Despite promises from Europe and America, vaccines are not getting shared fairly worldwide, contributing to the unequal fight against COVID-19. This is simply not good enough given the commitments of care and support we made to lower-income countries.
The COVID-19 pandemic resulted in a global public health crisis, severely disrupting health, social and economic structures worldwide. Two and a half years on, the death toll stands at huge 6.2 million with over 508 million cases worldwide, with Low and Low Middle Income Countries (LMIC) disproportionately affected.
Global vaccine delivery and its inequity
The race to find a COVID-19 vaccine and their subsequent mass delivery to the UK and other High-Income Countries (HIC) populations was done at rapid speed, contributing to the significant reduction of cases and mortality. However, these outcomes were not widespread globally. It has been estimated that most people in LMIC won’t receive a COVID-19 vaccine dose until 2023. So far, more than 80% of the doses delivered have gone to people in HIC, with only 14% of those in LMIC having received at least one dose.
It goes without saying that countries with lower vaccination rates are more likely to see variants develop, thus delaying the end of the pandemic. One third of humanity remains unvaccinated, yet richer countries are beginning to move on from the pandemic and declare it over, leaving the rest of the world behind.
What is COVAX?
The COVID-19 Vaccines Global Access (COVAX) facility, founded in April 2020, was meant to ensure equitable vaccine access in LMICs. The UK, alongside the World Health Organization, was one of the countries to kick-start efforts to establish COVAX. COVAX was an initiative intended to allow more equitable access to vaccines and increase overall global survival rates of COVID-19, aiming to vaccinate 1/5th of the population of each LMIC. Within the scheme, the UK alone has committed £548 million, contributing to COVAX’s delivery of 811 million vaccine doses to 144 of the world’s poorest countries.
COVAX is divided into two main parts; the COVAX facility, which focuses on driving the manufacturing of vaccines through investments, and the COVAX Advance Market Commitment (AMC), delivering the pledged vaccines to the 92 eligible LMICs.
So, can COVAX really be counted as a success?
Since its founding, COVAX has delivered nearly 1.2 billion doses to the 92 AMC-eligible countries.
Though at a first glance this figure shouts success, there is still deeply entrenched vaccine inequality, with around 8 in 10 people in HIC having received at least one vaccine dose, compared to just 1 in 10 in LMIC. COVAX aimed to deliver 2 billion vaccine doses to the 92 AMC-eligible countries by the end of 2021, yet it struggled with supply, delivering only 61% of the doses allocated and postponing the completion of its initial aim to 2022. As a result of vaccine shortages, 19 countries have 90% of their population to vaccinate and a further 20 countries have insufficient doses to vaccinate even their elderly citizens and health care workers. Furthermore, between February and March, African countries received only 18.2 million of the 66 million doses they had expected, meaning that only 2% have received a COVID vaccine dose in Africa. This indicates that within HICs supporting the COVAX initiative there is not enough haste nor significance placed on the need to support the global delivery of COVID-19 vaccinations, alongside their failure to fulfil their initial pledges.
Additional problems for LMICs
Due to the under-development and lack of funding of LMIC health systems, they are significantly more vulnerable to COVID-19 thus the vaccine pledges alone are not enough to support LMICs. Vaccine delivery to LMICs is likely to still be infringed due to exportation rules which prohibit certain vaccines and vaccine ingredients, slowing down vaccine delivery. Furthermore, poor transport infrastructure and lack of adequate refrigeration facilities may hamper vaccine distribution, in particular as the Pfizer vaccine needs to be stored at -70°C before use. LMIC also have competing public health priorities to address alongside COVID-19 including the vaccination against other diseases such as measles. In order to expand global immunity coverage these additional factors highlight the need for aid from HIC to support production, trade and vaccination equity.
The future for COVAX
A recent Gavi COVAX summit allowed the open discussion of the problems arising since COVAX’s launch and resulted in a further $4.8 billion pledged. Additionally, the Group of Seven (G7) have also recommitted their support to COVAX. These two developments give hope that COVAX can still fulfil its original mission.
To continue the more equitable distribution of vaccines I would propose that alongside greater vaccine pledges from HIC to LMIC, after identifying the most vulnerable countries, support needs to be provided to boost their health infrastructure, equip health centres, expand storage and train health workers who will carry out the vaccination. Despite the huge pledges given, in order to vaccinate the world’s population, we not only need an increased drive towards COVAX, but also continued donations and support to overcome the additional challenges of COVID-19, unique to LMIC. Though COVAX has so far succeeded in delivering a considerable number of vaccine doses to LMIC, far more than if it hadn’t been established, there is still a long way to go for equality in the bid to end the pandemic.
