The ambitious COVAX initiative, created to ensure the entire world has access to Covid-19 vaccines, has secured only a fraction of the 2 billion doses it hopes to buy over the next year.

And it is yet to confirm any actual deals to ship out vaccines and is short on cash.

Also, now experts say the chances that coronavirus vaccines will be shared fairly between rich nations and the rest are fading fast.

With vaccine supplies currently limited, developed countries, some of which helped fund the research with taxpayer money, are under tremendous pressure to protect their populations and are buying up shots. 

Meanwhile, some poorer countries that signed up to the COVAX initiative are looking for alternatives because of fears it will not deliver.

Also, some developing countries are pulling out entirely or seeking their private deals.

Earlier this month, the tiny Pacific island nation of Palau announced it was abandoning the initiative and would get donated vaccines from the US instead.

Other low and middle-income countries, including Malaysia, Peru, and Bangladesh, have stayed in the initiative but also recently inked their deals with drugmakers as a Plan B.

The virus that has killed more than 1.6 million people has exposed vast inequalities between countries, as fragile health systems and smaller economies were often hit harder.

Global COVID-19 trends

Red shades indicate an increase in new cases or deaths over last two weeks.
Green shades signal a decline in reported new cases or deaths.

COVAX was set up by the World Health Organization, vaccines alliance GAVI and CEPI, a global coalition to fight epidemics, to avoid the global stampede for vaccines.

“Of the approximately 12 billion doses the pharmaceutical industry is expected to produce next year, about 9 billion shots have already been reserved by rich countries,” said Arnaud Bernaert, head of global health at the World Economic Forum.

“COVAX has not secured enough doses, and the way the situation may unfold is they will probably only get these doses fairly late.”

To date, COVAX’s only confirmed, legally binding agreement is for up to 200 million doses, though that includes an option to order several times that number of additional doses, GAVI spokesperson James Fulker said.

“It has agreements for another 500 million vaccines, but those are not legally binding.”

The 200 million doses will come from the Serum Institute of India, the company that will likely make a large portion of the coronavirus shots destined for the developing world.

Serum Institute CEO Adar Poonawalla says it has a confirmed order for 100 million doses each of a vaccine developed by Oxford University and AstraZeneca and one from Novovax.

He said the lack of commitment from COVAX will mean a much longer wait for people in developing countries.

Poonawalla also noted that his company’s priority would be making shots for India, which has suggested it wants at least 300 million vaccines.

It is likely India would not be able to take all of those at once, but a big order could delay the distribution of vaccines for other parts of the developing world, Poonawalla said.

Asked on Tuesday about why the Serum Institute was only contracted to produce 200 million vaccines for COVAX, WHO’s Dr Bruce Aylward said they would go back to the company “to make sure they have the assurances they need.”

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He said the Serum Institute was “absolutely crucial to the supply of many vaccines.”

Potentially further slowing down the process is that neither the AstraZeneca vaccine nor the Novovax one has been licensed by any regulatory agency yet – and any injection distributed by COVAX will likely need WHO approval.

COVAX does not have any supplies of the two vaccines that appear to be most effective so far – the Pfizer-BioNTech shot and the Moderna one. 

The United Kingdom has already begun giving the Pfizer vaccine, and the United States and Canada are rolling it out this week. Some Gulf countries have also authorised it.

Still, GAVI said they “aim to start rolling out safe and effective vaccines to COVAX (member countries) at scale within the first and second quarters of the New Year.”

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Even with vaccines in hand, the rollouts will take many months in rich countries, and many developing ones are facing serious logistical challenges that will add to delays, noted Dr Gagandeep Kang, an infectious diseases expert at the Christian Medical College at Vellore in southern India.

Senior officials at the WHO have acknowledged privately that attempts to fairly allocate vaccines through the initiative are flawed, despite publicly lauding its success.

“The whole call for global solidarity has mostly been lost,” said Dr Katherine O’Brien, WHO’s vaccines chief.

Asked to clarify her remarks, O’Brien said in an email that “every country should have access to Covid-19 vaccines, as early as feasible.”

Adding to COVAX’s difficulties, O’Brien noted at a news conference this month that it was still $5 billion short to buy the doses it’s planning to obtain next year.

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According to a report, GAVI issued ahead of a meeting this week, the alliance itself concluded that the risk COVAX will fail is “very high,” saying it was “established in record time and has to navigate unchartered territory.”

John Nkengasong, director of the Africa Centers for Disease Control and Prevention, criticized Western countries for buying up the global vaccine supply “in excess of their needs while we in Africa are still struggling with the COVAX (effort).”

With no certainty about which shots would work, governments scrambled in recent months to sign multiple deals to ensure their citizens would have at least some Covid-19 injections.

Canada, for example, bought nearly 200 million vaccines – enough to cover its population of 38 million about five times over.

Also read: Majority of global population join COVAX Facility for access to vaccine: WHO

Nkengasong called the idea that people in rich countries would get immunised while Africans go without “a moral issue.”

Beyond the ethics, experts note that failing to protect people in the developing world will leave a reservoir of coronavirus that could spark new outbreaks at any time.

Anban Pillay of the South African Ministry of Health said that joining COVAX was just a stop-gap measure before signing bilateral deals with pharmaceutical companies.

Kate Elder, vaccines policy adviser at Doctors Without Borders, said “it’s increasingly looking like the ship has sailed on equitable vaccine distribution” – and GAVI, WHO and others need to discuss how to increase vaccine manufacturing.

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To that end, South Africa and India have asked the World Trade Organization to waive some provisions regulating intellectual property rights to make it easier for manufacturers in poor countries to make Covid-19 drugs and vaccines. But many rich countries are reluctant to do that.

As more countries in the West authorise the vaccine, “the difference between people in rich countries getting vaccinated and the lack of any vaccines for the developing world will become quite stark,” said Anna Marriott, health policy manager at Oxfam.