Coronavirus deaths were on the rise across Africa in June, when 100,000 doses of the Pfizer-BioNTech vaccine reached Chad. The delivery seemed like a test.a that the United Nations-backed program to immunize the world could bring the most desirable vaccines to less developed countries. However, five weeks later, according to Chad’s health minister, 94,000 doses were still unused.
Nearby in Benin only 267 vaccines were administered per day, such a slow pace that 110,000 of the doses in the AstraZeneca program had expired. Across Africa, according to confidential documents from July, the program monitored at least nine countries where doses to the poor were at risk of spoiling this summer.
Vaccine accumulation explains one of the most serious problemsBut largely unrecognized, those faced by the immunization program as it tries to recover from months of mistakes and disappointment: the difficulty of getting doses from airport runways into people’s arms.
Known as COVAX, the program was supposed to be a powerful locomotive, a multi-million dollar alliance of international health agencies and nonprofit organizations that, thanks to their purchasing power, would ensure that poor countries received vaccines as quickly as rich ones.
A vaccination center in Colombo, Sri Lanka. Photo EFE
But COVAX has had trouble getting doses: it has 500 million to go to reach its goal. Poor countries are dangerously unprotected at a time when the delta variant is spreading out of control – exactly the scenario for which COVAX was created.
The urgent need to vaccinate the world goes far beyond protecting the inhabitants of poor countries. The longer the virus circulates, more dangerous can be, even for vaccinated people in rich countries.
Without billions of more vaccines, experts warn, new variants could continue to appear that would endanger all nations.
“COVAX has not failed, but it is failing”said Dr. Ayoade Alakija, co-chair of the African Union’s vaccine supply program. “We really have no other options. For the good of humanity, COVAX must work.”
Now more supplies are finally on the way, courtesy of the Biden administration, than is buying 500 million doses of Pfizer and delivering them through COVAX, the centerpiece of a broader engagement of rich democracies. Donated doses should start shipping this month.
But Biden’s donation, worth $ 3.5 billion, comes with a caveat: To help fund it, the administration will siphon off hundreds of millions of dollars promised to vaccination drives in poor countries, according to notes from a meeting between COVAX and US officials.
In Addis Ababa, Ethiopia, the Covax program. Reuters photo
Lacking funds, these countries have had difficulty buying fuel to transport doses to vaccination centers, train the people who administer the vaccines, or convince people to receive them.
Even as COVAX officials struggle to fill that funding gap, the overriding issue is whether the program can overcome its mistakes and the imbalance of power that has left it at the mercy of rich countries and pharmaceutical companies.
Pfizer, for example, refused to deal directly with COVAX this spring, interviews reveal, and instead struck a deal through the Biden administration, a deal that hurt COVAX’s credibility as an independent vaccine buyer.
The program has suffered delays and internal disputes. According to interviews and COVAX logs, bureaucratic barriers imposed by his leadership have delayed the disbursement of $ 220 million to help countries administer the vaccines.
COVAX, a program promoted by a non-profit organization funded by the Gates Foundation, is an unprecedented creation. Has gotten vaccines reach poor countries faster than usual and has developed a system to compensate people for serious postvaccination reactions and exempt vaccine manufacturers from legal liability, a plan that has saved those countries months of negotiations.
But nevertheless, the 163 million doses that have been distributed – most free to poor countries and the rest to countries like Canada, which have paid for them – are a long way from plans to have at least 640 million doses available right now.
Dr. Seth Berkley, CEO of Gavi, the nonprofit organization on which COVAX is based, said that insufficient initial funding made shortages of supplies inevitable. When distribution problems arise like those in Chad and Benin, COVAX tries to “move those vaccines to other countries, but then it works with them to try to improve their capacity,” he explained.
The Covax plan was caught in the midst of inter-laboratory disputes. Reuters photo
Supporters and critics agree that the program should improve quickly. As of early July, confidential COVAX documents indicated that 22 countries, some of them with a growing number of fatalities, reported that they had almost or completely run out of doses of the program.
“Because of the way COVAX was presented, African countries they thought i was going to be their savior“said Dr. Catherine Kyobutungi, who heads the Africa Population and Health Research Center.” When it didn’t meet expectations, there was nothing else to do. “
Rich and poor
In the frenzied first months of 2020, health experts drew up a strategy to vaccinate the world fairly.
COVAX was the answer, and brought together two non-profit organizations funded by Gates, Gavi and the Coalition for Innovation in Epidemic Preparedness (CEPI); to the World Health Organization; and to UNICEF, which would lead the distribution efforts.
I was hoping to be a major vaccine buyer worldwidefor both rich and poor countries, giving it the ability to put pressure on vaccine manufacturers.
But while rich nations pledged to make donations, they were not complacent partners. Britain negotiated so that wealthier participants could choose the vaccines they would buy through COVAX, leading to delays, said Kate Elder, senior vaccine policy adviser for the Doctors Without Borders Access Campaign.
The Pfizer vaccine, out of the plan. Reuters photo
And most importantly, the rich countries they became rivals in a vaccine buying race, paying premiums to insure their vaccines while delaying the financial commitments COVAX needed to sign deals.
“You cannot be passing the piggy bank in the middle of a pandemic”said Dr. Nicole Lurie, director of CEPI in the United States, referring to the desperate fight for funding.
Initially, COVAX planned to have huge shipments from the Serum Institute, an Indian manufacturer. But after the virus spread to India in March, the Indian government stopped vaccine exports. Many poor countries were affected. They had trusted COVAX, even though they were often excluded from decision-making.
Alakija, who leads distribution efforts in Africa, said African health officials were barely consulted in mid-2020, when the program set the initial goal of vaccinating at least 20% of the population of poor countries.
Alakija recalled that the people involved in COVAX had said that they believed Africa was at low risk and that mass immunizations were unnecessary, a claim that a Gavi spokesperson denied.
The spokesperson noted that the goal was set in view of “limited resources” and the “poor understanding of the epidemiology of COVID-19”, and that he now had enough money to buy vaccines for almost 30% of the population in poor countries.
Desperate, 17 countries entitled to receive free doses of COVAX, including Rwanda, have reached agreements to buy doses directly from Pfizer.
In May of this year, COVAX appeared to be on the verge of reaching a new agreement to buy low-cost doses from Pfizer. He had already asked for 40 million in January; this agreement was expected to be greater.
However, behind the scenes, the tension between Pfizer and COVAX it made itself felt, according to two people with knowledge of the negotiations. The company wanted the new doses to go only to poor countries.
As a global purchasing pool, COVAX insisted on fulfilling orders as well from rich countries that had bought directly at higher prices. South Korea, for example, had received doses of Pfizer from the program.
And the two parties had already had clashes. In negotiations for the first batch of doses, Pfizer had asked for disclaimers that went beyond the COVAX model indemnity agreement, Berkley said, asking countries to sign additional legal letters.