Countries that are advanced in their vaccination programmes are seeing cases of COVID-19 decline, hospitalisations decrease and early signs of some kind of normality resume.
However, the global picture is far more concerning.
At no point in this pandemic have we seen such an acute need to look to the future challenges and not rest on the patchy achievements made so far.
We are seeing the traumatic effects of the terrible surge of COVID-19 in South Asia – a surge which has also severely impacted global vaccine supplies.
We are also witnessing why access to vaccines before a surge occurs is so important. For that reason, we must focus on ensuring countries who have not benefited from these life-saving tools do so now, and with urgency.
As the global mechanism for equitable access to COVID-19 vaccines, COVAX has proven it works. Designed and implemented in the midst of an unprecedented global public health crisis, it has delivered over 70 million doses to 126 countries and economies around the world since February – from remote islands to conflict settings – managing the largest and most complex rollout of vaccines in history. Over 35 countries received their first COVID-19 vaccine doses thanks to COVAX.
However, the terrible surge of the virus in India has had a severe impact on COVAX’s supply in the second quarter of this year, to the point where, by the end of June we will face a shortfall of 190 million doses.
Even though COVAX will have larger volumes available later in the year through the deals it has already secured with several manufacturers, if we do not address the current, urgent shortfall the consequences could be catastrophic.
But we can meet this challenge with concerted action and global leadership.
Millions of dollars and doses were committed to COVAX on 21 May, bringing the total of doses pledged so far to more than 150 million. At the World Health Assembly, governments have been united in recognising the political and financial urgency of supporting COVAX with doses and dollars. It is now imperative to build on this momentum to secure full funding for COVAX and more vaccines – right now – for lower income countries at the Advance Market Commitment Summit on 2 June.
If the world’s leaders rally together, the original COVAX objectives – delivery of 2 billion doses of vaccines worldwide in 2021, and 1.8 billion doses to 92 lower income economies by early 2022 are still well within reach.
But it will require governments and the private sector to urgently unlock new sources of doses, with deliveries starting in June, and funding so we can deliver. COVAX has the infrastructure in place to facilitate and coordinate this complex global effort.
To enable COVAX to deliver on the promise of global equitable access, we call for the following immediate actions:
The AMC mechanism is how COVAX provides doses to lower income economies. Thanks to the generosity of its donors, the AMC has already secured 1.3 billion doses for delivery in 2021. This is enough to protect the most at-risk population groups: health workers, the elderly and those with underlying health conditions. We need an additional $2 billion to lift coverage in AMC countries up to nearly 30%, and we need it by June 2 to lock in supplies now so that doses can be delivered through 2021, and into early 2022.
The pandemic has just taken a frightening new turn, as a deadly surge of cases rages across South Asia and other hotspots. Countries with the largest supplies should redirect doses to COVAX now, to have maximum impact.
We are starting to see countries stepping forward with doses, with the United States and Europe collectively pledging to share 180 million doses. But we still need more, we need them to go through COVAX, and we need them to start moving in early June. At least one billion doses could be shared by wealthy countries in 2021.
COVAX’s need for doses is greatest right now. Countries with higher coverage rates, which are due to receive doses soon should swap their places in supply queues with COVAX so that doses can be equitably distributed as quickly as possible.
By removing trade barriers, export control measures, and other transit issues that block, restrict or slowdown the supply and distribution of COVID-19 vaccines, raw materials, components and supplies.
Now more than ever, at the peak of the pandemic, we need ambitious, global solutions. When it comes to worldwide vaccine distribution, COVAX is the only initiative capable of rising to the challenge of this moment.
It’s understandable that some countries want to press ahead and vaccinate all of their populations. By donating vaccines to COVAX alongside domestic vaccination programmes, the most at-risk populations can be protected globally, which is instrumental to ending the acute phase of the pandemic, curbing the rise and threat of variants, and accelerating a return to normality.
COVAX is hugely appreciative to France, Germany, Italy, New Zealand, Spain, Sweden and the UAE for their initial commitments to donate doses through COVAX. We also welcome announcements by the USA, Norway, Croatia, Romania, Australia and Portugal to donate doses to countries in need and we put COVAX forward as the proven mechanism for global, rapid and equitable distribution to facilitate this.
Since COVAX was established in mid-2020, it has had the support and resources of 192 of the world’s economies. This tremendous vote of confidence has enabled us to demonstrate our ability to deliver an unprecedented global rollout. It’s time to finish the job.
Dr Richard Hatchett Chief Executive Officer, Coalition for Epidemic Preparedness Innovations (CEPI)
Dr Seth Berkley Chief Executive Officer, Gavi, the Vaccine Alliance (Gavi)
Dr Tedros Adhanom Ghebreyesus Director-General, World Health Organization (WHO)
Ms Henrietta Fore Executive Director, UNICEF
The goal of sharing at least 1 billion excess doses by the end of 2021 is based on a Bill & Melinda Gates Foundation analysis of current projections of excess doses globally. Even under conservative estimates, the analysis finds that after sharing 1 billion doses, wealthy countries would have sufficient doses to vaccinate 80% of their populations 12 years and older in 2021.
COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, is co-convened by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi) and the World Health Organization (WHO) – working in partnership with UNICEF as key implementing partner, developed and developing country vaccine manufacturers, the World Bank, and others. It is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries.
CEPI’s role in COVAX
CEPI is leading on the COVAX vaccine research and development portfolio, investing in R&D across a variety of promising candidates, with the goal to support development of three safe and effective vaccines which can be made available to countries participating in the COVAX Facility. As part of this work, CEPI has secured first right of refusal to potentially over one billion doses for the COVAX Facility to a number of candidates, and made strategic investments in vaccine manufacturing, which includes reserving capacity to manufacture doses of COVAX vaccines at a network of facilities, and securing glass vials to hold 2 billion doses of vaccine. CEPI is also investing in the ‘next generation’ of vaccine candidates, which will give the world additional options to control COVID-19 in the future.
Gavi’s role in COVAX
Gavi is leading on procurement and delivery at scale for COVAX: coordinating the design, implementation and administration of the COVAX Facility and the Gavi COVAX AMC and working with its Alliance partners UNICEF and WHO, along with governments, on country readiness and delivery. As part of this role, Gavi hosts the Office of the COVAX Facility to coordinate the operation and governance of the mechanism as a whole, manages relationships with Facility participants, and negotiates advance purchase agreements with manufacturers of promising vaccine candidates to secure doses on behalf of the 190 economies participating in the COVAX Facility. It also coordinates design, operation and fundraising for the COVAX AMC that supports 92 lower-income economies, including a no-fault compensation mechanism that will be administered by WHO. As part of this work, Gavi supports governments and partners on ensuring country readiness, providing funding and oversight of UNICEF procurement of vaccines as well as partners’ and governments work on readiness and delivery. This includes support for cold chain equipment, technical assistance, syringes, vehicles, and other aspects of the vastly complex logistical operation for delivery.
WHO’s role in COVAX
WHO has multiple roles within COVAX: It provides normative guidance on vaccine policy, regulation, safety, R&D, allocation, and country readiness and delivery. Its Strategic Advisory Group of Experts (SAGE) on Immunization develops evidence-based immunization policy recommendations. Its Emergency Use Listing (EUL) / prequalification programmes ensure harmonized review and authorization across member states. It provides global coordination and member state support on vaccine safety monitoring. It developed the target product profiles for COVID-19 vaccines and provides R&D technical coordination. WHO leads, together with UNICEF, the Country Readiness and Delivery workstream, which provides support to countries as they prepare to receive and administer vaccines. Along with Gavi and numerous other partners working at the global, regional, and country-level, the CRD workstream provides tools, guidance, monitoring, and on the ground technical assistance for the planning and roll-out of the vaccines. Along with COVAX partners, WHO has developed a no-fault compensation scheme as part of the time-limited indemnification and liability commitments
UNICEF’s role in COVAX
UNICEF is leveraging its experience as the largest single vaccine buyer in the world and working with manufacturers and partners on the procurement of COVID-19 vaccine doses, as well as freight, logistics and storage. UNICEF already procures more than 2 billion doses of vaccines annually for routine immunisation and outbreak response on behalf of nearly 100 countries. In collaboration with the PAHO Revolving Fund, UNICEF is leading efforts to procure and supply doses of COVID-19 vaccines for COVAX. In addition, UNICEF, Gavi and WHO are working with governments around the clock to ensure that countries are ready to receive the vaccines, with appropriate cold chain equipment in place and health workers trained to dispense them. UNICEF is also playing a lead role in efforts to foster trust in vaccines, delivering vaccine confidence communications and tracking and addressing misinformation around the world.
The Access to COVID-19 Tools ACT-Accelerator, is a new, ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. It was set up in response to a call from G20 leaders in March and launched by the WHO, European Commission, France and The Bill & Melinda Gates Foundation in April 2020.
The ACT-Accelerator is not a decision-making body or a new organisation, but works to speed up collaborative efforts among existing organisations to end the pandemic. It is a framework for collaboration that has been designed to bring key players around the table with the goal of ending the pandemic as quickly as possible through the accelerated development, equitable allocation, and scaled up delivery of tests, treatments and vaccines, thereby protecting health systems and restoring societies and economies in the near term. It draws on the experience of leading global health organisations which are tackling the world’s toughest health challenges, and who, by working together, are able to unlock new and more ambitious results against COVID-19. Its members share a commitment to ensure all people have access to all the tools needed to defeat COVID-19 and to work with unprecedented levels of partnership to achieve it.
The ACT-Accelerator has four areas of work: diagnostics, therapeutics, vaccines and the health system connector. Cross-cutting all of these is the workstream on Access & Allocation.
CEPI Press Office
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Meghana Sharafudeen, Gavi
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Laura Shevlin, Gavi
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Cirũ Kariũki, Gavi
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Iryna Mazur, Gavi
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Evan O’Connell, Gavi
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WHO Press Office
Sabrina Sidhu, UNICEF New York,
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