COVAX Explained

Policy Brief submitted by Claire Borgaonkar

Introduction

As the COVID-19 pandemic drags on, the push to develop and distribute a vaccine is growing stronger by the day. Around the world, dozens of vaccine trials are underway, with a handful already in the late stages of testing. Thanks to modern technology, it appears likely that the world will see a successful COVID-19 vaccine within the next year or so.

But once a vaccine finally rolls out, a host of pressing questions will quickly emerge. Who should be the first to get vaccinated? How will low- and middle-income countries be able to compete with wealthier nations for doses? How can a country be prevented from hoarding all available supply for itself? In an attempt to address these potential challenges, the World Health Organization (WHO), in conjunction with the Vaccine Alliance (Gavi), and the Coalition for Epidemic Preparedness Innovations (CEPI) have created the COVID-19 Vaccines Global Access Facility (COVAX)(1). COVAX aims to facilitate the development and distribution of an eventual COVID-19 vaccine by establishing a global partnership to finance multiple vaccine candidates. This partnership has huge implications for the duration of the global pandemic, as well as for the ability of developing nations to access vaccines once they become available. But the scale of international cooperation required for its success is almost unprecedented, and several key players have already stepped back from the initiative, putting the effectiveness of COVAX into question.

What is COVAX?

COVAX is one of three pillars in the Access to COVID-19 Tools (ACT) Accelerator, a global initiative spearheaded by the WHO that aims to provide widespread access to COVID-19 diagnostic tools and treatments(2). The COVAX pillar is concerned with vaccine development and distribution, and is currently investing in a multitude of promising vaccine trials in hopes that one will prove successful. Once one of these candidates gets approved, all participating nations will receive equal access to the vaccine relative to its total population size. COVAX’s goal is to have 2 billion doses available by the end of 2021, which it estimates will be enough to vaccinate high-risk individuals and essential healthcare workers worldwide.

The COVAX pillar is made up of two branches: the COVAX Facility and the COVAX Advance Market Commitment (AMC) (3). The COVAX Facility coordinates investments across a wide range of vaccine candidates, drawing on funds provided by wealthier nations. The COVAX AMC aims to finance the participation of 92 lower and middle income countries in the COVAX Facility who would otherwise be unable to afford a vaccine.

High-income nations should be incentivised to sign onto COVAX because it increases their odds of gaining access to a successful vaccine. The probability of success for vaccines in the preclinical phase is 7%, and around 15-20% for vaccines that reach clinical testing (4). Therefore, most vaccine trials currently in development are likely to fail, making joint investments in several candidates the safest bet. For low- and middle-income nations, COVAX will ensure that vaccines are distributed equitably among its participants. The COVAX pillar guarantees all participating nations enough doses to vaccinate at least 20% of their populations, which should be enough to protect frontline workers and other individuals who are most vulnerable to the disease (5). This way, every nation will have immediate access to COVID-19 vaccines, regardless of income. For nations that are typically unable to outbid wealthy countries in a supply conflict, COVAX is likely the only avenue through which they will be able to procure doses immediately upon availability.

Who has signed on?

183 nations worldwide have announced their involvement with COVAX, including Canada, China, Germany, and Japan (6). While many large economies have voiced their support for COVAX, the U.S. and Russia stand as notable exceptions. President Trump has been very vocal in his criticism of the WHO and thus has refused U.S. involvement with any WHO-sponsored initiative (7). Likewise, Russia has not committed its support to COVAX (8), likely because the country has already approved its own COVID-19 vaccine (9). This sort of reluctance from two of the world’s most powerful states has some concerning implications for the overall success of the initiative.

What are the potential challenges?

The success of COVAX is dependent on a level of global coordination that is almost unprecedented to ensure its success. Specifically, it requires urgent funding and cooperation from as many global actors as possible. A lack of U.S. or Russian support could spell trouble for the initiative, as both nations possess enormous financial resources. As it stands currently, the AMC still needs about U.S.$ 300 million before the end of the year to reach its goal of raising $2 billion to finance the distribution of doses to low- and middle-income countries (10).

Perhaps more significant is the risk of either of these nations partaking in vaccine nationalism once a safe and proven vaccine is discovered. Vaccine nationalism is a ‘my nation first’ approach to vaccination that would deny all other nations immediate access to a successful vaccine (11). Currently, four large-scale vaccine trials are underway in the U.S. (12), and if any of these prove successful, there is no guarantee the country would be willing to share with the rest of the world before inoculating its own population first. This kind of nationalism-motivated vaccine hoarding risks prolonging the severity of the pandemic, costing billions of dollars and hundreds of thousands of lives.

Going forward

It is rare that every nation on earth is affected so strongly and immediately by a disaster, but the COVID-19 pandemic demonstrates just how interconnected the world truly is. A global problem of this scale requires a global solution, and the COVAX pillar may just be the mechanism needed to escape the peak of the pandemic. But in order for it to succeed, nations need to cooperate with one another and not give in to the temptations of vaccine nationalism. By working together to ensure the rapid development and equitable distribution of a vaccine, we will all be better off.

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(1) Seth Berkley, “COVAX explained”, Gavi, The Vaccine Alliance, 2020,

https://www.gavi.org/vaccineswork/covax-explained

(2) Ibid.

(3) “172 countries and multiple candidate vaccines engaged in COVID-19 vaccine Global Access Facility”, World Health Organization, 2020, https://www.who.int/news-room/detail/24-08-2020-172-countries-and multiple-candidate-vaccines-engaged-in-covid-19-vaccine-global-access-facility

(4)“What is the COVAX pillar, why do we need it and how will it work?”, Gavi, The Vaccine Alliance, 2020, https://www.gavi.org/vaccineswork/gavi-ceo-dr-seth-berkley-explains-covax-pillar

(5) Ibid.

(6) Dave Lawler, “Vaccine initiative now covers almost entire world, but not U.S. or Russia”, Axios, 2020, https://www.axios.com/covax-initiative-vaccines-china-joins-trump-russia-26dce1f3-1b81-47af-8b7d 199900a928f3.html

(7) The Washington Post, 2020, “U.S. says it won’t join WHO-linked effort to develop, distribute coronavirus vaccine”, https://www.washingtonpost.com/world/coronavirus-vaccine-trump/2020/09/01/b44b42be-e965- 11ea-bf44-0d31c85838a5_story.html

(8) Lawler, “Vaccine initiative now covers almost entire world, but not U.S. or Russia”, Axios, 2020, https://www.axios.com/covax-initiative-vaccines-china-joins-trump-russia-26dce1f3-1b81-47af-8b7d 199900a928f3.html

(9) Putin vaunts Russian coronavirus vaccine at UN”, CTV News, 2020,

https://www.ctvnews.ca/health/coronavirus/putin-vaunts-russian-coronavirus-vaccine-at-un-1.5115301

(10)“Countries pledge nearly US$ 1 billion to support equitable access to COVID-19 vaccines”, Gavi, The Vaccine Alliance, 2020, https://www.gavi.org/news/media-room/countries-pledge-nearly-us-1-billion support-equitable-access-covid-19-vaccines

(11) Asaf Bitton, Mark L. Rosenberg, and Rebecca Weintraub, “The Danger of Vaccine Nationalism”, Harvard Business Review, 2020, https://hbr.org/2020/05/the-danger-of-vaccine-nationalism

(12) “Fourth large-scale COVID-19 vaccine trial begins in the United States”, National Institutes of Health, 2020, https://www.nih.gov/news-events/news-releases/fourth-large-scale-covid-19-vaccine-trial-begins united-states