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US Officials deliver COVID-19 vaccines to Ghana as part of the COVAX program in 2021. Ghana was the first recipient of vaccines through COVAX.

COVID-19 Vaccines Global Access, abbreviated as COVAX, is a worldwide initiative aimed at equitable access to COVID-19 vaccines directed by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO), alongside key delivery partner UNICEF. It is one of the four pillars of the Access to COVID-19 Tools Accelerator, an initiative begun in April 2020 by the WHO, the European Commission, and the government of France as a response to the COVID-19 pandemic. COVAX coordinates international resources to enable low-to-middle-income countries equitable access to COVID-19 tests, therapies, and vaccines.[1] UNICEF is the key delivery partner, leveraging its experience as the largest single vaccine buyer in the world and working on the procurement of COVID-19 vaccine doses, as well as logistics, country readiness and in-country delivery.

By 19 October 2020, 184 countries had joined COVAX.[2]

COVAX began distributing vaccines in February 2021. Though COVAX promised 100 million doses by the end of March,[3][4] this goal was not reached until 6 July.[5] By mid-August 2021, COVAX delivered 200 million vaccine doses to nearly 140 countries instead of the 600 million doses initially projected. The continued shortage of COVID-19 vaccines delivered through COVAX is blamed on "vaccine nationalism" by richer nations, and the diversion of 400 million Oxford–AstraZeneca COVID-19 vaccine doses, produced under license by the Serum Institute of India (SII), for domestic use in India.[6] As of April 2022, more than 1.4 billion doses were delivered, when the largest recipients were Bangladesh (183 mil. of doses), Pakistan (112 mil.) and Indonesia (104 million).[7]

History

In April 2020 the World Health Organization (WHO), the European Commission, and the government of France founded the Access to COVID-19 Tools Accelerator, an initiative begun as a response to the COVID-19 pandemic. COVID-19 Vaccines Global Access (COVAX) is one of its four pillars. It is a worldwide initiative aimed at equitable access to COVID-19 vaccines directed by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the WHO, alongside key delivery partner UNICEF. COVAX coordinates international resources to enable low-to-middle-income countries equitable access to COVID-19 tests, therapies, and vaccines.[1]

A financing instrument called the COVID-19 Vaccines Advance Market Commitment (COVAX AMC) was presented to prospective donors at the Gavi COVAX AMC 2021 Investment Opportunity Launch Event, otherwise named One World Protected, on 15 April 2021.[8] The virtual event was hosted by GAVI board chair José Manuel Barroso, U.S. Secretary of State Antony Blinken, and acting United States Agency for International Development (USAID) Administrator Gloria Steele.[9] Among the attendees were heads of state, corporate leaders and representatives from global nonprofit organizations.[10] The program was fully launched by GAVI at the Global Vaccine Summit on 4 June 2021.[11]

Vaccine candidates

As of 23 December 2021, the WHO had approved Oxford–AstraZeneca, Pfizer–BioNTech, Moderna, Sinopharm BIBP, CoronaVac, Janssen, Covaxin, and Novavax vaccines for emergency use.[12][13][14] These vaccines can be distributed as part of COVAX per decision in May 2021.[15][16]

Many of the countries benefitting from COVAX have "limited regulatory capacity" and depend on WHO's authorisations. By early 2021, WHO was reviewing 11 potential COVID-19 vaccines for its Emergency Use Listing (EUL).[17] The first vaccine WHO authorised for its EUL on 31 December 2020 was the Pfizer–BioNTech COVID-19 vaccine—an RNA vaccine developed by the German company BioNTech in cooperation with the American company Pfizer sold under the brand name Comirnaty.[18][19][20]

On 24 August 2020 WHO stated that COVAX had nine CEPI-supported vaccine candidates and nine candidates undergoing trials, giving it the largest selection of COVID-19 vaccinations in the world.[21] By December 2020, COVAX had finalized negotiations with other manufacturers that gave it access to two billion vaccine doses.[22]

Distribution (recipients)

COVAX provides vaccines to the developing world.[23] A total of 92 low- and middle-income countries are eligible to receive COVID-19 vaccines through the COVAX mechanism[24] through the COVAX Vaccines Advance Market Commitment (AMC) financing instrument.[24][25] COVAX AMC is funded by donor contributions.[25] COVAX AMC funds the COVAX Facility, the vaccine procurement platform.[25]

On 3 February 2021, GAVI, the WHO, and UNICEF published the country-by-country distribution of the Pfizer–BioNTech and Oxford–AstraZeneca vaccines forecast for first half of 2021.[26] The early projection includes 336 million doses of the Oxford–AstraZeneca vaccine as well as 1.2 million doses of the Pfizer–BioNTech vaccine to the 145 COVAX facility participants.[27][28] It is expected that health care workers and the most vulnerable will receive the first doses, which are anticipated to reach approximately 3.3% of the total population of each participating country by the end of the first half of 2021.[28]

In February 2021, the WHO and Chubb Limited announced the roll out of a no-fault compensation scheme for COVID-19 vaccinations for low and middle-income countries which would be financed initially through Gavi COVAX AMC donor funding.[29]

On 24 February 2021, Ghana became the first country in the world to receive vaccines through COVAX when 600,000 doses of the Oxford–AstraZeneca vaccine were delivered to Accra.[23][30] On 2 March, COVID-19 vaccines were being distributed in Ghana by Zipline drones.[31] This method allows reaching remote areas (which are underserved by traditional logistics).[32]

On 1 March 2021, frontline workers and public officials from the Ivory Coast became the first persons to be inoculated with COVID-19 vaccines shipped from the COVAX Facility. More than 500,000 doses of the Oxford–AstraZeneca COVID-19 vaccine manufactured by the Serum Institute of India were shipped to the city of Abidjan the week before. The vaccines were flown in by UNICEF from Mumbai.[33]

On 5 March 2021, Moldova received 14,400 Oxford–AstraZeneca COVID-19 vaccine units through COVAX, becoming the first European country to do so. The country had already been donated 21,600 doses of the same vaccine by Romania some days earlier.[34]

On 25 March 2021, Bosnia and Herzegovina received 24,300 Pfizer–BioNTech and 26,400 Oxford–AstraZeneca COVID-19 vaccine units through COVAX, becoming the second European country to do so.[35] The country had already been, in total, donated over 20,000 doses of the Oxford–AstraZeneca vaccine by Serbia and Slovenia some weeks earlier.[36][37]

On 8 June 2021, Uruguay released health data from their vaccination efforts through the COVAX program. Almost 800,000 individuals or 52% of the adult population received two doses of the CoronaVac or Pfizer vaccines. The government also studied the effectiveness of the Pfizer/BioNTech vaccine among 162,047 health workers and people over 80 years old. Both vaccine types reduced hospitalisations and deaths by over 90%, and infection rates by more than 60%. Because of accessible healthcare and available COVAX vaccine supplies, the small Latin nation was able to ward off a serious COVID-19 spike in May 2021.[38]

On 1 August 2021, the Venezuelan government announced it will receive 6.2 million doses of coronavirus vaccines through the COVAX initiative. Part of the payment to the GAVI alliance was first blocked due to economic sanctions. Venezuela is a self-financing participant of COVAX. According to the Pan-American Health Organization (PAHO), Venezuela will receive China's Sinopharm BIBP vaccine and CoronaVac. The country previously obtained the AstraZeneca vaccine through the program, but Venezuelan health officials did not approve the product for domestic use.[39]

According to a report produced by the People's Vaccine Alliance covering 14 countries, 'vaccine hesitancy' was not the reason for low jab rates in low- and middle-income countries. But the report found that a lack of testing capacity, sufficient vaccine doses and refrigerated storage were mostly to blame for the low vaccination rates. Poor information policies on vaccine distribution and underfunded healthcare systems were also mentioned. The Vaccine Alliance found that "systemic racism has plagued the global response to Covid-19".[40]

Interim Distribution Forecast as of 3 February 2021 (doses)[28]
AMC: Advance Market Commitment; SFP: Self-Financing Participants
Participant SFP/AMC AstraZeneca
SII		 AstraZeneca
SK Bioscience		 Pfizer–BioNTech Total
 India AMC 97,164,000 – – 97,164,000
 Pakistan AMC 17,160,000 – – 17,160,000
 Nigeria AMC 16,008,000 – – 16,008,000
 Indonesia AMC – 13,708,800 – 13,708,800
 Bangladesh AMC 12,792,000 – – 12,792,000
 Brazil SFP – 10,672,800 – 10,672,800
 Ethiopia AMC 8,928,000 – – 8,928,000
 Congo, Dem. Rep. AMC 6,948,000 – – 6,948,000
 Mexico SFP – 6,472,800 – 6,472,800
 Philippines AMC – 5,500,800 117,000 5,617,800
 Egypt AMC – 5,138,400 – 5,138,400
 Vietnam AMC – 4,886,400 – 4,886,400
 Myanmar AMC 4,224,000 – – 4,224,000
 Iran SFP – 4,216,800 – 4,216,800
 Kenya AMC 4,176,000 – – 4,176,000
 Uganda AMC 3,552,000 – – 3,552,000
 Sudan AMC 3,396,000 – – 3,396,000
 South Africa SFP – 2,976,000 117,000 3,093,000
 Afghanistan AMC 3,024,000 – – 3,024,000
 South Korea SFP – 2,596,800 117,000 2,713,800
 Colombia SFP – 2,553,600 117,000 2,670,600
 Uzbekistan AMC 2,640,000 – – 2,640,000
 Angola AMC 2,544,000 – – 2,544,000
 Mozambique AMC 2,424,000 – – 2,424,000
 Ghana AMC 2,412,000 – – 2,412,000
 Ukraine AMC – 2,215,200 117,000 2,332,200
 Yemen AMC 2,316,000 – – 2,316,000
 Argentina SFP – 2,275,200 – 2,275,200
   Nepal AMC 2,256,000 – – 2,256,000
 Algeria AMC – 2,200,800 – 2,200,800
 Cameroon AMC 2,052,000 – – 2,052,000
 Cote d'Ivoire AMC 2,040,000 – – 2,040,000
 Iraq SFP – 2,018,400 – 2,018,400
 North Korea AMC 1,992,000 – – 1,992,000
 Canada SFP – 1,903,200 – 1,903,200
 Morocco AMC – 1,881,600 – 1,881,600
 Niger AMC 1,872,000 – – 1,872,000
 Peru SFP – 1,653,600 117,000 1,770,600
 Saudi Arabia SFP – 1,747,200 – 1,747,200
 Sri Lanka AMC 1,692,000 – – 1,692,000
 Malaysia SFP – 1,624,800 – 1,624,800
 Burkina Faso AMC 1,620,000 – – 1,620,000
 Mali AMC 1,572,000 – – 1,572,000
 Malawi AMC 1,476,000 – – 1,476,000
 Zambia AMC 1,428,000 – – 1,428,000
 Venezuela SFP – 1,425,600 – 1,425,600
Non-UN Member States N/A – 1,303,200 – 1,303,200
 Cambodia AMC 1,296,000 – – 1,296,000
 Senegal AMC 1,296,000 – – 1,296,000
 Chad AMC 1,272,000 – – 1,272,000
 Somalia AMC 1,224,000 – – 1,224,000
 Zimbabwe AMC 1,152,000 – – 1,152,000
 Guinea AMC 1,020,000 – – 1,020,000
 Syrian Arab Republic AMC 1,020,000 – – 1,020,000
 Bolivia AMC 900,000 – 92,430 992,430
 Chile SFP – 957,600 – 957,600
 Benin AMC 936,000 – – 936,000
 Rwanda AMC 996,000 – 102,960 1,098,960
 Ecuador SFP – 885,600 – 885,600
 Haiti AMC 876,000 – – 876,000
 South Sudan AMC 864,000 – – 864,000
 Guatemala SFP – 847,200 – 847,200
 Tajikistan AMC 732,000 – – 732,000
 Tunisia AMC – 592,800 93,600 686,400
 Papua New Guinea AMC 684,000 – – 684,000
 Togo AMC 636,000 – – 636,000
 Sierra Leone AMC 612,000 – – 612,000
 Laos AMC 564,000 – – 564,000
 Dominican Republic SFP – 542,400 – 542,400
 Jordan SFP – 511,200 – 511,200
 Azerbaijan SFP – 506,400 – 506,400
 Kyrgyz Republic AMC 504,000 – – 504,000
 Nicaragua AMC 504,000 – – 504,000
 Honduras AMC – 496,800 – 496,800
 Congo, Rep. AMC 420,000 – – 420,000
 Liberia AMC 384,000 – – 384,000
 El Salvador AMC – 324,000 51,480 375,480
 Central African Republic AMC 372,000 – – 372,000
 Mauritania AMC 360,000 – – 360,000
 Paraguay SFP – 357,600 – 357,600
 Serbia SFP – 345,600 – 345,600
 Libya SFP – 343,200 – 343,200
 Lebanon SFP – 340,800 – 340,800
 Singapore SFP – 288,000 – 288,000
 Palestine AMC – 240,000 37,440 277,440
 Costa Rica SFP – 254,400 – 254,400
 Oman SFP – 254,400 – 254,400
 New Zealand SFP – 249,600 – 249,600
 Panama SFP – 216,000 – 216,000
 Georgia SFP – 184,800 29,250 214,050
 Mongolia AMC – 163,200 25,740 188,940
 Moldova AMC – 156,000 24,570 180,570
 Gambia, The AMC 180,000 – – 180,000
 Bosnia and Herzegovina SFP – 153,600 23,400 177,000
 Uruguay SFP – 172,800 – 172,800
 Lesotho AMC 156,000 – – 156,000
 Armenia SFP – 146,400 – 146,400
 Jamaica SFP – 146,400 – 146,400
 Guinea-Bissau AMC 144,000 – – 144,000
 Qatar SFP – 144,000 – 144,000
 Albania SFP – 141,600 – 141,600
 Namibia SFP – 127,200 – 127,200
 Botswana SFP – 117,600 – 117,600
 Bhutan AMC 108,000 – 5,850 113,850
 Cabo Verde AMC 108,000 – 5,850 113,850
 Comoros AMC 108,000 – – 108,000
 Djibouti AMC 108,000 – – 108,000
 Eswatini AMC 108,000 – – 108,000
 Solomon Islands AMC 108,000 – – 108,000
 North Macedonia SFP – 103,200 – 103,200
 Maldives AMC 108,000 – 5,850 113,850
 Bahamas SFP – 100,800 – 100,800
 Bahrain SFP – 100,800 – 100,800
 Barbados SFP – 100,800 – 100,800
 Belize SFP – 100,800 – 100,800
 Brunei Darussalam SFP – 100,800 – 100,800
 Fiji AMC – 100,800 – 100,800
 Guyana AMC – 100,800 – 100,800
 Kosovo AMC – 100,800 – 100,800
 Mauritius SFP – 100,800 – 100,800
 Timor-Leste AMC – 100,800 – 100,800
 Trinidad and Tobago SFP – 100,800 – 100,800
 Vanuatu AMC – 100,800 – 100,800
 Sao Tome and Principe AMC 96,000 – – 96,000
 Montenegro SFP – 84,000 – 84,000
 Samoa AMC – 79,200 – 79,200
 Suriname SFP – 79,200 – 79,200
 St. Lucia AMC – 74,400 – 74,400
 Kiribati AMC – 48,000 – 48,000
 Micronesia, Fed. Sts. AMC – 48,000 – 48,000
 Grenada AMC – 45,600 – 45,600
 St. Vincent and the Grenadines AMC – 45,600 – 45,600
 Tonga AMC – 43,200 – 43,200
 Antigua and Barbuda SFP – 40,800 – 40,800
 Dominica AMC – 28,800 – 28,800
 Andorra SFP – 26,400 – 26,400
 Marshall Islands AMC – 24,000 – 24,000
 St. Kitts and Nevis SFP – 21,600 – 21,600
 Monaco SFP – 7,200 – 7,200
 Nauru SFP – 7,200 – 7,200
 Tuvalu AMC – 4,800 – 4,800
TOTAL - 227,664,000 91,200,000 1,200,420 320,064,420

Participants (donors)

COVAX is principally funded by Western countries.[23] As of 19 February 2021, 30 countries have signed commitment agreements to the COVAX Facility as well as the European Union (apart from the individual member states). Although more than $6 billion was pledged, not all of the funding has been delivered yet. In April, the initiative wrote that it had not yet received its target of $3.2 billion for 2021.[41]

Although mainly funded by governments ("Official Development Assistance"), the COVAX scheme is also funded by private-sector and philanthropic contributions, and recipient countries may share some costs for vaccines and delivery.[25]

In May 2021, UNICEF made an urgent appeal to industrialised nations to pool their excess COVID-19 vaccine capacity to make up for a 125-million-dose gap in the COVAX program. Only a limited amount of vaccines are distributed efficiently, and the shortfall of vaccines in South America and parts of Asia are due to a lack of expedient donations by richer nations. International organisations have pointed at Nepal, Sri Lanka, and Maldives as well as Argentina and Brazil, and some parts of the Caribbean as problem areas, where vaccines are in short supply. UNICEF has also been critical towards proposed donations of Moderna and Pfizer vaccines since these are not slated for delivery until the second half of 2021, or early 2022.[42]

COVAX-AMC donors as of 27 April 2022[43]
(million USD)
Donor Contributions
 United States of America 4,000.0
 Germany 1,653.9
 Japan 1,500.0
 United Kingdom 735.2
 Canada 669.2
 Sweden 549.2
European Union European Commission 542.9
 Italy 442.7
Bill & Melinda Gates Foundation 236.3
 France 229.0
 South Korea 210.0
 Norway 197.7
 Australia 159.1
  Switzerland 157.5
 Kingdom of Saudi Arabia 150.0
 Spain 127.2
 Netherlands 108.7
 China 100.0
 Brazil 86.7
 Kuwait 50.0
Reed Hastings and Patty Quillin 30.0
Mastercard 28.3
 New Zealand 22.5
 Finland 19.3
 Denmark 18.2
Gates Philanthropy Partners 18.0
 Ireland 15.5
 Belgium 13.6
 Qatar 10.0
Shell 10.0
Twilio 10.0
 Austria 8.5
 Iceland 8.0
Google.org 7.5
WHO Foundation - Go Give One Campaign 6.0
 Luxembourg 5.7
KSRelief 5.3
 Singapore 5.0
Cisco 5.0
Procter & Gamble 5.0
TikTok 5.0
Wise 5.0
Visa Foundation 4.5
Soccer Aid 4.2
Thistledown Foundation 3.9
 Bahrain 2.5
Gamers without Borders / Ksrelief 2.3
Vaccine Forward Initiative 2.2
UBS Optimus Foundation 2.1
 Greece 1.8
Portuguese Private Sector 1.8
Asia Philanthropy Circle 1.5
 Philippines 1.1
 Oman 1.0
 Portugal 1.0
 Vietnam 1.0
Analog Devices Foundation 1.0
Stanley Black & Decker 1.0
Others 246.1
Total 12,445.7

Canada

Canada pledged $220 million worth of vaccines on 25 September 2020 to join as a self-financing contributor to COVAX. On 14 June, Canada doubled its pledge to add an additional 13 million doses of AstraZeneca, Johnson & Johnson, and NovaVax vaccines. This was in addition to the over 80 million available to purchase through financial contribution.[citation needed]

China

China joined COVAX on 9 October 2020.[44] The Sinopharm BIBP vaccine and CoronaVac (by Sinovac Biotech) are Chinese-developed vaccines approved by the WHO for distribution through COVAX.[45] By July 2021, GAVI had signed advanced purchase agreements for 170 million doses of the Sinopharm BIBP vaccine, 350 million doses of CoronaVac, and 414 million doses of SCB-2019, another vaccine in Phase III trials.[46][47] On 8 August 2021, China pledges US$100 million towards equitable access to COVID-19 vaccines for lower-income countries, brings the total raised for the Covax to nearly US$10 billion[48] Further, China's Leader Xi Jinping pledges 2 billion vaccines globally through year's end. According to AP News, China has already delivered 770 million doses to foreign countries since September 2020 (as of 6 August 2021)[49]

India

India joined COVAX through a membership with the GAVI alliance.[50] The Serum Institute of India is the main producer for the Oxford–AstraZeneca vaccine, up to 700 million doses were expected for 2021. After initial deliveries to North Africa, West Africa, Eastern Europe and the Middle East in March and April 2021, India began to limit vaccine exports until the end of 2021, due to high domestic demand.[51][52][53] Based on the high infection rates in India, COVAX was projected to deliver only 145 million doses instead of 240 million by May 2021. Vaccine production was also negatively affected because of a ban by the U.S. on the export of key raw materials.[54] In September 2021, the Government of India announced the resumption of vaccines exports from October 2021 onwards since it had quadrupled its production and only excess supplies would be exported.[55]

European Union

As of November 2020, the European Union (EU) and EU members have pledged €870 million to COVAX.[56] The European Commission (EC) brought the EU into COVAX on 31 August 2020 and pledged €400 million in guarantees,[57] but did not state how this money would be paid out or its conditions.[58] The EC pledged a further €100 million from the 11th European Development Fund to COVAX via a grant to GAVI on 12 November. Individual EU member states have also made additional pledges; France donated an additional €100 million, Spain an additional €50 million, and Finland an additional €2 million.[56]

According to the Foreign Office of the Federal Republic of Germany, Germany has joined COVAX through the European Union and has pledged €300 million for the treatment of COVID-19 in developing nations bringing the total EU contribution to over €2.2 billion.[59]

On the consilium site, Team Europe reported a €2.47 billion donation.[60]

The Gavi COVAX Advance Market Commitment, a financing mechanism supported by donors and expedited by the European Investment Bank, provided free vaccinations to individuals in the world's 92 poorest countries.[61][62] So far, more than 1.6 billion COVAX doses have been provided to poor nations, assisting in the vaccination of 52% of their population, compared to a global average of 64%.[61][63][64]

United Kingdom

The United Kingdom has provided £548 million to Covax.[65] The United Kingdom was the biggest single donor to COVAX-AMC until being overtaken by the European Union and the United States.[66]

United States

Vaccines donated by the United States are transported in Ecuador in 2021

As part of its America First policy,[67] the Trump administration stated that it would not join COVAX because of its association with the WHO,[68][69] from which it had begun a year-long withdrawal process on 6 July 2020.[70]

After Joe Biden was elected president in the 2020 election, he announced that the United States would remain in the WHO and would join COVAX on 20 January 2021. This reversal of American policy (announced by Anthony Fauci, Chief Medical Advisor to the President) was welcomed globally.[71][72] On 19 February, the US pledged $4 billion, making it the single largest contributor to the fund.[73]

On 16 July 2021, the African Union (AU)/African Vaccine Acquisition Trust (AVAT), COVAX and the United States government announced the donation of 25 million Johnson & Johnson COVID-19 vaccines to 49 African countries. Afreximbank put in place a US$2 billion Advance Procurement Commitment (APC) Guarantee to obtain 400 million more doses of the Johnson & Johnson COVID-19 vaccine, providing a total of 620 million doses to Africa by the end of 2021. The vaccines will be in part sourced from licensed production in South Africa,[74] and distributed by COVAX with the goal to vaccinate 60% of the population.[75]

United Arab Emirates

Since the UAE started producing Hayat-Vax in late March 2021, a rebranded version of the Chinese Sinopharm BIBP vaccine through a joint venture between Sinopharm and Group 42, the country has donated vaccine doses to several African countries.[76][77][78]

Private donors

It is possible for private donors to donate to COVAX through the "Go Give One" campaign. The WHO estimates the campaign's cost-effectiveness at one vaccine dose per US$7 donated.[79]

See also

References

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