After months of struggle, the UN-backed Covax alliance will have many more doses, promising relief for vaccine shortages in poorer countries. But it faces a deepening crisis: difficulties in getting shots into arms as the Delta variant spreads
Deaths from COVID-19 were surging across Africa in June when 100,000 doses of the Pfizer-BioNTech vaccine arrived in Chad. The delivery seemed proof that the United Nations-backed programme to immunise the world could get the most desirable vaccines to the least developed nations. Yet five weeks later, Chad’s health minister said, 94,000 doses remained unused.
Nearby in Benin, only 267 shots were being given each day, a pace so slow that 110,000 of the programme’s AstraZeneca doses expired. Across Africa, confidential documents from July indicated, the programme was monitoring at least nine countries where it said doses intended for the poor were at risk of spoiling this summer.
The vaccine pileup illustrates one of the most serious but largely unrecognised problems facing the immunisation programme as it tries to recover from months of missteps and disappointments: difficulty getting doses from airport tarmacs into people’s arms. Known as Covax, the programme was supposed to be a global powerhouse, a multibillion-dollar alliance of international health bodies and non-profits that would ensure through sheer buying power that poor countries received vaccines as quickly as the rich. Instead, Covax has struggled to acquire doses: It stands half a billion short of its goal. Poor countries are dangerously unprotected as the Delta variant runs rampant, just the scenario that Covax was created to prevent.
The urgent need to vaccinate the world goes far beyond protecting people in poor nations. The longer the virus circulates, the more dangerous it can become, even for vaccinated people in wealthy countries.
Without billions more shots, experts warn, new variants could keep emerging, endangering all nations. “Covax hasn’t failed, but it is failing,” said Dr. Ayoade Alakija, a co-chair of the African Union’s vaccine delivery programme.
“We really have no other options. For the sake of humanity, Covax must work.” More supplies are finally on the way, courtesy of the Biden administration, which is buying 500 million Pfizer doses and delivering them through Covax, the centrepiece of a larger pledge by wealthy democracies. The donated doses should begin shipping this month.
But the Biden donation, worth $3.5 billion, comes with a caveat: To help fund it, the administration is diverting hundreds of millions of dollars promised for vaccination drives in poorer countries, according to notes from a meeting between Covax and American officials. Short on funding, those countries have had a hard time buying fuel to transport doses to clinics, training people to administer shots or persuading people to get them.
Even as Covax officials scramble to fill that funding gap, the overriding question is whether the programme can move beyond its mistakes, and beyond an imbalance of power that has left it at the mercy of wealthy countries and pharmaceutical companies. Pfizer, for example, balked at a direct deal with Covax this spring, interviews reveal, instead reaching an agreement through the Biden administration, an arrangement that hurt Covax’s credibility as an independent vaccine purchaser.
The programme has struggled with delays and infighting. According to interviews and records from Covax, bureaucratic barriers imposed by its leadership have held up the disbursement of $220 million to help countries administer vaccines.
Driven by a non-profit funded by the Gates Foundation, Covax is a creation without precedent. It has gotten vaccines to poorer countries faster than was previously typical and developed a system to compensate people for serious post-vaccine reactions and protect vaccine makers from legal liability — a plan that saved those countries months of negotiations.
Still, the 163 million doses it has delivered — most free to poorer nations, with the rest to countries like Canada that paid their way — are a far cry from plans to have at least 640 million doses available by now.
Dr. Seth Berkley, the chief executive of Gavi, the non-profit at Covax’s heart, said insufficient early financing made supply shortages inevitable. When distribution problems of the type in Chad and Benin emerge, Covax tries to “move those vaccines to other countries, but then to work with those countries to try to improve capacity,” he said.
Supporters and critics agree that the programme must improve, rapidly. As of early July, confidential Covax documents indicated that 22 nations, some with surging fatalities, reported being nearly or entirely out of doses from the programme.
“The way Covax was packaged and branded, African countries thought it was going to be their saviour,” said Dr. Catherine Kyobutungi, who directs the African Population and Health Research Center. “When it didn’t meet expectations, there was nothing else.”In the frantic early months of 2020, health experts strategised on how to equitably inoculate the world. Covax was the answer, bringing together two Gates-funded non-profits, Gavi and the Coalition for Epidemic Preparedness Innovations, or CEPI; the World Health Organization; and UNICEF, which would lead delivery efforts. It hoped to be a major global vaccine buyer, for both rich and poor nations, giving it the clout to bully vaccine makers.
But if rich nations pledged donations, they did not make obliging partners. Britain negotiated for wealthier participants to be given a choice of vaccines to purchase through Covax, creating delays, said Kate Elder, senior vaccines policy adviser for Doctors Without Borders’ Access Campaign.
Most important, rich nations became rivals in a vaccine-buying race, paying premiums to secure their own shots while slow-walking financial pledges that Covax needed to sign deals.
“You can’t be passing the tin cup in the middle of a pandemic,” said Dr. Nicole Lurie, the U.S. director at CEPI, referring to the desperate scramble for financing.
