These two organizations sought to correct the imbalance by sponsoring an organization called Covax, a partnership of WHO and UNICEF with two non-profit organizations, the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance. Covax, which was launched last June, pools donor money from high-income countries with purchase commitments from low-income countries to ensure those countries will receive vaccines. (The Trump administration refused to join Covax; President Joe Biden overturned that decision on his first day in office and last month engaged $ 4 billion.)
On February 24, Ghana become first country to receive vaccines under the Covax program, 600,000 doses of the Oxford-AstraZeneca single-dose formula; it was followed a few days later by doses arriving in Côte d’Ivoire. Last week the cooperative had dispatched vaccines in 14 countries in sub-Saharan Africa, Southeast Asia and the Pacific, and predicted it will be able to distribute 237 million doses worldwide by the end of May.
Yet the amount of vaccine Covax can order is only a fraction of what rich countries have agreed to buy directly. As of March 1, according to at the launch and scale speedometer of the Duke Global Health Innovation Center, high and upper middle income countries of the world – including the United States, Canada, United Kingdom, European Union and Japan – have collectively reserved 5.8 billion doses. Covax has obtained contracts for 1.1 billion.
It is “an abject moral failure,” says Ruth R. Faden, professor at Johns Hopkins and founder of its Berman Institute for Bioethics, which is part of a WHO working group on Covid-19 vaccines. “It’s like the rich countries of the world have gone shopping and cleared the shelves before the other countries of the world can even get in.”
The problem isn’t just that manufacturers ‘shelves are empty (and, to extend the metaphor, that rich countries’ panic pantries are full). By drawing multiple countries into a buying collective, Covax was supposed to acquire the ability to negotiate lower prices than poor countries could afford. The fact that rich countries make their own deals undermines that. And in another twist, some of these countries are using their vaccine commitments as levers of diplomacy. Both Russia and China encouraged their state-affiliated manufacturers to strike deals with countries in Asia and Latin America, a subtle way of playing on political influence. (Vaccine nationalism goes both ways, however. Last Thursday, invoking a European Union pact, the Italian government refuse to let AstraZeneca sell EU-made vaccines to Australia, saying Italy needs them more.)
Multiple proposals are circulating to resolve the international imbalance, by imposing a universal ethic frame for distribution, prioritize by the population of each country or the number of health workers, or by sharing technology and looseness the custody of countries on the intellectual property of vaccines. Yamey suggested that rich countries be required to dime their purchases, redirecting one dose to Covax out of 10 purchased. The Norwegian government has done some sort of this before, committing to giving doses at the same rate it uses them at home, and UK officials have offered to give extra doses once their national vaccination campaign is over. “If there was a political will, or if there was a greater urgency or a will to move away from vaccine apartheid,” Yamey says, “we would all be better off.”
Meanwhile, globally and in the United States, a second ethical question arises. It has always been understood that administering doses to some of the hardest to reach places would be much easier with a vaccine that can be carried at room or refrigerator temperature, instead of the required home freezing temperatures. by the Moderna formula and the ultra-cold laboratory-freezer necessary to preserve that of Pfizer-BioNTech. Ideally, a vaccine for the hardest to reach last kilometers would also offer protection in a single dose, to solve the problem of having to stalk people a second time or forcing them to walk long distances or move over rough terrain.