAX, the global COVID-19 vaccine procurement hub, has changed how it allocates vaccines. Ann Danaiya Usher reports.
In its vaccine allocation round for October, 2021, COVAX will deliver doses to only 39 of the 89 eligible low-income and middle-income countries (LMICs), focusing mainly on those with the lowest vaccine coverage.
The original vision of COVAX—the vaccine mechanism managed by Gavi, the Vaccine Alliance; WHO; and the Coalition for Epidemic Preparedness Innovations—was a global procurement hub that would leverage prices to make COVID-19 vaccines accessible for all countries. COVAX will not reach its goal of delivering 2 billion doses in 2021. By mid-October, 288 million doses had been delivered to LMICs and COVAX recently reduced by 25% the number of vaccine doses it anticipates it will receive by the end of the year. Fewer than 3% of people in low-income countries have been vaccinated with one dose, compared with more than 60% in high-income countries.
In September, the Independent Allocation of Vaccines Group (IAVG), a group of 12 scientists who have been advising COVAX on vaccine distribution, recommended that doses be prioritised for countries with coverage of less than 10% and for which COVAX is their only source of COVID-19 vaccine. 28 countries are entirely dependent on COVAX for their supply of vaccines. Swedish epidemiologist Anna Mia Ekström, of the Karolinska Institutet, and a member of the IAVG, explains: “We all felt that now when the overall distribution is so unequal between high and lower income countries, it makes sense to really try to focus on the very lowest end countries. There is a need to make sure everybody reaches a reasonable minimum level”.
The change marks a radical departure from the population-based approach that has been used since the first COVAX deliveries began in February. For the past six allocation rounds, COVAX adhered diligently to a proportional distribution of vaccines to each of the 89 eligible countries. “Initially, our highest priority was to treat all countries equally, making sure that all countries knew that they would receive exactly the same proportion of doses, according to their population size”, says Ekström. “However, in a situation where there is so little vaccine to distribute, the volumes that some countries were receiving were so small that it had become almost absurd”, she says. COVAX has been criticised for supplying high-income countries that had already secured vaccines from bilateral deals with pharmaceutical companies.
In the latest round of allocations, 85 million doses are to be delivered. Gavi calls it an “exceptional round” that targets countries where “COVAX is either the only or the primary source of COVID-19 vaccines.” There are no high-income countries on the allocation list. Of the 39 LMICs, the majority are in Africa, although the largest individual allocations go to Pakistan (12 million) and Bangladesh (9 million). Egypt will receive 6•6 million doses, Ethiopia 3 million, Nigeria 2•5 million, and Uganda 2 million.
Brazil, Mexico, Morocco, and Sudan have earlier received millions of doses from COVAX but are not included in the latest allocation. Haiti, Nepal, Somalia, and Yemen are among other countries that do not appear on the list.
Suerie Moon, of the Global Health Centre at the Graduate Institute in Geneva, said: “It makes ethical and epidemiological sense to prioritise countries that have the fewest doses per capita…If COVAX is able to inject some equity and rationality into the highly unequal global distribution of vaccines, this would be very welcome and demonstrate the value of taking multilateral—vs purely bilateral—approaches to vaccine access.”
WHO Director-General Tedros Ghebreyesus has been pleading with high-income countries not to give a third dose to those who are fully vaccinated and do not belong to a specific risk group, and to redistribute these doses to COVAX instead. Ekström echoes Tedros’s call, underlining that the IAVG expert group is not opposed to giving a booster dose, but rather that it is a matter of timing. “We still don’t know how much vaccine COVAX will get by the end of 2021…This makes it really hard for COVAX and the rest of the world to plan”, she said.
COVAX hopes to access 1•25 billion doses for LMICs this year, equivalent to 20% global vaccine coverage. More than a billion more doses are required to reach 40%. To date, high-income countries have pledged to donate 945 million doses to COVAX but only 13% of these have actually been delivered. Moreover, Gavi figures show that 75% of donations are earmarked to specific countries and regions, further challenging COVAX in its efforts to distribute vaccines equitably. The IAVG has warned that donating countries should reduce or remove all geographical earmarking to allow COVAX the greatest flexibility to distribute based on need.
Source : Lancet