An ambitious humanitarian project to bring coronavirus vaccines to the world’s poorest could be short of money, freight planes, refrigeration and the vaccines themselves, in addition to skepticism even among the people it seeks to help most.

One of the main obstacles is the fact that rich countries have secured most of the possible vaccine supply during 2021. In addition, the United States and other countries have refused to join the project, called Covax.

“The vaccine supply is not going to arrive any time soon, and the money is not there either,” warned Rohit Malpani, a public health consultant who worked with Doctors Without Borders.

Covax was conceived as a way to give countries access to coronavirus vaccines regardless of their wealth.

It is run by the World Health Organization, which is a United Nations agency; Gavi, a public-private partnership funded by the Bill and Melinda Gates Foundation, which purchases vaccines for 60% of the world’s children, and the Coalition for Epidemic Preparedness Innovations, or CEPI, another public-private partnership with support from the Gates.

Covax’s goal is to purchase 2 million doses by the end of 2021, although it is not yet clear whether the successful vaccine will require one or two doses for the planet’s 7.8 billion people. Countries participating in the project can buy the vaccines from Covax or receive them free of charge, if necessary.

A problem appeared from the beginning: Some of the richest countries in the world negotiated their own deals directly with drug companies, so they don’t need to be involved in the project at all. China, France, Germany, Russia and the United States do not plan to join.

And there are so many rich countries that have bought vaccines from manufacturers – before the vaccines are even approved – that they have already grabbed almost the entire vaccine supply by 2021.

The European Union has contributed 400 million euros ($ 469 million) to finance Covax, but the 27-nation bloc will not use it to buy vaccines, something some have interpreted as a lack of confidence in the project’s ability to meet its goals. objectives. Instead, the EU has struck its own deals to buy more than 1 billion doses, depriving Covax of the bargaining force to buy drugs for the continent.

Favi, WHO and CEPI announced in September that countries representing two-thirds of the world’s population had joined Covax, but acknowledged that they still needed $ 400 million from governments or other sources. Without them, according to internal documents accessed by The Associated Press before the organization’s board meeting this week, Gavi cannot sign deals to buy vaccines.

Covax got a big deal this week for 200 million doses from Indian vaccine maker Serum Institute, although the firm made it clear that a large portion of it would go to people in India.

The project will need $ 5 billion by the end of next year.

Covax said the vaccine negotiations were going ahead despite a lack of funds.

“We are working with governments that have expressed interest before to ensure that we receive commitments to agreements in the coming days,” Aurelia Nguyen, Covax managing director, said in an email. She added that nothing similar has ever been tried in the field of public health.

Covax “is an enormously ambitious project,” he said, “but it is the only plan on the table to end the pandemic worldwide.”

Still, poor and activist countries have expressed doubts about how the program will operate and how effective it will be.

Dr Clemens Auer, a member of the WHO board of directors who was the EU’s main negotiator for its vaccine deals, said there is a worrying lack of transparency about how Covax will work.

“We would have no say in the vaccines, the price, the quality, the technical platform or the risks,” Auer said. “This is totally unacceptable.”

He noted that the WHO never consulted countries on the strategy they were planning for vaccines, and said the health agency’s goal of vaccinating the world’s most vulnerable before anyone else is a “noble idea,” but politically naive.

Within Covax’s efforts, the WHO and Gavi have asked countries to prioritize front-line healthcare workers, followed by the elderly, with the goal of vaccinating 20% ​​of the world’s population.

One costly bottleneck is the fact that many potential vaccines must be kept cold from the factory and until they are administered to the patient, according to internal Gavi documents. The pharmaceutical sector has indicated that “the air transport of COVID vaccines will be an important limitation” and that “a significant and urgent expansion of the cold chain capacity may be necessary”.

Another hurdle: Many of the top potential vaccines require two doses. That means twice as many syringes, twice the waste management, and complications from making sure patients in remote corners of the world get their second dose on time and are free of side effects.

“As we are trying to get vaccines as fast as possible, we expect limited follow-up and efficacy data,” said Gian Gandhi, logistics manager for UNICEF’s supply division in Copenhagen.

It is also feared that the fear of lawsuits could derail agreements. According to internal documents, Gavi told countries that pharmaceutical companies will probably ask for guarantees that they will not face civil liability for deaths or other side effects of the vaccine.

Dr. Nakorn Premsi, director of the National Vaccine Institute of Thailand, said authorities in the country are studying whether the condition is acceptable. For now, Thailand has only signed a non-binding agreement with Covax.

Some critics claim that Gavi is not ambitious enough. The pandemic won’t end – and the world won’t be able to reopen its borders – until group immunity goes beyond rich countries that have secured doses, said Eric Friedman, a global health law scholar at Georgetown University, and which generally supports the Covax project.

“If we want to achieve group immunity and get rid of this, 20% is not going to be enough,” he said.

Alicia Yamin, associate professor of global health at Harvard University, said she feared “the window is closing” for Covax to turn out to be operational. She noted that it is disappointing that Gavi, WHO and their partners have not put more pressure on drug companies on issues like intellectual property or open licenses, which could increase available vaccines.

With little sign of such a fundamental change in the world of global health, Yamin noted, developing countries are likely to rely on donated vaccines rather than any affordable access program.

“I would say that poor countries probably won’t get vaccinated until 2022 or 2023,” Yamin said.


Lori Hinnant reported from Paris.

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